Status epilepticus.

Abstract

Status epilepticus (SE) is one of the most common neurologic emergencies in pediatrics. It is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which leads to abnormally, prolonged seizures. This definition provides a good guidance, when emergency treatment must be considered. In general, time point t1 is the time when treatment should be started, which is at 5 minutes for generalized tonic-clonic seizures, and at 10 min for focal seizures with or without impairment of consciousness. Time-point t2 marks the time at which neuronal damage or self-perpetuating alteration of neuronal networks may begin and indicates that SE should be controlled latest by that time; 30 min in case of generalized tonic-clonic seizures. All treatment protocols recognize a staged approach to treatment with different drugs used in early (stage I), established (stage II), refractory (stage III) and super-refractory SE (stage IV); and emphasize prompt recognition and treatment of persisting seizure activity at each stage aiming to reduce morbidity, mortality, and long-term consequences of status epilepticus (beyond t2).