[Status epilepticus].

Abstract

Status epilepticus (SE) is one of the most important neurological emergencies. We describe the most recent aspects concerning the definition, classification, aetiology, physiopathological and epidemiological aspects of SE, together with the therapeutic principles and pharmacotherapy in adults and adolescents. The therapeutic control of SE becomes more difficult as its duration becomes longer, and the possibility of causing permanent neurological damage also increases. Treatment is more effective when it is performed following a protocol. The benzodiazepines are still a first line of treatment. Home care treatment of patients with recurring seizures or important risk factors for developing SE could help to improve the future response to therapy and, therefore, its prognosis. Thus, several therapies involving benzodiazepines are developed which can be administered rectally, nasally and sublingually. In the future, treatment may include the use of neuroprotective drugs that reduce the morbidity and mortality of SE and prevent cell death. In spite of the progress made in understanding SE, there are still certain shortcomings that must be solved, i.e. mistakes made during diagnosis, a need for wider availability of electrographic controls, the basic physiopathological mechanisms require further research, and controlled studies with currently available antiepileptic drugs and others that have only recently appeared should be conducted in order to evaluate their therapeutic effectiveness, in both home care and hospitalised patients (refractory SE).