Status epilepticus is a life-threatening neurological emergency that affects both adults and children. Approximately 36% of episodes of status epilepticus do not respond to the current preferred first-line treatment, benzodiazepines. The proportion of episodes that are refractory to benzodiazepines is higher in low-income and middle-income countries (LMICs) than in high-income countries (HICs). Evidence suggests that longer episodes of status epilepticus alter brain physiology, thereby contributing to the emergence of benzodiazepine resistance. Such changes include alterations in GABA_A receptor function and in the transmembrane gradient for chloride, both of which erode the ability of benzodiazepines to enhance inhibitory synaptic signalling. Often, current management guidelines for status epilepticus do not account for these duration-related changes in pathophysiology, which might differentially impact individuals in LMICs, where the average time taken to reach medical attention is longer than in HICs. In this Perspective article, we aim to combine clinical insights and the latest evidence from basic science to inspire a new, context-specific approach to efficiently managing status epilepticus.

癫痫持续状态是一种危及生命的神经系统急症，影响成人和儿童。大约 36% 的癫痫持续状态发作对当前首选的一线治疗苯二氮卓类药物没有反应。低收入和中等收入国家 (LMIC) 对苯二氮卓类药物难治的发作比例高于高收入国家 (HIC)。有证据表明，较长的癫痫持续状态会改变大脑生理，从而导致苯二氮卓类药物耐药性的出现。这些变化包括 GABA _{A 的变化}受体功能和氯离子的跨膜梯度，这两者都会削弱苯二氮卓类药物增强抑制性突触信号传导的能力。通常，当前的癫痫持续状态管理指南没有考虑这些与持续时间相关的病理生理学变化，这可能会对 LMIC 中的个体产生不同的影响，其中到达医疗护理的平均时间比 HIC 长。在这篇 Perspective 文章中，我们旨在将临床见解和来自基础科学的最新证据结合起来，以激发一种新的、针对具体情况的方法来有效管理癫痫持续状态。