title: 25 years of advances in the definition, classification and treatment of status epilepticus.
abstract: OBJECTIVE
  Status epilepticus (SE) requires not only urgent symptomatic treatment with antiepileptic drugs but also rapid identification and treatment of its cause. This narrative review summarizes the most important advances in classification and treatment of SE.
  
  
  METHODS
  Data sources included MEDLINE, EMBASE, ClinicalTrials.gov, and back tracking of references in pertinent studies, reviews, and books.
  
  
  RESULTS
  SE is now defined as "a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1). It is a condition, which can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures." A new diagnostic classification system of SE introduces four axes: semiology, aetiology, EEG correlates, and age. For the acute treatment intravenous benzodiazepines (lorazepam, diazepam, clonazepam) and intramuscular midazolam appear as most effective treatments for early SE. In children, buccal or intranasal midazolam are useful alternatives. In established SE intravenous antiepileptic drugs (phenytoin, valproate, levetiracetam, phenobarbital, and lacosamide) are in use. Treatment options in refractory SE are intravenous anaesthetics; ketamine, magnesium, steroids and other drugs have been used in super-refractory SE with variable outcomes.
  
  
  CONCLUSIONS
  Over the past 25 years major advances in definition, classification and understanding of its mechanisms have been achieved. Despite this up to 40% of patients in early status cannot be controlled with first line drugs. The treatment of super-refractory status is still an almost evidence free zone.
authors.affiliation: Department of Neurology, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria. Electronic address: e.trinka@salk.at.
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
authors.affiliation: Epilepsy Center, Neurocenter, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Kälviäinen
mesh_terms: D002986:Clinical Trials as Topic / Q000266:history / Q000379:methods; D016208:Databases, Factual / Q000706:statistics & numerical data; D004569:Electroencephalography; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D013226:Status Epilepticus / Q000145:classification / Q000175:diagnosis / Q000628:therapy
keywords: Anesthetics; Antiepileptic drugs; Benzodiazepines; Classification; Status epilepticus