L’état de mal épileptique, this most extreme manifestation of the sacred disease, is still a major medical emergency and a major unresolved therapeutic problem, with a mortality of 27% in adults and a formidable array of medical and neurological sequellae. We have learned to control the fever and many of the metabolic complications that were so often fatal in earlier times, yet this condition remains poorly understood and still extolls an unacceptably high price from its victims.

The first large meeting on status epilepticus was the tenth “Colloque de Marseilles” in 1962, which emphasized electroclinical description and classification. The Santa Monica meeting in 1980 brought basic science into the clinical picture, and the second international Santa Monica meeting in 1997 focused on mechanisms and management.

Interest in status epilepticus has exploded in the past 20 years: while Shorvon found 370 publications on status epilepticus from 1965 to 1978, a PubMed search reveals 4227 publications on status epilepticus since 1979, including 1761 in the past five years. Because more than 20 years have passed since the publication of the first multiauthored book on status epilepticus and more than 10 years have passed since Shorvon's beautiful monograph, there was a need for a comprehensive review of the considerable progress made in the last decade. The current book attempts this daunting task, but because the field has expanded so much in the past 10 years, it focuses on the two areas in which progress has been most rapid, namely basic mechanisms and treatment. Coverage of other areas of the field of status epilepticus is selective, rather than comprehensive.

In the area of basic mechanisms, we have seen the emergence of a concept of what status epilepticus is and how it differs from serial or grouped seizures. With this has come an understanding of some of the complications of status epilepticus at the molecular level, and this should eventually lead to improved therapy. Because of the realization that neuronal apoptosis and necrosis can be triggered very quickly and that status epilepticus–induced damage may be highly epileptogenic, treatment strategies today differ from those of yesteryear by their far greater sense of urgency, including prehospital administration of anticonvulsants whenever feasible and rapid induction of general anesthesia when seizures do not quickly abate with treatment. However, the number of agents available to treat status epilepticus has not kept pace with the rapid expansion of our therapeutic armamentarium for epilepsy.

The book is divided equally between studies of basic mechanisms in animal models and clinical studies, so that one can go from the reductionist experiment that isolates a small component of status to the complex clinical situation in which that component is a small and interactive part of a large array. Hopefully, this marriage of basic and clinical science will provide a scientific rationale for our clinical decisions and will help develop therapeutic attitudes that are firmly grounded in pathophysiology.

This book is aimed at the diverse medical groups that deal with status epilepticus in addition to the investigators who study it: emergency room physicians, intensivists, pediatricians, neurologists and pediatric neurologists, anesthesiologists, pharmacists, emergency room and intensive care unit nurses, and internists. We hope that it will bridge the gap between these disciplines and will renew interest in this complex clinical and experimental problem.