title: Drug-resistant epilepsy: definition and treatment alternatives.
abstract: BACKGROUND
  Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate.
  
  
  METHODS
  PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions.
  
  
  CONCLUSIONS
  Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.
authors: Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España. Electronic address: javieritol@yahoo.com.
authors: F J
authors: FJ
authors: López González
authors: Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España.
authors: X
authors: X
authors: Rodríguez Osorio
authors: Hospital Rúber Internacional, Madrid, España.
authors: A
authors: A
authors: Gil-Nagel Rein
authors: Hospital Clínic, Barcelona, España.
authors: M
authors: M
authors: Carreño Martínez
authors: Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
authors: J
authors: J
authors: Serratosa Fernández
authors: Hospital Universitario La Fe, Valencia, España.
authors: V
authors: V
authors: Villanueva Haba
authors: Hospital Clínic, Barcelona, España.
authors: A J
authors: AJ
authors: Donaire Pedraza
authors: Hospital Regional Universitario Carlos Haya, Málaga, España.
authors: J M
authors: JM
authors: Mercadé Cerdá
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D046690:Deep Brain Stimulation; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy / Q000601:surgery*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D012640:Seizures / Q000517:prevention & control
chemical_list: D000927:Anticonvulsants
keywords: Cirugía epilepsia; Deep brain stimulation; Dieta cetógena; Drug-resistant epilepsy; Epilepsia refractaria; Epilepsy surgery; Estimulación cerebral profunda; Estimulación vagal; Ketogenic diet; Politerapia racional; Rational combination therapy; Vagus nerve stimulation