Intractable epilepsy, also called drug-resistant, uncontrolled, or refractory, epilepsy, is when recurrent seizures cannot be fully controlled by medications. This happens in approximately one-third of cases, and often negatively impacts the affected individual’s quality of life.
There are multiple items that must be ruled out in order to determine if a person’s seizures are truly refractory or drug-resistant: The diagnosis of a seizure disorder is correct, the proper treatment has been tried but failed, and known triggers or lifestyle factors have been ruled out. Patients must be thoroughly evaluated to be sure the episodes they are experiencing are truly seizures, since many conditions have symptoms that can mimic them (such as fainting episodes, psychiatric issues, or sleep disorders). In fact, one study found that 13% of patients referred for refractory epilepsy, upon further investigation, did not have epilepsy at all.
Medication adjustments may continue to improve seizure frequency, and evaluation for surgical options for epilepsy should be undertaken to understand a person’s risk for complications and potential for benefit including seizure reduction or seizure freedom. Multiple surgical options exist including resective brain surgery, laser ablation, and bionic implants to reduce or stop seizures. Special diets, lifestyle changes, and other alternative therapies may also be helpful. Guidance from a specialist who treats seizures is recommended if a person is felt to have intractable epilepsy.
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The Northwell Comprehensive Epilepsy Center is one of the largest and most comprehensive programs on Long Island for the evaluation, diagnosis and medical and surgical treatments of epilepsy.