Status epilepticus: Managing refractory cases and treating out-of-hospital patients

Status epilepticus (SE) is an emergency medical situation that may not respond to benzodiazepine or phenobarbital treatment. This situation is termed refractory SE and requires more aggressive treatment such as anesthesia. SE may also occur in the home environment where facilities are limited. The time that passes before treatment is instituted is crucial in the prevention of permanent cerebral damage and may be important in saving the patient's life. For such patients, the efficacy of rectally delivered diazepam has been established. Intranasal delivery of anticonvulsants is being evaluated in dogs and may represent a future method of at-home seizure control.