Convulsive status epilepticus (CSE) is the most common neurological medical emergency and continues to be associated with significant morbidity and mortality. Our approach to the epilepsies in childhood has been clarified by the broad separation into benign and malignant syndromes. The factors that suggest a poorer outcome in terms of seizures, cognition, and behaviour include the presence of multiple seizure types, an additional, particularly cognitive disability, the presence of identifiable cerebral pathology, a high rate of seizures, an early age of onset, poor response to antiepileptic drugs, and the occurrence of CSE.1

Convulsive status epilepticus is not a syndrome in the same sense as febrile convulsions, benign rolandic epilepsy, and infantile polymorphic epilepsy. These latter disorders have a tight age frame, seizure semiology, and a reasonably predictable outcome. Episodes of CSE can occur in each: occasionally in febrile convulsions, rarely in benign rolandic epilepsy, and often in infantile polymorphic epilepsy. The issue of whether episodes of status epilepticus are intrinsically more dangerous in the malignant syndromes needs consideration before we accept global figures for CSE outcome, and we need to separate the immediate outcome of CSE from the eventual outcome, which may be heavily influenced by the context or syndrome in which it occurs.

In practical management we are likely to want to stop prolonged seizures as soon as possible, but in theoretical terms it may be important to know if some causes of CSE are intrinsically more dangerous. The paediatric dimension to CSE is therefore of many different causes and occurring in a patient who is less likely to have concomitant cardiovascular or respiratory disease. The hazards and outcome might be different. This paper reviews advances in the pathophysiology and consequences of CSE with special reference to age related phenomena.