This chapter discusses the diagnosis, evaluation and management of status epilepticus. Seizures, which may be the result of central nervous system (CNS) infection, require early and empiric antibiotics, antivirals, and possibly steroids, ideally before lumbar puncture is performed. Seizures may require additional treatment and can be refractory to first-line agents (i.e., benzodiazepines) and second-line agents (i.e., phenytoin, phenobarbital, and valproate). If seizures are refractory to first- and second-line agents, levetiracetam or lacosamide, or induction with general anesthesia by inhalational anesthetics has to be considered. The most likely causes for sudden decompensation are airway compromise/respiratory failure, sepsis/septic shock, and recurrent seizure activity. Patients requiring multiple boluses of medications or continuous infusions should be considered for intubation for airway protection. Patients with an infectious etiology may rapidly progress to sepsis and require additional hemodynamic support. Prolonged seizure activity with or without overt muscle twitching is associated with increased mortality.