Refractory or Drug Resistant Epilepsy










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Dr Haseeb Hassan
12 Jan, 2023
Refractory or Drug Resistant Epilepsy
Refractory or Drug Resistant Epilepsy

Refractory or Drug Resistant Epilepsy

In recent years Neuroscience has advanced amazingly. Research is continuing to find the optimum solution to relieve patients suffering from the most difficult conditions. Here our focus is on one such complicated condition called Refractory Epilepsy, commonly known as Difficult to treat Epilepsy or drug-resistant Epilepsy.

Epilepsy is perhaps one of the oldest recorded medical illnesses in history.It is a serious neurological disorder that affects around 50 million people worldwide. Almost 30% of epilepsy patients has Drug Resistant Epilepsy, which is associated with social isolation, dependent behavior, low marriage rates, unemployment, psychological issues and reduced quality of life. The drug resistant Epilepsy is the major reason for morbidity and mortality of person with epilepsy.

Epilepsy is usually treated with one or a combination of two or sometime more anti-seizure medicines. But one in three epilepsy patients suffer from Drug Resistant or Refractory Epilepsy when medications cannot control seizures. Adult or children anybody can have it. Seizures can last from a few seconds to a few minutes.

The symptoms are same as common epilepsy like:

  • Seizure/Convulsion
  • Black out
  • Loses control of one’s bowels or bladder
  • Stares blankly into space
  • Falls down suddenly
  • Gets stiff muscles
  • Bites the tongue

Diagnosis

 

  • Electroencephalogram
  • CT Scan
  • MRI

Some probable causes for drug resistant Epilepsy:

It is not well-established why and how epilepsy becomes drug resistant in some patients while others with seemingly identical seizure types and epilepsy syndromes can achieve seizure control with medication. Some of the reasons are:

  • If the diagnosis is wrong and this is not epilepsy – Research has shown that a person with epilepsy not responding to medications, may not have epilepsy. So, first step is to reconfirm the diagnosis.
  • Wrong medications – The epilepsy medications may be inappropriate for the type of epilepsy; dose can be sub-optimal or there may be other medications that patient is taking that interact with epilepsy medications. Some medications can worsen certain seizure types.
  • Poor compliance with medicine – There is high risk of seizure recurrence if dosage is missed or patient stops medications abruptly.

  • Some lifestyle factors may affect seizure control. Factors such as severe sleep deprivation  or excessive alcohol intake may limit how well medication works.

  • True refractory epilepsy: Sometimes seizures do not respond even to the best medical treatment.

Treatment options

Drug Resistant Epilepsy may be defined as poor seizure control despite accurate diagnosis and carefully monitored pharmacologic treatment.


Despite the introduction of new drugs, the problem of pharmaco-resistance has not been solved, although most of the new drugs have better safety profiles than those of older drugs.


Surgical treatment of epilepsy must be explored in patients having inadequate control of seizures. The patient having “focal epilepsy” and if there is lesion/ scar in small area of brain, surgical options can be considered. This option may not be suitable for all patients. (See Epilepsy surgery section)

Some other options

  • Ongoing trials of anti-seizure medications – To try medications having effect of different pathway of epilepsy
  • Dietary Therapy – Especially in pediatric epilepsies
  • Stimulation of Vagus nerve
  • Responsive Neuro-stimulation or Deep Brain Stimulation.

Which food can help?

 

A high-fat, low-carbohydrate and restricted protein diet, which is called Ketogenic diet  is beneficial in patients with some refractory Epilepsy. The efficacy of the ketogenic diet is variable. In general, its more effective in certain epilepsies of childhood. It needs monitoring to avoid complications of high fat diet under guidance of trained dietician.

 

 

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