Status epilepticus: pathophysiology and management in adults

Lancet Neurol. 2006 Mar;5(3):246-56. doi: 10.1016/S1474-4422(06)70374-X.


As in Clark and Prout's classic work, we identify three phases of generalised convulsive status epilepticus, which we call impending, established, and subtle. We review physiological and subcellular changes that might play a part in the transition from single seizures to status epilepticus and in the development of time-dependent pharmacoresistance. We review the principles underlying the treatment of status epilepticus and suggest that prehospital treatment is beneficial, that therapeutic drugs should be used in rapid sequence according to a defined protocol, and that refractory status epilepticus should be treated with general anaesthesia. We comment on our preference for drugs with a short elimination half-life and discuss some therapeutic choices.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Anesthesia, General / methods
  • Animals
  • Humans
  • Models, Biological
  • Neuroprotective Agents / therapeutic use
  • Seizures / etiology
  • Seizures / therapy
  • Status Epilepticus / diagnosis
  • Status Epilepticus / epidemiology
  • Status Epilepticus / physiopathology*
  • Status Epilepticus / therapy*


  • Neuroprotective Agents