The arrival of benzodiazepines changed status epilepticus from an emergency with few rapidly acting medical options into one in which ongoing convulsive activity could often be interrupted pharmacologically within minutes.
Before the benzodiazepine era
Status epilepticus had long been recognised, but treatment was inconsistent and often slow. Sedatives, anaesthetic agents and older anticonvulsants were used without the fast first-line strategy familiar today.
Diazepam changes emergency care
Diazepam became available in the 1960s. Its rapid central nervous system action made it especially suitable for acute seizures and status epilepticus. Historical reviews describe its introduction as the beginning of the modern therapeutic era for this neurological emergency.
Lorazepam and later comparisons
Lorazepam later became an important intravenous alternative. Comparative studies explored whether its pharmacokinetic profile could provide more sustained seizure control. Modern practice does not reduce the history to a single universally best benzodiazepine because route, age, availability and national protocol matter.
From hospital to community rescue
Rectal diazepam, buccal or intranasal midazolam and other rescue formulations allowed some prolonged or repeated seizures to be treated earlier in homes, schools and community settings when prescribed within an individual plan.
A lasting legacy
More than half a century after diazepam entered practice, benzodiazepines remain first-line medicines for convulsive status epilepticus in major guidelines worldwide.
Related reading
Sources and further reading
- The impact of diazepam’s discovery on status epilepticus
- Brief history of anti-seizure drug development
- Diazepam versus lorazepam meta-analysis
Evidence checked: September 2026.