What is a commonly used second-line agent for SE in patients who cannot receive valproate or phenytoin?

• A. Levetiracetam
• B. Valproate
• C. Phenytoin
• D. Lacosamide

Answer: (A)

In status epilepticus, after initial benzodiazepine treatment, a second-line IV anticonvulsant is chosen to stop ongoing seizures. Levetiracetam is commonly used when valproate or phenytoin cannot be given because it offers rapid IV administration, broad anticonvulsant coverage, and a very favorable safety profile in critically ill patients. It has minimal drug interactions and does not rely on hepatic metabolism, which makes it a safer option in many settings. In contrast, valproate carries hepatotoxicity concerns and phenytoin can cause cardiovascular instability and numerous drug interactions. Lacosamide is another viable option, but levetiracetam is typically favored in this scenario due to its ease of use and safety.