Treatment-resistant epilepsy

Treatment-resistant epilepsy is epilepsy in which seizures continue despite adequate trials of at least two appropriately chosen and tolerated anti-seizure medications.

Also called drug-resistant or refractory epilepsy, it affects roughly a third of people with epilepsy and is more common in certain syndromes, in epilepsy with a structural brain cause and in those whose seizures began in early childhood. Ongoing seizures carry risks of injury, cognitive effects, reduced quality of life and sudden unexpected death in epilepsy, so the diagnosis prompts referral to a specialist center.

Evaluation at an epilepsy center includes prolonged video-EEG monitoring, high-resolution MRI and neuropsychological testing to confirm the diagnosis, identify the seizure focus and consider surgery, neurostimulation devices or dietary therapy. A purified prescription cannabidiol is approved by the U.S. Food and Drug Administration for seizures in three specific syndromes, and research on cannabinoids in other forms of drug-resistant epilepsy is ongoing and not conclusive.