Refractory epilepsy: drug treatments
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Refractory epilepsy: drug treatments. Major disabling seizures, High risk of injury or death, Progressive syndromes. Fully referenced neurology checklist.
Indications for aggressive treatment
- Major disabling seizures
- High risk of injury or death
- Seizures with stigmatising behaviour: incontinence or disrobing
- Significant post-ictal symptoms: cognitive, psychiatric, fatigue, or sleepiness
- Progressive syndromes
- Surgically remediable cause
Treatments of resistant adult focal epilepsy (TRAFE)
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Treatments of resistant childhood focal epilepsy (TRCFE)
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Treatment of other forms of refractory epilepsy (Level B evidence)
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Treatments considerations to minimise side effects
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Treatment considerations for severe symptomatic cases
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Treatment considerations for primary generalised epilepsy
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Treatments considerations for partial onset epilepsy
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Other treatment considerations
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Synonyms
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References
- Beleza P. Refractory epilepsy: a clinically oriented review. Eur Neurol 2009; 62: 65-71.
- Krauss GL, Sperling MR. Treating patients with medically resistant epilepsy. Neurol Clin Pract 2011; 1: 14-22.
- Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2018; 91:82-90.
- Hu Q, Zhang F, Teng W, Hao F, Zhang J, Yin M, Wang N. Efficacy and safety of antiepileptic drugs for refractory partial-onset epilepsy: a network meta-analysis. J Neurol 2018; 265:1-11.
- Tang V, Poon WS, Kwan P. Mindfulness-based therapy for drug-resistant epilepsy: an assessor-blinded randomized trial. Neurology 2015; 85:1100-1107.
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