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It emphasizes “time is brain,” rapid benzodiazepine administration, then intravenous antiseizure medication, including Brazilian options phenytoin and levetiracetam. It further explains refractory and super-refractory stages, the role of induction of therapeutic coma with IV anesthetics, and the need for clinical judgment where randomized trials are lacking.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/treatment-of-convulsive-status-epilepticus-in-brazil-a-review/435843/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/treatment-of-convulsive-status-epilepticus-in-brazil-a-review/435843.png","ImageObject",300,407,{"name":92,"@type":93},"Jiven","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How are time points used to define and manage convulsive status epilepticus?","Question",{"text":113,"@type":114},"SE is framed by two time points: time 1 (5 minutes) indicates spontaneous resolution becomes unlikely, and time 2 (30 minutes) marks a higher likelihood of long-term consequences. Treatment should start at time 1 with enough intensity to prevent prolongation to time 2.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What is the recommended initial treatment sequence for convulsive SE after clinical stabilization?",{"text":118,"@type":114},"After stabilization, the first step is administration of intravenous benzodiazepines. Next, treatment continues with an intravenous antiseizure medication (ASM), where rapid initiation and appropriate dosing are emphasized over choosing a specific benzodiazepine.",{"name":120,"@type":111,"acceptedAnswer":121},"What differentiates refractory and super-refractory convulsive SE, and how is treatment guided when evidence is limited?",{"text":122,"@type":114},"Refractory SE persists after benzodiazepines and intravenous ASM. Super-refractory SE persists despite continuous infusion of IV anesthetic drugs or recurs after they are tapered. In the absence of randomized trials, management should rely on physician experience, clinical judgment, and previously established therapeutic options.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},435843,1790794104,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1099513958607,"https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399","Article published online: 2025-02-11  \nView and Review 1  \nTreatment of convulsive status epilepticus in Brazil: a review  \nLuis Otavio Caboclo 1  \n1 Hospital Israelita Albert Einstein, São Paulo SP, Brazil.  \nArq. Neuro-Psiquiatr. 2025;83(1):s00451801872 .  \nAddress for correspondence Luis Otavio Caboclo (email: [luisotaviocaboclo@gmail.com](luisotaviocaboclo@gmail.com))  \nAbstract  \nKeywords  \n► Status Epilepticus  \n► Refractory  \n► Super-Refractory  \n► Antiseizure Medications  \nStatus epilepticus (SE) is the most severe presentation of epilepsy. Currently, SE is defined according to 2 sequential time frames: time 1, after which it is unlikely that the seizure will resolve spontaneously, therefore requiring the initiation of therapy; and time 2, when long-term consequences become more likely. For convulsive SE, these time frames are well defined: 5 minutes for time 1 and 30 minutes for time 2 .“Time is brain” in the treatment of SE, as delays in diagnosis and treatment are associated with worse outcomes. After clinical stabilization, the first step is the administration of intravenous (IV) benzodiazepines. Rapid initiation of treatment and use of appropriate dosing are more important than the selection of a specific benzodiazepine. Following this, treatment continues with the use of an IV antiseizure medication (ASM) . In Brazil, the recommended options available are phenytoin and levetiracetam. Status epilepticus is considered refractory to treatment if seizures persist after the administration of benzodiazepines and IV ASM. The cornerstone of this stage is the induction of therapeutic coma using IV anesthetic drugs (IVADs), although evidence is limited regarding the choice among midazolam, propofol, or barbiturates. Super-refractory SE is defined when seizures persist despite continuous infusion of IVADs or recur after these drugs are tapered. There is very limited data regarding the treatment of superrefractory SE. In the absence of randomized controlled trials, treatment should be guided by the physician’s experience, clinical judgment, and established therapeutic options from previous reports.  \nINTRODUCTION  \nStatus epilepticus (SE) is considered the most extreme form of seizure and the most severe presentation of epilepsy. It consists in abnormally-prolonged or recurrent seizures without recovery of the baseline status between them. Previous classifications of seizures defined SE as a seizure that “persists for a sufficient length of time or is repeated  \nreceived  \nNovember 11, 2024 received in its final form December 9, 2024 accepted  \nDecember 10, 2024  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1801872 . ISSN 0004-282X  \nEditor-in-Chief: Ayrton Roberto Massaro.  \nAssociate Editor: Hélio A. G. Teive.  \nfrequently enough that recovery between attacks does not occur.”1 More recently, SE has been defined considering two distinct time frames, which will be discussed in the following sections.  \nStatus epilepticus affects all age groups, though with different etiologies and outcomes. It causes higher mortality and morbidity in elderly people, while it has better outcomesin children and adolescents.  \n© 2025 . The Author(s) .  \nThis is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)).  \nThieme Revinter Publicações Ltda., Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil  \n2 Treatment of convulsive status epilepticus in Brazil Caboclo  \nDEFINITION  \nStatus epilepticus has long been defined as abnormallyprolonged or recurrent seizures.2 In 2015, the International League Against Epilepsy (ILAE) Task Force on Classification of Status Epilepticus published a definition and classification of SE.3 According to the current ILAE proposal, SE i","cbCaichmgRJP7Tyf","https://ap.wps.com/l/cbCaichmgRJP7Tyf","pdf",741430,"English","# Abstract\n# Keywords\n# Introduction\n# Definition","[{\"question\":\"How are time points used to define and manage convulsive status epilepticus?\",\"answer\":\"SE is framed by two time points: time 1 (5 minutes) indicates spontaneous resolution becomes unlikely, and time 2 (30 minutes) marks a higher likelihood of long-term consequences. Treatment should start at time 1 with enough intensity to prevent prolongation to time 2.\"},{\"question\":\"What is the recommended initial treatment sequence for convulsive SE after clinical stabilization?\",\"answer\":\"After stabilization, the first step is administration of intravenous benzodiazepines. Next, treatment continues with an intravenous antiseizure medication (ASM), where rapid initiation and appropriate dosing are emphasized over choosing a specific benzodiazepine.\"},{\"question\":\"What differentiates refractory and super-refractory convulsive SE, and how is treatment guided when evidence is limited?\",\"answer\":\"Refractory SE persists after benzodiazepines and intravenous ASM. Super-refractory SE persists despite continuous infusion of IV anesthetic drugs or recurs after they are tapered. In the absence of randomized trials, management should rely on physician experience, clinical judgment, and previously established therapeutic options.\"}]","Treatment of convulsive status epilepticus in Brazil - a review | PDF",1790675544,25]