title: [Refractory epilepsy].
abstract: DRUG-RESISTANCE: Partial epilepsies are more often drug-resistant than generalized epilepsies, excepting severe syndromes which often begin in childhood. There is no need to try all anti-epileptic drugs before concluding as to the drug-resistant nature of the seizures. Refractory epilepsy can be diagnosed if well-conducted therapy (two alternative single-drug regimens with classical anti-seizure drugs and 1 or 2 trials with a two-drug regimen using new-generation compounds) is unsuccessful. MECHANISMS OF DRUG-RESISTANCE: The clinician should revisit the entire clinical history in patients with apparently refractory epilepsy, evaluating the treatments and the specific manifestations of the seizures. Conducted in a specialized center, this reassessment can recognize false cases of drug resistance such as non-epilepsy-related malaise or syncopes, inadequate regimens, or psychogenic "pseudo-seizures" which can be observed in patients with authentic epilepsy. Video-coupled EEG and ambulatory EEG may offer very useful information. SEVERAL EFFECTIVE THERAPEUTIC OPTIONS: Prognosis depends on effective and early control of seizures. This implies entertaining surgical excision of the epileptogenic focus early in the disease course. With several promising anti-epilepsy drugs, either recently marketed or under development, therapeutic indications in epilepsy should progress to more evidence-based prescriptions adapted to the type of epilepsy and the underlying cause.
authors.affiliation: Service de Neurophysiologie Clinique, Hôpital Sainte-Anne, Paris. gueguen@chsa.broca.inserm.fr
authors.forename: B
authors.initials: B
authors.lastname: Gueguen
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple; D004569:Electroencephalography; D004827:Epilepsy / Q000145:classification* / Q000188:drug therapy; D019317:Evidence-Based Medicine; D006801:Humans; D011379:Prognosis; D012640:Seizures / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants