Therapy of Status Epilepticus

1. Big picture

Status epilepticus is a neurological emergency. In the exam, the key idea is not to describe epilepsy in general, but to show that you know the urgent treatment sequence:

ABCDE stabilization → benzodiazepine → IV antiseizure loading drug → ICU anesthesia if refractory → treat the cause.

Classically, status epilepticus was defined as a seizure lasting >30 minutes or recurrent seizures without recovery of consciousness. Modern practice treats generalized convulsive status epilepticus after 5 minutes, because spontaneous termination becomes less likely and brain/systemic injury risk rises with time. The ILAE uses two practical time points: t1 = when treatment should start and t2 = when long-term injury risk increases; for convulsive status epilepticus these are approximately 5 minutes and 30 minutes.