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February 2002

Refractory Status Epilepticus in 2001

Arch Neurol. 2002;59(2):188-189. doi:10.1001/archneur.59.2.188

IN THE 4 decades since the participants of the Marseilles colloquium set in motion the contemporary study of status epilepticus,1 neurologists have seen several shifts in our understanding of the disorder and its treatment. The definition of status epilepticus arising from that meeting was "a fixed and lasting epileptic condition," which has most often been interpreted to mean 30 minutes of either continuous seizure activity or repetitive seizures without recovery between them and frequently without a specified duration. These 2 types differ prognostically.2 In a prehospital study in San Francisco, Calif, status epilepticus was essentially declared if a patient was still experiencing a seizure when emergency medical personnel arrived.3 Some of us have argued that the definition should be statistical, based on the selection of a point at which seizures become unlikely to terminate spontaneously.4 A subsequent study suggested that more than half of seizures lasting longer than 10 minutes may lead to status epilepticus.5 Although the question of definition is best left as an operational one, dependent on the purpose of the study, the consensus seems to be that seizures should be terminated as expeditiously as possible to prevent complications, including the emergence of treatment-refractory status.

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