Defining the end point of status epilepticus: A scoping review and framework for standardization

Status epilepticus (SE) is a life-threatening neurological emergency with consensus-driven definitions for onset but no standardized criteria for its end point. This gap creates uncertainty in research and clinical practice. We conducted a scoping review to evaluate how end points have been defined in SE research and to identify key areas of variability. Comprehensive searches of MEDLINE, Embase, and CENTRAL (Cochrane Central Registry of Controlled Trials; 1980-2025) yielded 3940 citations (1674 unique). After screening, 207 studies met the inclusion criteria and were charted using scoping review methodology (Preferred Reporting Items of Systematic Reviews and Meta-Analyses, extension for scoping reviews). Data were extracted on terminology, electroencephalography (EEG) use, temporal thresholds, and definitions of therapeutic success across retrospective and prospective designs. Five domains of heterogeneity were identified: (1) semantic terminology (e.g., "resolved," "controlled," "terminated," "cessation"); (2) EEG confirmation of the SE end point (reported in 54% of studies, with variable criteria); (3) whether time was included in defining the end point; (4) how quickly seizures were judged to have stopped, based on clinical signs, EEG findings, or both; and (5) how long seizure freedom had to be maintained to count as a successful end point. No consistent global or time-based patterns were identified, and overlapping terminology further limited comparison across studies. Despite established consensus definitions for SE onset, the end point remains variably defined, undermining methodological rigor and limiting cross-study synthesis. A unified, consensus-driven framework is urgently needed to standardize SE end points through the use of standard terminology and methodologies, thereby strengthening clinical trial design and facilitating regulatory evaluation of novel therapies.