Status epilepticus in adults: a clinically oriented review of etiologies, diagnostic challenges, and therapeutic advances

Status epilepticus (SE) is a neurological emergency associated with a high mortality rate. Collaborative efforts have been made to establish standardized definitions, classifications, and treatment protocols to improve management and reduce mortality. In 2015, the International League Against Epilepsy (ILAE) developed a new definition and classification system for SE, taking into account the pathophysiology of SE and setting time points for treatment decision-making, while considering the variability in seizure semiology.Timely identification of the underlying cause of SE would facilitate more targeted treatment, as almost half of all SE cases require specific therapy for the underlying cause in addition to providing symptomatic treatment.A stepwise algorithm for seizure management is proposed, with the initial stage involving the administration of benzodiazepines (BZD), followed by the use of non-sedating anti-seizure medications (ASM) as the second line of treatment. The decision to resort to therapeutic coma is made on a case-by-case basis, as most invasive treatments may not always be the best approach.This comprehensive review provides an overview of SE and its definition, pathophysiology, diagnostic challenges, and recent treatment advances.