Skip to main content
WoMWeb of Medicine
SearchGraphHistory
Emergency Medicine›Condition·Updated Apr 17, 2026·v1

Status Epilepticus

Status epilepticus requires a tiered, time-sensitive intervention strategy focusing on rapid seizure termination via GABAergic and NMDA-targeted pathways while identifying underlying triggers.

High Evidence109 references·5,017 words·21 min read·v1
emergency medicineneurologycritical careseizures

Quick Reference

RxDrug of choiceLorazepam (4 mg IV) or Midazolam (10 mg IM)
AltAlternativesLevetiracetam (60 mg/kg), Fosphenytoin (20 mg PE/kg), Valproate (40 mg/kg)
⊘AvoidValproate in pregnancy (relative), Phenytoin in certain cardiac arrhythmias
DxTest of choiceContinuous EEG (cEEG)
ScKey scoreSTESS (Status Epilepticus Severity Score)
→When to referFailure of second-line ASMs, requirement for intubation/anesthesia, or suspected NORSE
Status epilepticus is a time-critical emergency; treat aggressively at 5 minutes with benzodiazepines and escalate rapidly to prevent GABA-receptor internalization and permanent brain injury.
Status epilepticus (SE) is a life-threatening neurologic emergency defined by the failure of seizure-termination mechanisms, leading to abnormally prolonged or recurrent seizures without a return to baseline consciousness. The operational definition for initiating emergency treatment is 5 minutes of continuous seizure activity (Timepoint 1), while 30 minutes (Timepoint 2) marks the threshold for potential long-term neuronal injury or death. Management is a race against time; as the seizure persists, the brain undergoes rapid molecular changes, including the internalization of inhibitory GABA receptors and the recruitment of excitatory NMDA receptors, rendering standard treatments progressively less effective. Immediate stabilization, rapid administration of benzodiazepines, and early escalation to non-sedating antiseizure medications and anesthetics are required to prevent permanent cognitive deficits and systemic multi-organ failure.

Overview and Recommendations

Background

  • •Define status epilepticus (SE) using the two-timepoint framework: Timepoint 1 (t1) is 5 minutes of continuous activity, indicating the seizure is unlikely to self-terminate; Timepoint 2 (t2) is 30 minutes, indicating a high risk of long-term neuronal injury.
  • •Recognize the receptor trafficking hypothesis, which explains why SE becomes pharmacoresistant: prolonged seizures cause the internalization (endocytosis) of synaptic GABA-A receptors and the increased surface expression of excitatory NMDA and AMPA receptors.
  • •Distinguish between the two physiological stages of SE: Stage 1 (Compensated) involves massive autonomic discharge with , tachycardia, and hyperglycemia; Stage 2 (Uncompensated) involves hemodynamic collapse, hypotension, hyperkalemia, and metabolic (lactic) acidosis.
  • •Identify common etiologies including medication non-compliance, acute structural brain injury (stroke, hemorrhage, trauma), metabolic derangements, and .
  • •Understand the concept of (NORSE), a clinical construct describing a previously healthy patient presenting with refractory SE without an obvious acute cause, often requiring an aggressive workup for autoimmune or paraneoplastic triggers.

Evaluation

  • •Suspect SE in any patient presenting with rhythmic motor activity, fluctuating mental status, or persistent coma following a witnessed seizure.
  • •Obtain a fingerstick glucose immediately upon arrival to rule out hypoglycemia, which is a rapidly reversible cause of status-like activity.
  • •Time the seizure activity from the moment of onset or arrival; clinical protocols for first-line therapy must be activated at the 5-minute mark.
  • •Examine the patient for signs of "subtle" status epilepticus, such as nystagmus, rhythmic eye blinking, or small-amplitude twitching of the face or extremities, which may persist after overt convulsions cease.
  • •Order emergent laboratory studies including a comprehensive metabolic panel (to check for hyponatremia or hypocalcemia), toxicology screen, and serum levels of known antiseizure medications (ASMs).
  • •Perform a pregnancy test in all women of reproductive age to guide ASM selection and screen for , which requires different management (magnesium sulfate).
  • •Obtain a non-contrast CT as soon as the patient is stabilized to rule out intracranial hemorrhage, large masses, or acute hydrocephalus.
  • •Order an emergent (EEG) within 30–60 minutes if the patient does not regain consciousness after motor seizures stop to rule out nonconvulsive status epilepticus (NCSE).
  • •Utilize point-of-care EEG (pocEEG) in the emergency department for rapid screening if full continuous EEG (cEEG) is not immediately available.
  • •Consider a lumbar puncture for cerebrospinal fluid (CSF) analysis if there is clinical suspicion of meningitis, encephalitis, or if the patient has a fever of unknown origin.
  • •Calculate the STESS (Status Epilepticus Severity Score) or EMSE (Etiology, Age, Comorbidities, EEG) score to assist in prognostic stratification and mortality risk assessment.
  • •Look for specific MRI findings such as Crossed Cerebellar Diaschisis (CCD)—reversible hyperintensity in the contralateral cerebellum—which indicates high metabolic demand from a supratentorial seizure focus.

Management

  • •Administer first-line benzodiazepines immediately at the 5-minute mark: IV Lorazepam 4 mg (may repeat once) or IM Midazolam 10 mg for patients weighing >40 kg.
  • •Initiate second-line non-sedating intravenous ASMs if seizures persist after the first benzodiazepine dose: IV Levetiracetam 60 mg/kg (maximum 4500 mg) is often preferred for its safety profile.
  • •Consider alternative second-line agents: IV Fosphenytoin 20 mg PE/kg (maximum 1500 mg PE) or IV Valproate 40 mg/kg (maximum 3000 mg).
  • •Avoid IV Valproate in pregnant patients due to high teratogenic risk unless all other options have failed.
  • •Escalate to Refractory Status Epilepticus (RSE) management if seizures continue despite one benzodiazepine and one appropriately dosed second-line ASM.
  • •Induce anesthesia for RSE using IV Midazolam: 0.2 mg/kg bolus followed by a continuous infusion of 0.05–2.0 mg/kg/hr.
  • •Utilize IV Propofol as an alternative anesthetic: 1–2 mg/kg bolus followed by 20–100 μg/kg/min; monitor closely for Propofol-Related Infusion Syndrome (PRIS) characterized by metabolic acidosis and bradycardia.
  • •Incorporate NMDA antagonism for super-refractory cases: IV Ketamine 1–2 mg/kg bolus followed by 1–5 mg/kg/hr infusion.
  • •Maintain continuous EEG (cEEG) monitoring to guide anesthetic titration; the goal is typically the cessation of electrographic seizures or a burst-suppression pattern.
  • •Administer Magnesium Sulfate 4–6 g IV loading dose followed by 1–2 g/hr infusion if the patient is pregnant and eclampsia is suspected.
  • •Monitor for systemic complications including , acute kidney injury, and neurogenic pulmonary edema.
  • •Avoid underdosing in elderly patients; while they are more sensitive to side effects, subtherapeutic dosing is a primary cause of treatment failure.
  • •Consult neurocritical care early for patients requiring anesthetic infusions or those with suspected NORSE.
  • •Initiate gradual weaning of anesthetics only after at least 24 hours of electrographic seizure control to prevent rebound status epilepticus.
  • •Consider adjunctive Tocilizumab 8 mg/kg IV (max 800 mg) in cases of refractory SE with a suspected autoimmune or neuroinflammatory component.
  • •Refer for surgical evaluation or (VNS) in cases of super-refractory SE that fail all pharmacological interventions.

Board Review — High Yield

  • •GABA-A Internalization — The primary molecular mechanism for benzodiazepine resistance in prolonged SE.
  • •T1 vs T2 — T1 (5 min) is when to start treatment; T2 (30 min) is when permanent damage begins.
  • •Crossed Cerebellar Diaschisis — A reversible MRI finding in SE showing contralateral cerebellar hyperintensity.
  • •Propofol-Related Infusion Syndrome (PRIS) — Metabolic acidosis, rhabdomyolysis, and cardiac failure during high-dose propofol use.
  • •Eclampsia Treatment — Magnesium sulfate is the drug of choice, not standard antiseizure medications.
  • •Subtle Status — The transition from convulsive SE to electrographic SE with minimal motor movements.
  • •Ketamine Mechanism — Non-competitive NMDA receptor antagonist used for refractory SE when GABAergic drugs fail.
  • •NORSE — New-onset refractory status epilepticus in a healthy person, often autoimmune.

Deep Dive — Evidence Details

References

  1. [1]

    Winkler MK, Chassidim Y, Lublinsky S et al.. “Impaired neurovascular coupling to ictal epileptic activity and spreading depolarization in a patient with subarachnoid hemorrhage: possible link to blood-brain barrier dysfunction.” Epilepsia (2012). PMID: 23134492 ↗

    L4CASE_REPORTCited in: Pathophysiology and Mechanisms of Neuronal Injury
  2. [2]

    Iglesias AH, Balabanov A, Raedy A. “Systemic Complications of Status Epilepticus.” Current neurology and neuroscience reports (2025). PMID: 41068542 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury, Etiology and Triggering Factors
  3. [3]

    Alshehri RS, Alrawaili MS, Zawawi BMH et al.. “Pathophysiology of Status Epilepticus Revisited.” International journal of molecular sciences (2025). PMID: 40806628 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  4. [4]

    Magro G, Laterza V. “Status epilepticus: Is there a Stage 1 plus?” Epilepsia (2024). PMID: 38507275 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  5. [5]

    Wasterlain CG, Chen JW. “Mechanistic and pharmacologic aspects of status epilepticus and its treatment with new antiepileptic drugs.” Epilepsia (2008). PMID: 19087119 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  6. [6]

    Walker M. “Neuroprotection in epilepsy.” Epilepsia (2007). PMID: 18330004 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  7. [7]

    Ohe Y, Hayashi T, Deguchi I et al.. “A case of nonconvulsive status epilepticus with a reversible contralateral cerebellar lesion: temporal changes in magnetic resonance imaging and single-photon emission computed tomography finding.” Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (2013). PMID: 23910513 ↗

    L4CASE_REPORTCited in: Pathophysiology and Mechanisms of Neuronal Injury
  8. [8]

    Specchio N, Auvin S. “To what extent does status epilepticus contribute to brain damage in the developmental and epileptic Encephalopathies.” Epilepsy & behavior : E&B (2025). PMID: 39883989 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  9. [9]

    Niquet J, Lumley L, Baldwin R et al.. “Early polytherapy for benzodiazepine-refractory status epilepticus.” Epilepsy & behavior : E&B (2019). PMID: 31636007 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  10. [10]

    Scott RC. “What are the effects of prolonged seizures in the brain?” Epileptic disorders : international epilepsy journal with videotape (2014). PMID: 25323416 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  11. [11]

    Engrand N, Crespel A. “[Pathophysiologic basis of status epilepticus].” Revue neurologique (2009). PMID: 19243800 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanisms of Neuronal Injury
  12. [12]

    De Luca P, Mele M, Tanqueiro S et al.. “Synaptic accumulation of GluN2B-containing NMDA receptors mediates the effects of BDNF-TrkB signalling on synaptic plasticity and in hyperexcitability during status epilepticus.” Journal of biomedical science (2025). PMID: 40890771 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  13. [13]

    Abbasova K, Kubová H, Mareš P. “Does status epilepticus modify the effect of ifenprodil on cortical epileptic afterdischarges in immature rats?” Pharmacological reports : PR (2018). PMID: 29355816 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  14. [14]

    Engel T, Martinez-Villarreal J, Henke C et al.. “Spatiotemporal progression of ubiquitin-proteasome system inhibition after status epilepticus suggests protective adaptation against hippocampal injury.” Molecular neurodegeneration (2017). PMID: 28235423 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  15. [15]

    Shao H, Yang Y, Qi AP et al.. “Gastrodin Reduces the Severity of Status Epilepticus in the Rat Pilocarpine Model of Temporal Lobe Epilepsy by Inhibiting Nav1.6 Sodium Currents.” Neurochemical research (2017). PMID: 27743286 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  16. [16]

    Hocker S, Nagarajan E, Rabinstein AA et al.. “Progressive Brain Atrophy in Super-refractory Status Epilepticus.” JAMA neurology (2016). PMID: 27533350 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  17. [17]

    Wasterlain CG, Naylor DE, Liu H et al.. “Trafficking of NMDA receptors during status epilepticus: therapeutic implications.” Epilepsia (2013). PMID: 24001081 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  18. [18]

    Engel T, Gomez-Villafuertes R, Tanaka K et al.. “Seizure suppression and neuroprotection by targeting the purinergic P2X7 receptor during status epilepticus in mice.” FASEB journal : official publication of the Federation of American Societies for Experimental Biology (2012). PMID: 22198387 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  19. [19]

    Engel T, Tanaka K, Jimenez-Mateos EM et al.. “Loss of p53 results in protracted electrographic seizures and development of an aggravated epileptic phenotype following status epilepticus.” Cell death & disease (2010). PMID: 21368852 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  20. [20]

    Avchalumov Y, Kirschstein T, Köhling R. “Altered physiology and pharmacology in the corticostriatal system in a model of temporal lobe epilepsy.” Epilepsia (2011). PMID: 21070218 ↗

    L5OTHERCited in: Pathophysiology and Mechanisms of Neuronal Injury
  21. [21]

    Peng W, Lu L, Yin J et al.. “Factors associated with long-term outcomes in people with new onset refractory epilepticus: A single-center cohort study.” Epilepsia (2026). PMID: 41277767 ↗

    L2bCOHORTCited in: Etiology and Triggering Factors, Special Populations: Pediatrics, Pregnancy, and Elderly
  22. [22]

    Lopez-Espejo M, Skorin I, Mesa T et al.. “Three-year incidence and acute setting predictors of epilepsy after neonatal and childhood arterial ischaemic stroke: a disease-based cohort study.” European journal of pediatrics (2024). PMID: 38170290 ↗

    L2bCOHORTCited in: Etiology and Triggering Factors
  23. [23]

    Wang X, Wang YY, Gao Q et al.. “Development and validation of a nomogram to provide individualized predictions of functional outcomes in patients with convulsive status epilepticus at 3 months: The modified END-IT tool.” CNS neuroscience & therapeutics (2023). PMID: 37334755 ↗

    L1bRCTCited in: Etiology and Triggering Factors, Recognition and Triage
  24. [24]

    Lee S, Kim SH, Kim HD et al.. “Identification of etiologies according to baseline clinical features of pediatric new-onset refractory status epilepticus in single center retrospective study.” Seizure (2024). PMID: 38908141 ↗

    L2bCOHORTCited in: Etiology and Triggering Factors
  25. [25]

    Mikdashi J, Krumholz A. “Long-term outcome of status epilepticus-related to systemic lupus erythematosus: An observational study and a systematic review.” Seminars in arthritis and rheumatism (2023). PMID: 37595509 ↗

    L2aSR_OBSCited in: Etiology and Triggering Factors
  26. [26]

    Tabaee Damavandi P, Bosque-Varela P, Santos HBH et al.. “Crossed cerebellar diaschisis in status epilepticus: A systematic review of the literature.” Epileptic disorders : international epilepsy journal with videotape (2026). PMID: 41483388 ↗

    L2aSR_OBSCited in: Etiology and Triggering Factors, Secondary Assessment and Diagnostic Workup
  27. [27]

    Romozzi M, Vollono C, Calabresi P et al.. “Epilepsia Partialis Continua as a manifestation of aquaporin-4 autoimmunity.” Multiple sclerosis (Houndmills, Basingstoke, England) (2024). PMID: 39077880 ↗

    L4CASE_REPORTCited in: Etiology and Triggering Factors
  28. [28]

    Cabreira V, Ferreira D, Melo C et al.. “Child Neurology: Anti-Hu Encephalitis in an Adolescent With a Mediastinal Seminoma.” Neurology (2023). PMID: 37527936 ↗

    L4CASE_REPORTCited in: Etiology and Triggering Factors
  29. [29]

    Gaillard JR, Whitt Z, Selwa LM et al.. “Pearls & Oy-sters: Whole-Genome Sequencing in Critically Ill Neurologic Patient Leads to Diagnosis With Treatment Implications.” Neurology (2023). PMID: 37460236 ↗

    L4CASE_REPORTCited in: Etiology and Triggering Factors
  30. [30]

    Marini C, Rosati A, Fusco L et al.. “Genetic Etiologies of Epilepsies With Status Epilepticus: Insights From the Italian Pediatric Status Epilepticus Group Cohort.” Neurology (2026). PMID: 41915870 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  31. [31]

    Damiano M, Lambrecq V, Nguyen-Michel VH et al.. “EEG, clinical, and MRI features of status epilepticus associated with mitochondrial diseases.” Journal of neurology (2026). PMID: 41729327 ↗

    L5OTHERCited in: Etiology and Triggering Factors, Special Populations: Pediatrics, Pregnancy, and Elderly
  32. [32]

    Jayalakshmi S, Pachipala S, Patil A et al.. “Clinical characteristics, etiology and outcome of new onset refractory status epilepticus in adults.” Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2026). PMID: 41498863 ↗

    L5OTHERCited in: Etiology and Triggering Factors, Special Populations: Pediatrics, Pregnancy, and Elderly
  33. [33]

    Lattanzi S, Matricardi S, Vogrig A et al.. “Predicting epilepsy after new onset refractory status epilepticus due to autoimmune encephalitis: The DAME score.” Epilepsia (2026). PMID: 41467927 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  34. [34]

    Pelletier J, Merriman W, Koyfman A et al.. “Benzodiazepine-refractory status epilepticus: A narrative review.” The American journal of emergency medicine (2026). PMID: 40974752 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Recognition and Triage, Refractory and Super-Refractory Status Epilepticus Management
  35. [35]

    Kilmer J, Ransley G, Murphy E et al.. “The Role of Metabolic Testing in the Diagnostic Evaluation of Adult NORSE: A Retrospective, Single-Centre Study.” European journal of neurology (2025). PMID: 40470573 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  36. [36]

    Steriade C, Thomas SC, Xu F et al.. “Patients with status epilepticus and new-onset refractory status epilepticus display drastically altered fecal microbiomes compared to chronic epilepsy patients.” Epilepsia (2025). PMID: 40387216 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  37. [37]

    Ferreira JHF, Gomes AM, Zetehaku AC et al.. “Performance of cryptogenic new onset refractory status epilepticus score in a Brazilian cohort after testing for antineuronal antibodies with tissue-based and cell-based assays.” Epilepsia (2025). PMID: 40318023 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  38. [38]

    Halawani LM, Myers KA. “Comparative analysis of new-onset refractory status epilepticus in adult and pediatric patients: immunotherapy timing and functional outcomes.” Journal of neurology (2025). PMID: 40251332 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  39. [39]

    Ferhat L, Soussi R, Masse M et al.. “A peptide-neurotensin conjugate that crosses the blood-brain barrier induces pharmacological hypothermia associated with anticonvulsant, neuroprotective, and anti-inflammatory properties following status epilepticus in mice.” eLife (2025). PMID: 40152901 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  40. [40]

    Vignatelli L, Tontini V, Meletti S et al.. “Clinical practice guidelines on the management of status epilepticus in adults: A systematic review.” Epilepsia (2024). PMID: 38606469 ↗

    L1cGUIDELINECited in: Recognition and Triage
  41. [41]

    Simma L, Kammerl A, Ramantani G. “Point-of-care EEG in the pediatric emergency department: a systematic review.” European journal of pediatrics (2025). PMID: 40053132 ↗

    L2aSR_OBSCited in: Recognition and Triage, Secondary Assessment and Diagnostic Workup
  42. [42]

    Limotai C, Jirasakuldej S, Wongwiangiunt S et al.. “Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study.” Critical care (London, England) (2025). PMID: 39773282 ↗

    L1bRCTCited in: Recognition and Triage, Secondary Assessment and Diagnostic Workup
  43. [43]

    Rubinos C. “Emergent Management of Status Epilepticus.” Continuum (Minneapolis, Minn.) (2024). PMID: 38830068 ↗

    L4CASE_REPORTCited in: Recognition and Triage, Refractory and Super-Refractory Status Epilepticus Management
  44. [44]

    Shen JY, Saffari SE, Yong L et al.. “Evaluation of prognostic scores for status epilepticus in the neurology ICU: A retrospective study.” Journal of the neurological sciences (2024). PMID: 38490090 ↗

    L2bCOHORTCited in: Recognition and Triage
  45. [45]

    Gélisse P, Crespel A. “Nonconvulsive status epilepticus in patients under intensive care: Should we view epilepsy as a sleep disorder?” Epilepsia (2025). PMID: 39821147 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage, Secondary Assessment and Diagnostic Workup
  46. [46]

    Gélisse P, Crespel A. “When patients with Creutzfeldt-Jakob disease are misdiagnosed as having nonconvulsive status epilepticus.” Epilepsia (2025). PMID: 39754446 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage, Secondary Assessment and Diagnostic Workup
  47. [47]

    O'Kula SS, Hill CE. “Improving Quality of Care for Status Epilepticus: Putting Protocols into Practice.” Current neurology and neuroscience reports (2024). PMID: 38995482 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  48. [48]

    Gélisse P, Tatum WO, Crespel A et al.. “Stimulus-induced arousal with transient electroencephalographic improvement distinguishes nonictal from ictal generalized periodic discharges.” Epilepsia (2024). PMID: 38624097 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  49. [49]

    Green A, Wegman ME, Ney JP. “Economic review of point-of-care EEG.” Journal of medical economics (2024). PMID: 38014443 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  50. [50]

    Davey Z, Gupta PB, Li DR et al.. “Rapid Response EEG: Current State and Future Directions.” Current neurology and neuroscience reports (2022). PMID: 36434488 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  51. [51]

    De Stefano P, Kaplan PW, Quintard H et al.. “Nonconvulsive status epilepticus following cardiac arrest: overlooked, untreated and misjudged.” Journal of neurology (2023). PMID: 36076090 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  52. [52]

    Alkhachroum A, Appavu B, Egawa S et al.. “Electroencephalogram in the intensive care unit: a focused look at acute brain injury.” Intensive care medicine (2022). PMID: 35997792 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  53. [53]

    Rosati A, Bartolotta P, Marini C et al.. “Optimizing pediatric status epilepticus management: The role of early midazolam infusion and adherence to clinical practice guidelines.” Epilepsia (2025). PMID: 40377450 ↗

    L1cGUIDELINECited in: Refractory and Super-Refractory Status Epilepticus Management
  54. [54]

    Chiriboga N, Spentzas T, Abu-Sawwa R. “A systematic review and meta-analysis of ketamine in pediatric status epilepticus.” Epilepsia (2024). PMID: 38881333 ↗

    L2aSR_OBSCited in: Refractory and Super-Refractory Status Epilepticus Management
  55. [55]

    Yan M, Sun T, Liu J et al.. “The efficacy and safety of ketamine in the treatment of super-refractory status epilepticus: a systematic review.” Journal of neurology (2024). PMID: 38782798 ↗

    L2aSR_OBSCited in: Refractory and Super-Refractory Status Epilepticus Management
  56. [56]

    Au YK, Kananeh MF, Rahangdale R et al.. “Treatment of Refractory Status Epilepticus With Continuous Intravenous Anesthetic Drugs: A Systematic Review.” JAMA neurology (2024). PMID: 38466294 ↗

    L2aSR_OBSCited in: Refractory and Super-Refractory Status Epilepticus Management
  57. [57]

    Cornwall CD, Piilgaard H, Engedal TS et al.. “Fast Acute Sedation at Intensive Care vs. High-Dose IV Anti-seizure Medication for Treatment of Non-convulsive Status Epilepticus: A Randomized, Multicenter Trial.” Critical care explorations (2025). PMID: 40953286 ↗

    L2bTRIAL_NONRANDOMCited in: Refractory and Super-Refractory Status Epilepticus Management
  58. [58]

    Vossler DG. “First Seizures, Acute Repetitive Seizures, and Status Epilepticus.” Continuum (Minneapolis, Minn.) (2025). PMID: 39899098 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  59. [59]

    El-Haggar SM, Hegazy SK, Mustafa W et al.. “Possible immuno-modulatory effects of tocilizumab in patients with refractory status epilepticus.” European review for medical and pharmacological sciences (2023). PMID: 36876691 ↗

    L1bRCTCited in: Refractory and Super-Refractory Status Epilepticus Management
  60. [60]

    Chiu WT, Campozano V, Schiefecker A et al.. “Management of Refractory Status Epilepticus: An International Cohort Study (MORSE CODe) Analysis of Patients Managed in the ICU.” Neurology (2022). PMID: 35918156 ↗

    L2bCOHORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  61. [61]

    Daniels ZS, Srdanovic N, Rychlik K et al.. “High-Dose Midazolam for Pediatric Refractory Status Epilepticus: A Single-Center Retrospective Study.” Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2022). PMID: 35894600 ↗

    L2bCOHORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  62. [62]

    Aboul-Fotouh S, Habib MZ, Magdy SM et al.. “Tranexamic acid-associated fatal status epilepticus in a paediatric non-cardiac surgery: A case report and literature review.” British journal of clinical pharmacology (2022). PMID: 35244235 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  63. [63]

    Hu Y, Peng X, Wang X. “Therapeutic approaches for super-refractory status epilepticus: an update of the literature.” Expert review of neurotherapeutics (2025). PMID: 40583044 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  64. [64]

    Kapur J. “Strategies to innovate emergency care of status epilepticus.” Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics (2025). PMID: 39701892 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  65. [65]

    Finney JD, Schuler PD, Rudloff JR et al.. “Evaluation of the Use of Ketamine in Prehospital Seizure Management: A Retrospective Review of the ESO Database.” Prehospital emergency care (2025). PMID: 39058382 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  66. [66]

    Rossetti AO, Claassen J, Gaspard N. “Status epilepticus in the ICU.” Intensive care medicine (2024). PMID: 38117319 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  67. [67]

    Buratti S, Giacheri E, Palmieri A et al.. “Ketamine as advanced second-line treatment in benzodiazepine-refractory convulsive status epilepticus in children.” Epilepsia (2023). PMID: 36792542 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  68. [68]

    Roberti R, Rocca M, Iannone LF et al.. “Status epilepticus in pregnancy: a literature review and a protocol proposal.” Expert review of neurotherapeutics (2022). PMID: 35317697 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  69. [69]

    Mastroianni G, Iannone LF, Roberti R et al.. “Management of status epilepticus in patients with liver or kidney disease: a narrative review.” Expert review of neurotherapeutics (2021). PMID: 33297776 ↗

    L5REVIEW_NARRATIVECited in: Refractory and Super-Refractory Status Epilepticus Management
  70. [70]

    Machado RA, Patel J, Elsayed MS. “The role of ketamine-induced beta activity in the treatment of refractory status epilepticus. Is the EEG useful to determine responder's rate? A retrospective study.” Epilepsy & behavior : E&B (2022). PMID: 34974373 ↗

    L2bCOHORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  71. [71]

    Chakravartty A, Gilmore EJ, Hirsch LJ et al.. “Clinical Reasoning: A 40-Year-Old Man With Refractory Status Epilepticus After Small Bowel Resection for Volvulus.” Neurology (2025). PMID: 40986431 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  72. [72]

    Finney JD, Kowalski M, Wang J et al.. “Prehospital Ketamine Administration in Benzodiazepine Refractory Status Epilepticus: A Case Series Review.” Prehospital emergency care (2026). PMID: 40193549 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  73. [73]

    Syed MJ, Zutshi D, Muzammil SM et al.. “Ketamine to Prevent Endotracheal Intubation in Adults with Refractory Non-convulsive Status Epilepticus: A Case Series.” Neurocritical care (2024). PMID: 37783825 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  74. [74]

    Kimmons LA, Alzayadneh M, Metter EJ et al.. “Safety and Efficacy of Ketamine Without Intubation in the Management of Refractory Seizures: A Case Series.” Neurocritical care (2024). PMID: 37610640 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  75. [75]

    Perlmutter M, Price M, Kothari K et al.. “Prehospital Treatment of Benzodiazepine-Resistant Pediatric Status Epilepticus with Parenteral Ketamine: A Case Series.” Prehospital emergency care (2023). PMID: 37276174 ↗

    L4CASE_REPORTCited in: Refractory and Super-Refractory Status Epilepticus Management
  76. [76]

    Pirgit ML, Beniczky S. “EEG and semiology in the elderly: A systematic review.” Seizure (2025). PMID: 39294074 ↗

    L2aSR_OBSCited in: Secondary Assessment and Diagnostic Workup
  77. [77]

    Peña-Ceballos J, Moloney PB, Kinney MO et al.. “How are we doing? The electroclinical diagnosis of status epilepticus in idiopathic generalized epilepsy in a tertiary referral center: A case series and scoping review of 40 years of literature.” Journal of the neurological sciences (2026). PMID: 41807915 ↗

    L4CASE_REPORTCited in: Secondary Assessment and Diagnostic Workup
  78. [78]

    Hirsch LJ, Gopaul MT. “EEG in the critical care setting.” Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology (2026). PMID: 41297117 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  79. [79]

    Spagnoli C, Ramantani G, Sharpe C et al.. “Rethinking the definition of neonatal status epilepticus.” European journal of pediatrics (2025). PMID: 40906263 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  80. [80]

    De Stefano P. “Reconsidering the management and prognostic implications of myoclonus and status epilepticus post-cardiac arrest.” Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology (2026). PMID: 40436658 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  81. [81]

    Nagarajan L, Ghosh S. “Status epilepticus in the neonate.” BMJ paediatrics open (2025). PMID: 40121015 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  82. [82]

    Lévi-Strauss J, Marois C, Worbe Y et al.. “Utility and Value of Movement Recording with Combined EEG-EMG Monitoring in the Intensive Care Unit.” Neurocritical care (2025). PMID: 40032771 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  83. [83]

    Haider HA. “Initial Management of Acute Seizures and Status Epilepticus.” The Medical clinics of North America (2025). PMID: 39893025 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  84. [84]

    Gettings JV, Mohammad Alizadeh Chafjiri F, Patel AA et al.. “Diagnosis and management of status epilepticus: improving the status quo.” The Lancet. Neurology (2025). PMID: 39637874 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  85. [85]

    Chiarello D, Perrone A, Ricci E et al.. “The Role of Electroencephalography in Children with Acute Altered Mental Status of Unknown Etiology: A Prospective Study.” Neuropediatrics (2024). PMID: 39106957 ↗

    L2bCOHORTCited in: Secondary Assessment and Diagnostic Workup
  86. [86]

    Gomutbutra P, Krongsut S, Lott J. “A Systematic Review and Meta-Analysis Evaluating the Clinical Impact and Accuracy of Artificial Intelligence in EEG for the Early Detection of Nonconvulsive Seizures.” The Neurodiagnostic journal (2025). PMID: 40679314 ↗

    L2aSR_OBSCited in: Secondary Assessment and Diagnostic Workup
  87. [87]

    Neves Briard J, Duquette A, Cayrol R et al.. “Refractory Status Epilepticus in a Patient With Aducanumab-Induced Amyloid-Related Imaging Abnormalities.” Neurology (2024). PMID: 39121445 ↗

    L4CASE_REPORTCited in: Secondary Assessment and Diagnostic Workup
  88. [88]

    Siegel CR, Khoujah D. “Status Epilepticus.” Emergency medicine clinics of North America (2026). PMID: 41260851 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup, Special Populations: Pediatrics, Pregnancy, and Elderly
  89. [89]

    Leitinger M, Bosque-Varela P, Kuchukhidze G et al.. “Seminars in epileptology: How to diagnose status epilepticus in adults and children.” Epileptic disorders : international epilepsy journal with videotape (2025). PMID: 40528536 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  90. [90]

    Ford H, Seneviratne U. “The electroencephalogram in the diagnosis and classification of status epilepticus: a practical guide.” Practical neurology (2025). PMID: 39890455 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment and Diagnostic Workup
  91. [91]

    Zehtabchi S, Beall J, Silbergleit R et al.. “Chronological Sequence of Convulsive Status Epilepticus Treatment Steps in a Real-Life Scenario for Patients Enrolled in a Large Multicenter Trial.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2026). PMID: 41854499 ↗

    L1bRCTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  92. [92]

    Wang P, Lu L, Gao H et al.. “Will Memantine Exacerbate Seizures in People With Epilepsy? A Prospective Cohort Study.” Annals of clinical and translational neurology (2026). PMID: 41288262 ↗

    L2bCOHORTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  93. [93]

    Pichardo-Rojas D, Camarena-Rubio KJ, Gómez-Oropeza I et al.. “Optimizing vagus nerve stimulation for Super Refractory Status Epilepticus: A case series and systematic review.” Epileptic disorders : international epilepsy journal with videotape (2025). PMID: 40539748 ↗

    L2aSR_OBSCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  94. [94]

    Yoo JY, Bloomfield J, Eka O et al.. “Vagus nerve stimulation as an adjunctive therapy for super-refractory status epilepticus including NORSE: a retrospective cohort study.” Epilepsy & behavior : E&B (2026). PMID: 41875755 ↗

    L2bCOHORTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  95. [95]

    Manai H, Kharraz T, Zouari H et al.. “Prognostic performance of STESS and qSOFA scores in pre-hospital status epilepticus: A prospective cohort study.” Seizure (2026). PMID: 41679101 ↗

    L2bCOHORTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  96. [96]

    Nakamura Y, Aso S, Yasunaga H et al.. “In-hospital outcomes of lacosamide versus levetiracetam for early adjunctive treatment of status epilepticus: A Nationwide Japanese retrospective cohort study.” Epilepsia open (2026). PMID: 41222404 ↗

    L2bCOHORTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  97. [97]

    Woodward MR, Armahizer MJ, Wang TI et al.. “Status epilepticus in older adults: A critical review.” Epilepsia (2025). PMID: 40365943 ↗

    L5REVIEW_NARRATIVECited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  98. [98]

    Alghadeer SM, Alsuwayegh A, AlMuqati H et al.. “Underdosing and response to pharmacotherapy in patients with status epilepticus: a retrospective study from Saudi Arabia.” Annals of medicine (2025). PMID: 40317249 ↗

    L2bCOHORTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  99. [99]

    Al Wahaibi A, Kazazian K, Gopaul M et al.. “The spectrum of cognitive outcomes following admission to hospital for refractory status epilepticus (RSE): A scoping review.” Seizure (2025). PMID: 40972237 ↗

    L5REVIEW_NARRATIVECited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  100. [100]

    Spuler K, Kaukas L, Tawfik S et al.. “Fatal Status Epilepticus After Elective Revision Cranioplasty: Case Report and Literature Review.” The American journal of case reports (2026). PMID: 41719224 ↗

    L4CASE_REPORTCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  101. [101]

    Lanzone J, Bellini A, Cursi M et al.. “Structured EEG report complements the prognostic stratification of status epilepticus.” Journal of neurology (2026). PMID: 41986752 ↗

    L5OTHERCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  102. [102]

    Schlabitz S, Doerrfuss JI, Hebel JM et al.. “Neurofilament light-chain (Nf-L) as a biomarker in seizures and status epilepticus of varying duration.” Journal of neurology (2026). PMID: 41927849 ↗

    L5OTHERCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  103. [103]

    Orav K, Bosque-Varela P, Lauth W et al.. “Peri-Ictal MRI Abnormalities and Risk of Unprovoked Seizures After De Novo Status Epilepticus.” Neurology (2026). PMID: 41838966 ↗

    L5OTHERCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  104. [104]

    Sala Padró J, Fonseca E, Quintana M et al.. “Impact of Treatment Delays in Epileptic Seizures: Time to Hospital Care and to EEG Increases Risk of Status Epilepticus and ICU Admission in Epileptic Seizures.” European journal of neurology (2026). PMID: 41778530 ↗

    L5OTHERCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  105. [105]

    De Stefano P, Baumann SM, Fisch U et al.. “Impact of Etiology on Mortality and Recovery in Patients With Status Epilepticus.” Neurology (2026). PMID: 41637681 ↗

    L5OTHERCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  106. [106]

    Krishnamurthy PV, Philibert-Rosas S, Rivkin M et al.. “Duration of EEG monitoring needed to ensure a low risk of seizure recurrence in hospitalized patients.” Journal of neurology (2026). PMID: 41507611 ↗

    L5OTHERCited in: Special Populations: Pediatrics, Pregnancy, and Elderly
  107. [107]

    Brophy GM, Bell R, Claassen J et al.. “Guidelines for the evaluation and management of status epilepticus.” Neurocritical care (2012). PMID: 22528274 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  108. [108]

    Harden CL, Hopp J, Ting TY et al.. “Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society.” Neurology (2009). PMID: 19398682 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  109. [109]

    Harden CL, Hopp J, Ting TY et al.. “Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society.” Epilepsia (2009). PMID: 19496807 ↗

    L1cGUIDELINECited in: Guidelines and Resources

Revision History

All updates applied to this page

Loading revisions…