Epidemiology The estimated incidence of 35 per 100,000, more common in poorer populations 1. It is a clinical emergency associated with high morbidity and mortality. The paucity of ICUs in developing countries limits the use of these management protocols. Status epilepticus is an acute and prolonged seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. Recently, concerns have been raised on the safety of burst suppression in RSE and SRSE. Complications caused by status epilepticus are common, even in patients with clinically evident seizures who receive rapid treatment. In RSE patients, electroencephalogram (EEG) burst suppression with interburst interval of 2-20 s or even flat EEG has been tried. Most intravenous anesthetic drugs produce hypotension and respiratory suppression therefore, patients with RSE are managed in intensive care units (ICUs). Following benzodiazepines, the second line antiepileptic drugs include sodium valproate, phenytoin, levetiracetam, and anesthetic drugs such as midazolam, phenobarbital, and propofol. The treatment of RSE and SRSE is not evidence based. The etiology of RSE in developing countries is dominated by central nervous system (CNS) infections and head injury compared to stroke and drug withdrawal in the developed countries. In general, RSE occurs in patients with new-onset seizures rather than in patients with chronic epilepsy. RSE occurs in 23%-48% of the patients and SRSE in approximately 22% of the patients with SE. Super refractory SE (SRSE) is defined as SE that continues for 24 hours or more after the use of anesthetic therapy, including cases that recur on weaning of the anesthestic agent. Refractory SE (RSE) is defined as SE persisting despite sufficient dose of benzodiazepines and at least one antiepileptic drug (AED), irrespective of time. Once intubation and mechanical ventilation are established, the outcome is primarily related to the underlying brain disease and the ability to control seizures. It is defined as seizures lasting for 5 minutes or more or recurrent seizures without recovery of consciousness to baseline between the attacks. Status epilepticus is a clinical expression of potentially severe brain disease and may threaten life through impairment of airway control and respiratory function. Status epilepticus (SE) is an important neurological emergency.