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Yet this pragmatic framework does not fully capture the biological heterogeneity apparent at first clinical evaluation. Some patients are treatment\u2010naive but may already be at increased risk of early BDZ failure, because duration, semiology, etiology, or delayed recognition have moved the disorder into a less responsive state, in the context of time\u2010dependent receptor trafficking and evolving pharmacoresistance. These presentations can be classified as Stage 1 Plus: a semiology\u2010 and etiology\u2010based framework for a likely BDZ\u2010resistant, high\u2010risk phase of SE in which early polytherapy may be warranted. It includes prolonged SE (defined by semiology\u2010adapted thresholds), nonconvulsive SE with coma, and acute symptomatic SE due to primary central nervous system disorders. 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