Defining and overcoming the therapeutic obstacles in canine refractory status epilepticus

Status epilepticus (SE) can be effectively resolved if diagnosis and treatment are addressed at an early stage, although this is not always possible in clinical practice. If untreated, continuous seizure activity leads to refractory SE which does not respond to antiseizure medication. Although refractory SE is a life-threatening emergency, there is a lack of veterinary consensus on its appropriate management. Classical therapeutic approaches often fail to prevent the progression of SE. One of the main reasons for failure or inadequate response, is a lack of understanding of the fundamental progressive pathophysiology occurring during SE. If the therapeutic approach is focussed on the specific pathophysiologic alterations responsible for initiating and maintaining continuous seizure activity, SE could be successfully resolved during its early stages, preventing progression to a refractory state. The aim of this review is to detail the underlying pathophysiology of SE at its different temporal stages in order to determine a more effective therapeutic approach.