Drug-Resistant Seizures
Refractory Epilepsy
In this video, Dr. Fountain talks about drug-resistant seizures, previously called refractory epilepsy.
What does uncontrolled or drug-resistant seizures mean?
Drug-resistant epilepsy occurs when a person has failed to become (and stay) seizure free with adequate trials of two seizure medications (called ASMs). These seizure medications must have been chosen appropriately for the person’s seizure type, tolerated by the person, and tried alone or together with other seizure medications.
Drug-resistant epilepsy may also be referred to as "uncontrolled" or the outdated term, "refractory".
What are the reasons for uncontrolled seizures?
Seizures can be uncontrolled for four broad reasons:
- The diagnosis is wrong.
- The treatment is wrong.
- Despite the best treatment, triggers or lifestyle factors may affect seizure control.
- Properly diagnosed seizures do not respond to the best medical treatment.
Not all uncontrolled seizures are considered drug-resistant. For example:
- If the diagnosis is corrected and seizures can be brought under control with a different treatment, then they would not be considered drug-resistant.
- If triggers of lifestyle factors could be avoided or modified preventing breakthrough seizures, then medication therapy may work better. A person in this situation would not be considered drug-resistant, but different drug trials may be considered and non-drug treatments may be considered to help control seizures.
If the diagnosis is wrong, what’s causing the seizures?
Imagine coming home at night after too much partying, and finding yourself unable to unlock your front door. One possibility is that you are at the wrong house. Another is that you are using the wrong key. Or you really may be locked out. Perhaps someone inside has engaged the deadbolt. Drug-resistant epilepsy displays three similar categories.
An incorrect diagnosis of epilepsy, going to the wrong house, is more common than most people might think. One chart review study by Smith and colleagues in England found that 13% of patients referred for drug-resistant epilepsy did not have epilepsy. If seizures are not controlled, then a reasonable first question is: “Are the episodes really seizures?” A number of conditions can imitate seizures.
Resources
Epilepsy Centers
Epilepsy centers provide you with a team of specialists to help you diagnose your epilepsy and explore treatment options.
Epilepsy Medication
Find in-depth information on anti-seizure medications so you know what to ask your doctor.
Epilepsy and Seizures Helpline
Call our Epilepsy and Seizures Helpline and talk with an epilepsy information specialist or submit a question online.
Tools & Resources
Get information, tips, and more to help you manage your epilepsy.
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