The treatment of status epilepticus

Purpose of review This review discusses the advances in the treatment of status epilepticus since the first London-Innsbruck Colloquium on Status Epilepticus, held in London in April 2007. Recent findings The review focuses on new drug treatment. The treatment of tonic-clonic status epilepticus is usually divided into three stages. In the first stage (stage of early status epilepticus), buccal midazolam has become an important out-of-hospital treatment option. In the second stage (stage of established status epilepticus) modern treatment choices include valproate, levetiracetam and lacosamide. In the third stage (stage of refractory status epilepticus), a variety of anaesthetics and nonpharmacological therapies can be administered. Treatment should also be focused on the causes of status epilepticus, and immunological therapy is sometimes given in cryptogenic refractory status epilepticus. Summary There have been a number of advances in recent years in the treatment of status epilepticus. In stage 2 and stage 3 of status epilepticus, the therapies have almost invariably been assessed in open studies only, and there is a need for multicentre randomized controlled therapy comparisons.