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How do I know if I have drug resistant epilepsy?

Jerome Engel, MD
Neurology

Drug resistant epilepsy, also called medically refractory epilepsy and pharmacoresistant epilepsy, means that epileptic seizures can not be controlled by available antiseizure drugs. Approximately 4-in-10 people with epilepsy have epileptic seizures that continue despite antiseizure drug treatment.  There are so many available antiseizure drugs that it would take a lifetime to try them all and be sure that none are effective, so this is not a practical way to determine if your epileptic seizures are drug resistant. Consequently, the International League Against Epilepsy has defined drug resistant epilepsy as:

“failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom.”

This means that a practical diagnosis of drug resistant epilepsy can be made if you still have epileptic seizures after trying two appropriate antiseizure drugs, either alone or in combination.  Studies have shown that, in this situation, there is only about a 3 percent chance that a third antiseizure drug will control your seizures.  If, after two trials of antiseizure drugs, you still have epileptic seizures that are interfering with work, school, or interpersonal relationships, it is important to seek a consultation at a specialized epilepsy center where advanced diagnostic testing may determine that you do not have drug resistant epilepsy.  For instance: your seizures may be nonepileptic; you may have been given the wrong epilepsy diagnosis so the wrong antiseizure drugs were prescribed; you may need much higher doses of drugs; you may be taking your drugs incorrectly or they may not be absorbed properly; or you may have lifestyle habits that provoke your seizures.  If testing at an epilepsy center confirms that your epileptic seizures are drug resistant, there are many alternative treatments that might be considered, including new experimental antiseizure drugs, vagus nerve stimulation, the ketogenic diet, behavioral therapy, and surgical procedures which can eliminate all disabling seizures in carefully chosen patients.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.