Volume 30, Issue 174, August 2026

Management of status epilepticus: Treatment strategies and barriers to implementation

Kacper Kulik^1♦, Martyna Saleh¹, Jakub Tomczyszyn¹, Patrycja Pogorzelska¹, Paulina Żuk¹

¹Regional Specialist Hospital in Wrocław, Research and Development Center, Kamieńskiego 73a, 51-124 Wrocław, Poland

^♦Corresponding author
Kacper Kulik, Regional Specialist Hospital in Wrocław, Research and Development Center, ul. H. M. Kamieńskiego 73a, 51-124 Wrocław, Poland

ABSTRACT

Background: Status epilepticus is considered a life-threatening condition that requires immediate treatment. Although internationally structured pharmacological treatment algorithms exist, their implementation can be hampered by factors such as insufficient benzodiazepine supply and insufficient availability of continuous electroencephalography monitoring. Objective: This narrative review summarizes the current knowledge regarding the management of status epilepticus in adults, with a particular focus on the barriers to implementing the presented treatment guidelines. Methods: A literature search was conducted using PubMed and Google Scholar for English-language articles published between January 2000 and January 2026. This work was based on systematic and narrative reviews, clinical trials, and consensus guidelines for the management of status epilepticus in adults. Results: Benzodiazepines are the first-line treatment for status epilepticus. However, if the condition is prolonged, the next step is to use antiseizure medication (ASM) such as levetiracetam, valproic acid, or fosphenytoin. Refractory status epilepticus requires emergency procedures, including intensive care unit treatment and continuous monitoring of vital parameters. Continuous electroencephalography (cEEG) plays an important role in monitoring seizure activity. Significant barriers include delayed administration of benzodiazepines and insufficient dosing, which manifests as underdosing and limited use of continuous electroencephalography. Conclusions: Improving the management of status epilepticus requires both evidence-based pharmacological treatment and reliable systems for its adequate implementation. Further prospective studies could help determine whether specific organizational interventions improve functional outcomes and mortality.

Keywords: status epilepticus; antiseizure medications; benzodiazepines; clinical guidelines; continuous electroencephalography

Medical Science, 2026, 30, e154ms3954

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Published: 18 August 2026