Management of Drug-Resistant Epilepsy.

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.