The historical evolution of, and the paradigms shifts in, the therapy of convulsive status epilepticus over the past 150 years.

The evolution of the treatment of convulsive status epilepticus since the mid- nineteenth century is outlined. Therapy has been advanced not only by the use of new drugs, but also by advances in the approach to therapy. The major pharmacologic developments were the introductions of bromide, anesthetics, barbiturate, phenytoin, paraldehyde, chlormethiazole, and the benzodiazepines. Throughout this period, the emphasis of therapy was on "sedation" and anesthesia, and the development of technologies for safe anesthesia in the postwar years were an important step. Since 1970, changes to the approach to therapy have been more important than any pharmacologic advance, and it is only recently that new drugs have been introduced into the therapy of status epilepticus. We may now be on the threshold of significant new paradigm shifts.