Narrative review explores diagnostic controversies between status epilepticus and ictal-interictal continuum

This narrative review explores the diagnostic and therapeutic controversies surrounding the boundaries between status epilepticus (SE) and the ictal-interictal continuum (IIC). The review examines how the IIC challenges traditional EEG classification systems, creating a significant zone of uncertainty in clinical practice. Key areas of debate include the interpretation of ictality, assessment of treatment responsiveness, and evaluation of neuronal injury risk in these ambiguous EEG patterns.

The review does not report primary research findings, effect sizes, or statistical measures. No specific study population, sample size, intervention, comparator, or outcomes are detailed. The analysis focuses on summarizing existing controversies and paradoxes in the literature rather than presenting new data.

No safety or tolerability information is reported. The review acknowledges that the boundaries between SE and IIC remain uncertain and controversial, representing a major gap in current knowledge. Limitations include the narrative nature of the review and the absence of primary data or quantitative synthesis.

For clinical practice, this review highlights the persistent diagnostic challenges in distinguishing SE from IIC patterns. It underscores the need for cautious interpretation of ambiguous EEG findings and recognition of current knowledge gaps. The review serves as a summary of ongoing debates rather than providing definitive guidance.