Emergency and intensive medical care of status epilepticus

Convulsive status epilepticus is defined as a general or focal epileptic seizure lasting longer than 5 min or recurrent seizures without regaining consciousness between seizures. Status epilepticus is a life-threatening condition caused by underlying pathologies (e.g., stroke, meningitis, cerebral hypoxia, cerebral edema). In addition, patients are in danger of physical injury and impaired brain stem reflexes. This also applies to nonconvulsive status epilepticus, which is often characterized by an "unclear loss of consciousness". Although it can only be diagnosed by electroencephalography, it is an important differential diagnosis in the prehospital or emergency room situation, which may be decisive for the therapeutic strategy. Benzodiazepines are the first choice treatment for status epilepticus. This article summarizes a guideline-directed therapy with different pharmaceutical substances and ways of application. A pragmatic approach for limited diagnostic and therapeutic possibilities in the emergency situation is presented.