Status epilepticus is a neurologic emergency and a systemic physiologic emergency. The longer seizures continue, the harder they become to stop and the more secondary injury accumulates.
Early status epilepticus may be driven by excessive excitatory signaling and impaired inhibition. Over time, receptor trafficking and cellular changes make seizures more resistant to benzodiazepines. This is why time matters. Benzodiazepines are first-line therapy because they enhance GABAergic inhibition. Under-dosing benzodiazepines is a common failure point.
If seizures continue, second-line antiseizure medications should follow promptly. Options include levetiracetam, fosphenytoin, valproate, or other agents depending on context, contraindications, pregnancy status, liver disease, drug interactions, and local protocols. Persistent seizures create systemic injury.