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
Raúl Alonso Avilés1,2, Cesáreo Fernández Alonso3, Félix González Martínez4, Manuel Liñán López5, en representación del Grupo de Trabajo de NeuroSEMES
Objective.
To update the available evidence on the management of all types of status epilepticus (SE) in hospital emergency departments (EDs) and prehospital emergency medical services (EMS).
Methods.
We conducted a systematic review following PRISMA 2020 methodology. A comprehensive search was conducted across biomedical databases (PubMed, Embase, Cochrane, Web of Science, and Spanish databases) from January 2015 through October 2025. Studies on treatment, validated prognostic scales, and multicenter registries of convulsive and nonconvulsive SE were included. Quality assessment was performed using GRADE and the Newcastle–Ottawa Scale.
Results.
A total of 47 studies were included. Benzodiazepines remain the first-line therapy (high certainty of evidence, GRADE). As second-line therapy, levetiracetam, phenytoin, and valproate showed comparable efficacy (50–60%; moderate certainty). The ESETT trial demonstrated no superiority among second-line antiseizure drugs. Spanish evidence includes the ACESUR Registry (664 patients) and the validated RACESUR (AUC 0.72) and ADAN scales (predictive accuracy 90.9%; 95% CI, 88.4–93.4), providing context-specific evidence for the Spanish healthcare system.
Conclusions.
SE management requires rapid sequential treatment with benzodiazepines followed by second-line antiseizure drugs. Comparable efficacy among second-line options allows individualized treatment. The Spanish RACESUR and ADAN scales are validated tools that facilitate risk stratification in emergency settings.
