Early Polytherapy for Probably Benzodiazepine-Refractory Status Epilepticus (Stage 1 Plus)

Stage 1 Plus is defined here as a naïve Status Epilepticus (SE) that is probably refractory to Benzodiazepines (BDZ). These cases include not only Prolonged SE as previously proposed by the author (SE lasting > 10 minutes) but also other cases notoriously associated with BDZ refractoriness such as the absence of prominent motor phenomena and acute etiology (especially in primary central nervous system etiology). Interestingly, the absence of prominent motor phenomena as is the case of Non-Convulsive SE might implicitly fall in the category of prolonged SE as per delay in recognition and treatment. Future studies should help identify other factors associated with BDZ refractoriness, therefore widening the definition of Stage 1 Plus. These cases of naïve SE might require a different approach: combined polytherapy from the start.