Status epilepticus

Status epilepticus (SE) is one of the most common neurological emergencies. In many cases that present to the intensive care unit, SE is refractory to initial medical therapy. Seizures may be caused by structural intracranial lesions, as well as toxic and metabolic abnormalities. Many patients in whom SE appears to have subsided continue to have nonconvulsive seizures. Nonconvulsive SE is also particularly prevalent among brain-injured patients with stupor and coma and requires a high index of suspicion to be diagnosed in a timely fashion. Seizures can perpetuate neurological injury and lead to worsened outcomes. Treatment requires a timely, algorithmic approach, with use of continuous electroencephalography in refractory cases. Neuroprotection should be emphasized when intensivists choose physiological targets.