UPDATES IN THE MANAGEMENT OF STATUS EPILEPTICUS IN THE EMERGENCY DEPARTMENT: A REVIEW OF EVIDENCE-BASED GUIDELINES AND NOVEL AGENTS

Status epilepticus (SE) is a critical neurological emergency requiring urgent, evidence-based management to mitigate high morbidity and mortality. This systematic review synthesizes current evidence and guidelines on the emergency treatment of SE, focusing on recent pharmacological advances. A comprehensive literature search was conducted per PRISMA guidelines across major databases from 2000-2024. The review included RCTs, systematic reviews, and clinical guidelines, with quality assessed via tools like Cochrane RoB 2 and AGREE II. From 2,189 records, 18 studies were included. Findings robustly confirm benzodiazepines as first-line therapy. The practice-changing ESETT trial established "three-drug equipoise" for second-line treatment, demonstrating equivalent efficacy and safety for levetiracetam, fosphenytoin, and valproate. For refractory SE, ketamine emerges as a key third-line agent, with a 63% seizure cessation rate and a favorable hemodynamic profile. Novel agents like brivaracetam, perampanel, and allopregnanolone offer promise for super-refractory cases. Major guidelines consistently endorse a time-sensitive, staged treatment algorithm. In conclusion, emergency SE management is evolving toward protocol-driven care emphasizing rapid benzodiazepine administration, flexible second-line agent selection, and the early use of ketamine. Future research must prioritize RCTs in super-refractory SE and investigate long-term functional outcomes. Keywords: Status Epilepticus, Emergency Treatment, Refractory Status Epilepticus, Levetiracetam, Ketamine.