Refractory epilepsy is a seizure disorder that resists drug treatment, but there is debate about how to define it. Patients with this condition may benefit from exploring alternative treatments with an epilepsy specialist.
Refractory epilepsy is a seizure disorder that resists drug treatment. There is some debate among clinicians and researchers about how to define refractory epilepsy. As a result, this term is used in a variety of ways and when a patient’s epilepsy is described as refractory, resistant or unresponsive, it may be advisable to ask for more details on what the diagnosis means. This will help the patient understand the conclusions drawn by a healthcare professional.
Seizures are not uncommon in the general population. People may experience a single attack once and never again, especially in early childhood. In other people, the seizures turn into epilepsy, a disorder that comes in many forms. Epilepsy is classified according to the types of seizures the person experiences and can also be classified according to the response to treatment.
In some patients, seizures persist despite the use of several antiepileptic drugs. In these cases, the patient is said to have refractory epilepsy. Some doctors apply this diagnosis when the patient experiences a single seizure relapse within a specified period of time. Others can diagnose a patient with refractory epilepsy if no obvious differences are seen between the medications. If a patient experiences fewer seizures while taking medication, the patient will not be viewed as a non-responder because he or she is actually responding, albeit imperfectly, to the medication.
It is possible for a patient with refractory epilepsy to begin responding to medications and improve. Conversely, patients who are doing well on medications may relapse and develop refractory epilepsy. Treatment of patients with epilepsy is complicated by non-compliance with drug regimens. A patient who does not take medication as directed may have seizures, and if the patient is not honest about the noncompliance, the physician may be led to believe that the patient has refractory epilepsy.
People with early onset of seizures, developmental delays, abnormal neurological exams, clustering of seizures, and several cycles of seizures before treatment begins are at higher risk for refractory epilepsy. Patients with epilepsy who are unresponsive to drug treatment may be candidates for treatments such as a ketogenic diet, epilepsy surgery, or vagus nerve stimulation. These treatments can be explored as possible options once it becomes apparent that a patient is not responding to multiple AEDs. Usually such patients attend seizure clinics and receive treatment from an epilepsy specialist who can provide access to the latest research and treatment options.
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