STATUS EPILEPTICUS IN TERTIARY CARE SETTINGS: A REVIEW OF UPDATED DIAGNOSTIC CRITERIA, EVIDENCE-BASED ACUTE MANAGEMENT PROTOCOLS, AND PROGNOSTIC FACTORS

Abstract

Background: Status epilepticus (SE) is one of the most dangerous neurological emergencies, necessitating prompt diagnosis and treatment to avoid irreparable neuronal damage, long-term neurological disability, and death. Despite significant breakthroughs in neurocritical care and antiseizure medicines, SE remains a significant clinical and healthcare burden, particularly for critically ill and elderly patients. Objective: This review summarizes current data on revised diagnostic criteria, evidence-based acute management options, and prognostic predictors of status epilepticus in tertiary care settings, with a focus on new recommendations from international clinical practice guidelines. Methods: A systematic literature review was undertaken in accordance with the PRISMA 2020 standards. We searched electronic databases such as PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar for papers published between January 2015 and June 2026. Seventy-five suitable research, including randomised controlled trials, cohort studies, systematic reviews, meta-analyses, and international clinical guidelines, were critically examined and narratively synthesized. Methodological quality was examined using validated instruments such as the RoB 2, Newcastle-Ottawa Scale, AMSTAR-2, and AGREE II. Results: The synthesized evidence shows that rapid recognition and protocol-driven treatment significantly improve seizure termination and neurological recovery. Current international guidelines propose starting therapy at the operational time point (t1 = 5 min), using intravenous benzodiazepines first, followed by levetiracetam, valproate, or fosphenytoin if seizures persist. Continuous electroencephalographic monitoring is essential for detecting non-convulsive status epilepticus and directing treatment in refractory instances. Patients with refractory and super-refractory SE typically require intensive care unit hospitalization, continuous anaesthetic infusions, mechanical ventilation, and adjuvant medications such as ketamine or immunotherapy. Advanced age, increased seizure duration, delayed therapy, acute symptomatic aetiologies, and refractory disease were consistently identified as the biggest predictors of worse neurological outcomes and mortality. Early treatment escalation, standardized management algorithms, and multidisciplinary neurocritical care have all been linked to better survival and functional recovery according to worldwide recommendations. Conclusion: Contemporary evidence reinforces that rapid diagnosis, immediate evidence-based treatment, continuous EEG surveillance, and early escalation to specialized neurocritical care remain the cornerstones of successful status epilepticus management. Future multicenter clinical trials integrating precision medicine, artificial intelligence-assisted EEG interpretation, and novel therapeutic approaches are warranted to optimize individualized treatment strategies and further improve long-term neurological outcomes.