medicationrefractory

Medication refractory, also known as treatment resistant or refractory epilepsy, describes a condition where an individual continues to experience seizures despite trying at least two different anti-epileptic medications at appropriate doses and durations. This means that even after careful selection and administration of prescribed drugs, seizures persist with significant frequency or severity. It is important to distinguish medication refractory epilepsy from epilepsy that is poorly controlled due to issues like poor adherence to medication, incorrect diagnosis, or the presence of other underlying medical conditions.

The International League Against Epilepsy (ILAE) has established criteria for defining medication refractory epilepsy. These typically involve a history of inadequate response to at least two monotherapy or combination drug regimens. This lack of response can manifest as either insufficient reduction in seizure frequency or a failure to achieve complete seizure freedom. The assessment of medication refractory epilepsy requires a thorough medical history, neurological examination, and appropriate diagnostic tests such as electroencephalography (EEG) and magnetic resonance imaging (MRI).

When epilepsy is deemed medication refractory, treatment strategies often shift towards alternative options. These can include exploring different combinations of anti-epileptic drugs, considering ketogenic diets, or investigating surgical interventions like resective surgery or neuromodulation devices such as vagus nerve stimulation (VNS) or responsive neurostimulation (RNS). The goal remains to reduce seizure frequency and severity, improve quality of life, and minimize the potential risks and complications associated with uncontrolled seizures.