How are acute seizures treated?

• A. Observe and wait for spontaneous resolution.
• B. Treatment with lorazepam (Ativan) or diazepam (Valium) may be given to stop clusters; IV phenytoin (Dilantin) may be added.
• C. Use oral antibiotics to prevent seizures.
• D. Administer caffeine to increase alertness.

Answer: (B)

Acute seizures require rapid termination of abnormal brain activity. The best approach is to give a benzodiazepine, such as lorazepam or diazepam, to quickly enhance GABAergic inhibition and stop the seizure activity. If seizures continue or there are clusters, adding an IV anticonvulsant like phenytoin helps stabilize neuronal membranes and prevent further firing by blocking voltage-gated sodium channels. This combination addresses both immediate control and prevention of recurrence during the acute phase. Observing and waiting does not treat ongoing seizures, antibiotics don’t prevent seizures, and caffeine would worsen seizure activity.