When SE does not respond to treatment as expected, the clinician's attention should refocus along several lines:

• Is the diagnosis of SE correct?
• Has the underlying cause been correctly assessed? This is crucial, because SE is most likely to continue when trauma, hemorrhage, or infections such as encephalitis remain untreated.
• Have medications been given in adequate doses? (The 1000-mg standard phenytoin infusion may be insufficient, for example.)
• Have medications been adequately absorbed? Absorption can be a problem if there are difficulties with intravenous access or if the drug is given by another route.
• Has the SE recurred after successful treatment? This situation most often results from inadequate attention to maintenance levels of longer-acting anticonvulsants or lack of treatment of the underlying disease.

Adapted from: Drislane FW. Status epilepticus. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 149-172.
With permission from Elsevier (www.elsevier.com)
Reviewed and revised February 2004 by Thaddeus Walczak, MD, MINCEP® Epilepsy Care, Minneapolis, MN