In spite of more than one century of clinical and scientific interest on status epilepticus, further definitions of semiological and etiopathogenetical aspects of this challenging condition are still required. Very recent papers proposed a new mode of classification with the aim to define the operational dimensions of status epilepticus and, of course, an appropriate treatment approach based on clinical and etiopathogenetical criteria. Nevertheless, it remains one of the most common neurological emergencies worldwide, and, its pharmacotherapy still represents an "evidence-free zone" because of lack of controlled trials supporting clinical management. Herein, we reviewed the physiopathology of status epilepticus, from the first descriptions to the more recent data on specific immuno-inflammatory patterns and microglial activation. Moreover, the mostly reported criteria of classification and their pharmacological implications were summarized. Treatment stepwise approaches were also sistematically reviewed.