Comprehensive Contemporary Perspectives On Convulsive And Nonconvulsive Status Epilepticus Across The Lifespan: Definitions, Pathophysiology, Timeliness Of Therapy, And Evidence-Based Management

Dr. Rafael J. Quintana

Open Access

Comprehensive Contemporary Perspectives On Convulsive And Nonconvulsive Status Epilepticus Across The Lifespan: Definitions, Pathophysiology, Timeliness Of Therapy, And Evidence-Based Management

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Dr. Rafael J. Quintana ¹ ,

⁴ Faculty of Medicine, University of Barcelona, Spain

Abstract

Status epilepticus represents one of the most severe neurological emergencies encountered in both pediatric and adult populations, characterized by prolonged or recurrent seizure activity associated with substantial morbidity and mortality. Over recent decades, evolving conceptual frameworks, refined electroclinical definitions, and increasingly nuanced treatment algorithms have reshaped clinical understanding of this condition. In particular, the recognition of nonconvulsive status epilepticus as a frequent, underdiagnosed, and biologically injurious state has expanded the scope of status epilepticus beyond overt convulsive manifestations. This article provides an integrative, theory-driven, and evidence-based examination of convulsive and nonconvulsive status epilepticus, synthesizing current international definitions, mechanistic insights into excitotoxic neuronal injury, clinical semiology, electroencephalographic correlates, genetic contributions, and the critical role of treatment latency. Drawing strictly on established guidelines, experimental models, and clinical cohort studies, the paper explores how evolving classification systems have influenced diagnostic reasoning and therapeutic urgency. Particular attention is devoted to refractory and super-refractory status epilepticus, including emerging consensus concepts such as new-onset refractory status epilepticus and febrile infection-related epilepsy syndrome. The discussion emphasizes pediatric considerations, including genetic burden and developmental vulnerability, while also addressing adult critical care contexts. Across all age groups, delayed recognition and intervention are consistently associated with poorer outcomes, reinforcing the centrality of rapid diagnosis and escalation of therapy. By deeply elaborating theoretical implications, unresolved controversies, and future research directions, this article aims to serve as a comprehensive scholarly resource that bridges pathophysiology, clinical neurophysiology, and evidence-based management in modern status epilepticus care.

Keywords

Status epilepticus, nonconvulsive status epilepticus, refractory seizures

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