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Management of Drug-Resistant Epilepsy

Nair, Dileep R. MD

CONTINUUM: Lifelong Learning in Neurology: February 2016 - Volume 22 - Issue 1, Epilepsy - p 157–172
doi: 10.1212/CON.0000000000000297
Review Articles

ABSTRACT Purpose of Review: This review discusses the definition, evaluation, and management of patients with drug-resistant epilepsy.

Recent Findings: Drug-resistant epilepsy is defined as a failure of two or more appropriately selected and adequately tried anticonvulsant medications to achieve seizure freedom for a sustained period of time in either monotherapy or polytherapy. Once this definition has been met, the likelihood that further medication trials will lead to seizure freedom is in the range of 5% to 10%. Reasons for pseudoresistance to anticonvulsant therapy include wrong diagnosis, wrong drug, wrong dose, or poor compliance. Patients with epilepsy who are drug resistant should be referred to an epilepsy center for a surgical evaluation or more specialized care. The odds of being seizure free following epilepsy surgery versus continued medications are around 4 to 3. Currently, surgical referrals occur late in the disease.

Summary: Determination of drug-resistant epilepsy and referral to an epilepsy surgical center can be expedited to avoid exposing patients to continued seizures and the resultant morbidity.

Address correspondence to Dr Dileep R. Nair, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, naird@ccf.org.

Relationship Disclosure: Dr Nair serves as a consultant for Brain Sentinel and has received personal compensation for speaking engagements from NeuroPace, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Nair discusses the unlabeled/investigational use of cannabinoids in the treatment of epilepsy.

© 2016 American Academy of Neurology
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