The physiological compromise described above results, if unchecked, in neuronal damage. Furthermore, as shown in classic animal experiments in the 1970s and 1980s, neuronal damage can occur even without the systemic disturbance associated with status epilepticus.21 This neuronal damage is solely dependent upon the presence of electrographic seizure activity, and is due to "excitotoxicity".22 In both animal models and humans, the degree of excitotoxic neuronal damage relates to the duration of electrographic status epilepticus.23-25 The occurrence of excitotoxic neuronal damage emphasises the importance of aggressively treating electrographic status epilepticus, which can occur in the absence of clinical signs of seizure activity, especially in the later stages of status epilepticus or if paralysing agents have been used.

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