Status Epilepticus: An Evidence-Based Review of Mechanisms, Emergency Care, Rehabilitation, Treatment Lines, and Psychosocial Support for Health Assistants and Social Assistants

Abstract

Background: Status epilepticus (SE) is a neurological emergency characterized by prolonged seizure activity resulting from failure of normal seizure termination mechanisms. Delayed treatment increases the risk of permanent neuronal injury, systemic complications, cognitive impairment, and mortality. Recent advances have improved understanding of the molecular mechanisms, treatment strategies, and long-term outcomes associated with SE. Aim: This review aimed to summarize current evidence regarding the pathophysiology, emergency management, treatment algorithms, rehabilitation, and psychosocial support for patients with status epilepticus, with particular emphasis on the roles of health assistants and social assistants in multidisciplinary care. Methods: An evidence-based narrative review was conducted using findings from experimental studies, prospective clinical investigations, epidemiological research, randomized clinical trials, and contemporary international treatment guidelines. The review integrates current knowledge on neurotransmitter alterations, receptor trafficking, metabolic dysfunction, seizure propagation, pharmacological management, and rehabilitation strategies. Results: Prolonged seizures produce progressive impairment of GABAergic inhibition, enhanced glutamatergic excitation, disrupted chloride homeostasis, receptor remodeling, and widespread neuronal network activation, leading to pharmacoresistance and neuronal injury. Early benzodiazepine administration remains the cornerstone of treatment, followed by levetiracetam, fosphenytoin, or valproate for established SE. Emerging evidence supports rational polytherapy targeting multiple molecular pathways and highlights potential roles for ketamine, neurosteroids, and metabolic therapies in refractory cases. Conclusion: Status epilepticus requires immediate evidence-based intervention supported by coordinated multidisciplinary management. Advances in understanding its molecular mechanisms continue to guide development of targeted therapies, while integrating acute treatment with rehabilitation and psychosocial care offers the greatest opportunity to reduce mortality, neurological disability, and long-term disease burden.