Drug Resistant Epilepsy: Current Challenges and the Path Forward

Epilepsy is a tendency of brain to have recurrent unprovoked seizures. Traditionally, the diagnosis of epilepsy has been made after having two unprovoked seizures greater than 24 hours apart. According to recent revised definition by International League Against Epilepsy (ILAE), epilepsy definition includes one unprovoked (or reflex) seizure and a probability of further seizures similar to general recurrence risk (at least 60%) [1]. Important and perhaps the most challenging subset of patients with epilepsy is patients who have drug resistant epilepsy. The chance of seizure freedom progressively diminishes with successive antiepileptic drug failures. According to the study by Kwan and Brodie, after failure of first two antiepileptic drugs, the chance of seizure freedom with third or subsequent drug trial is approximately 3%. ILAE defines drug resistant epilepsy as Failure of adequate trials of two well tolerated, appropriately chosen and used antiepileptic drugs (whether as monotherapy or in combination) to achieve sustained seizure freedom [2]. The aim of this article is to provide overview of current management and outline typical work up for drug resistant epilepsy.