Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.
To improve patient care and facilitate clinical research, the International League Against Epilepsy (ILAE) appointed a Task Force to formulate a consensus definition of drug resistant epilepsy. The overall framework of the definition has two "hierarchical" levels: Level 1 provides a general scheme to categorize response to each therapeutic intervention, including a minimum dataset of knowledge about the intervention that would be needed; Level 2 provides a core definition of drug resistant epilepsy using a set of essential criteria based on the categorization of response (from Level 1) to trials of antiepileptic drugs. It is proposed as a testable hypothesis that drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. This definition can be further refined when new evidence emerges. The rationale behind the definition and the principles governing its proper use are discussed, and examples to illustrate its application in clinical practice are provided.
Kwan
Patrick
P
Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. patrickkwan@cuhk.edu.hk
Arzimanoglou
Alexis
A
Berg
Anne T
AT
Brodie
Martin J
MJ
Allen Hauser
W
W
Mathern
Gary
G
Moshé
Solomon L
SL
Perucca
Emilio
E
Wiebe
Samuel
S
French
Jacqueline
J
D026683:Advisory Committees; D000927:Anticonvulsants / Q000627:therapeutic use*; D032921:Consensus; D004351:Drug Resistance; D004827:Epilepsy / Q000145:classification* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D038622:Internationality; D016896:Treatment Outcome
D000927:Anticonvulsants