When do we say seizures are refractory to medicines?

                                 When do we say seizures are refractory to medicines?

                                                        Nitin.K.Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065

 

Yesterday I saw a patient with medically refractory epilepsy in my office. As I took pains to explain to the family about refractory seizures, I realised that understanding the same can be difficult for a lay person. So in this post I shall talk about refractory seizures.

So what do I mean if I say a patient has medically refractory epilepsy or medically refractory seizure disorder? In simple words all I am saying is that the patient has a seizure disorder which has not shown an adequate response to anti-seizure medicines.

In most patients with epilepsy/ seizure disorder, adequate seizure control can be obtained by just one seizure medicine. By adequate control I mean no more seizures. No more seizures, the side-effects of the anti-seizure medication used are tolerable (if none that is the best): the patient is happy and I am happy. While good control of seizures can be obtained in the majority of patients, there are a few in whom the seizures are harder to control. You use one seizure medicine but the seizures still persist, you stop the first and use a second-still seizures, you try a third-same story. You start using 2 or more drugs together (at the same time) to try control the seizures. This is referred to as polytherapy or polypharmacy.  You can imagine what happens next. The patient is on 3 and at times more drugs, more side-effects, more drug-drug interaction and at times still poor seizure control. The patient feels miserable and I am not happy too. Such a patient has medically intractable epilepsy, seizures are refractory to medications.

So what can be done for a patient who has medically refractory epilepsy? Can we offer them something to control their seizures. I am happy to say yes. Patients with medically refractory epilepsy should be ideally seen in specialized epilepsy centers (comprehensive epilepsy centers).  These centers offer expertise: patients can be enrolled in trials of experimental drugs, other options like neurostimulation (vagus nerve stimulator) and finally epilepsy surgery can be explored (see my post on epilepsy surgery at http://braindiseases.info) .