Identification and Treatment of Drug-Resistant Epilepsy

Ji Yeoun Yoo, MD; Fedor Panov, MD Epilepsy p. 362-380 April 2019, Vol.25, No.2 doi: 10.1212/CON.0000000000000710
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PURPOSE OF REVIEW: Drug-resistant epilepsy is a potentially life-threatening condition affecting one-third of people living with epilepsy. Despite existing evidence of improved outcomes in patients who received surgical treatment compared to continued medical treatment, epilepsy surgery remains underused in patients with drug-resistant epilepsy. This article discusses the gap between evidence and practice and common misconceptions about epilepsy surgery and reviews the current diagnostic and therapeutic surgical options.

RECENT FINDINGS: Three randomized controlled trials comparing the medical versus surgical treatment for patients with drug-resistant epilepsy have shown the superiority of surgery in controlling seizures and improving patients’ quality of life. In addition to resective surgery, neuromodulation through devices such as responsive neurostimulation and vagal nerve stimulation have also shown efficacy in seizure control that increases over time. Diagnostic and therapeutic surgical tools are tailored to the needs of each patient.

SUMMARY: Appropriate patients with drug-resistant epilepsy benefit more from epilepsy surgery than from continuing medical treatment. These patients should be referred to comprehensive epilepsy centers where a thorough presurgical workup and surgical options can be provided. The gap between evidence and practice can be bridged by education, community outreach, and providers’ earnest efforts to improve the quality of life of patients with epilepsy.

Address correspondence to Dr Ji Yeoun Yoo, Mount Sinai Hospital, 1468 Madison Ave, Annenberg Bldg 210, New York, NY 10029, jiyeoun.yoo@mssm.edu.

RELATIONSHIP DISCLOSURE: Dr Yoo has received publishing royalties from Elsevier for the book Rowan's Primer of EEG and has received personal compensation as a lecturer for the Korean Epilepsy Society and for serving on the advisory board of Zimmer Biomet. Dr Yoo has received research/grant support from the NeuroNEXT Program of the National Institutes of Health/National Institute of Neurological Disorders and Stroke. Dr Panov has received personal compensation as a consultant for NeuroPace, Inc and Zimmer Biomet.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Yoo and Panov report no disclosures.

© 2019 American Academy of Neurology