Methods, system and apparatus for identifying an extreme epileptic state/event in a patient are provided. In one aspect, at least two seizure events are identified. At least one inter-seizure interval (ISI) value related to the at least two seizure events are determined. The ISI value is compared to at least one reference value. An occurrence of an extreme seizure event is determined based upon the comparison of the determined ISI value to the at least one reference value. In another aspect, a first seizure event is detected. At least one body index affected by the first seizure event is determined. A second seizure event is detected. An occurrence of an extreme seizure event is determined based at least in part in response to a determination that the second seizure event occurred prior to the body index value returning to a reference value.
