Drug-resistant Epilepsy

Drug-resistant epilepsy or refractory epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures that are not controlled by anti-epileptic drugs (AEDs). It affects millions of people globally, and its impact on the quality of life of those affected, as well as their families and caregivers, cannot be underestimated. The primary goal of treating epilepsy is to achieve seizure freedom or at least significant reduction in seizure frequency, but this is often not possible in patients with drug-resistant epilepsy. However, various therapeutic alternatives have been developed for patients with refractory epilepsy, such as surgery, neurostimulation, and dietary therapy. Surgical intervention is an option for drug-resistant epilepsy when it is determined that the seizures arise from a specific area of the brain that can be removed without causing significant functional loss. This approach can be highly effective, achieving seizure freedom or significant seizure reduction in up to 60–80% of cases. Neurostimulation methods—such as vagus nerve stimulation, responsive neurostimulation (RNS), deep brain stimulation (DBS), and transcranial magnetic stimulation (TMS)—can also be used to treat drug-resistant epilepsy. These approaches offer the capacity for personalized treatment and are often considered when surgery is not a viable option. Ketogenic diets are a highly effective dietary therapy options for drug-resistant epilepsy. These diets are high in fat with limited carbohydrate intake, leading to the production of ketones in the body, which helps reduce seizures. In conclusion, drug-resistant epilepsy is a severe condition that affects millions of people worldwide. Although challenging, appropriate management of this condition is possible through various approaches such as surgery, neurostimulation, and dietary therapy. Collaborative management involving a multidisciplinary team of healthcare professionals is crucial to achieve the best possible outcomes for patients.

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