Status epilepticus is a neurological emergency with significant mortality and morbidity. Refractory status epilepticus occurs when seizures persist despite the administration of the first two line medications, while super-refractory status is a seizure that persists despite the treatment with IV anesthetic or a status which does not stop after 24 hours in spite of the third line treatment. Refractory and super-refractory status epilepticus are associated with even worse prognosis. Status epilepticus is most often due to an acute symptomatic etiology. Autoimmune, infectious and paraneoplastic causes are particularly related to refractory and super-refractory cases. Pathophysiological changes in prolonged seizures support the continuation of epileptic activity. Therefore, the longer the seizure lasts it becomes less likely to end, while the response to the treatment becomes weaker and weaker. In addition to that, prolonged epileptic activity results in neuronal injury leaving permanent damage, as well as the increased risk of multiorgan failure. Epileptic status is categorized according to the level of impaired consciousness and the presence of motor symptoms. In refractory and super-refractory patients the loss of consciousness without prominent motor symptoms (non-convulsive SE) can be detected more often. EEG plays the main role in detecting seizures in most cases of non-convulsive SE that are otherwise hard to recognize. Continuous EEG monitoring is one of the key components in care for patients with refractory and super-refractory epileptic status. Despite numerous medications and other therapeutic options, the care of these patients is usually very challenging, with complications being the norm. NORSE stands out as a distinguished subgroup representing new-onset refractory epileptic status and is linked to an extremely poor prognosis. The aim of this paper is to summarize the definitions, etiology, semiology and pathophysiology, as well as the diagnostic and therapeutic approach in refractory and super-refractory status epilepticus and to illustrate this clinical problem with a case report from every-day practice.