Drug-Resistant Epilepsy

Epilepsy in which adequate trials of two tolerated, appropriately chosen antiseizure medication schedules fail to achieve sustained seizure freedom. It may respond to non-medication treatments.

Epilepsy surgery: Procedures that remove or disconnect brain tissue responsible for seizures. Resection can stop seizures when they arise from a safely removable brain region.
Antiseizure medication: A medicine used to reduce the likelihood or severity of epileptic seizures. Resistance is defined by failure of appropriately selected medication schedules.
Focal seizure: An epileptic seizure that begins in networks limited to one cerebral hemisphere. Focal onset can make localized surgical treatment possible despite medication failure.
Sudden unexpected death in epilepsy: A sudden, unexplained death in a person with epilepsy, not caused by trauma or drowning. Ongoing generalized tonic-clonic seizures are a major risk factor.
Pharmacoresistance: Failure of a disease or condition to respond adequately to medication. Epilepsy is one setting for the broader problem of pharmacoresistance.
Vagus nerve stimulation: A treatment that periodically stimulates the vagus nerve through an implanted device to reduce seizure burden. It offers neuromodulation when resection is unsuitable or seizures persist.
International League Against Epilepsy: An international professional organization that develops standards and classifications for epilepsy. Its definition specifies when treatment failure qualifies as drug resistance.
Generalized seizure: An epileptic seizure that begins in networks distributed across both cerebral hemispheres. Generalized onset affects medication selection and often changes surgical options.
Status epilepticus: A seizure lasting unusually long or repeated seizures without recovery between them. Drug-resistant epilepsy can complicate seizure emergencies and their prevention.
Drug transporter hypothesis: The hypothesis that increased drug transport out of the brain can reduce medication concentrations at seizure sites. It proposes one possible mechanism for antiseizure medication failure.

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