Intractable epilepsy

Intractable epilepsy, also called drug-resistant epilepsy, is a condition where seizures cannot be controlled by standard anti-seizure medications. Doctors usually diagnose it when a person has tried at least two appropriate anti-seizure medications without success. It affects both children and adults and can have a serious impact on daily life, learning, and emotional health. Even though the seizures continue, there are other treatment options available, including surgery, special diets, and devices like vagus nerve stimulators.

Intractable epilepsy is not one single condition. It can appear in different forms depending on the type of seizures (focal or generalized) and the brain areas involved. Some patients have syndromic intractable epilepsy (e.g., Lennox-Gastaut syndrome, Dravet syndrome, West syndrome (infantile spams), etc..).

The main symptom is repeated seizures that do not improve with medication. Depending on the type of epilepsy, symptoms can include:

• Frequent seizures, despite taking anti-seizure medications
• Different seizure types: tonic-clonic, focal aware/impaired, absence, myoclonic, or drop attacks
• Post-seizure confusion or extreme tiredness
• Developmental delays or regression in children
• Cognitive problems, such as memory loss or poor concentration
• Emotional or behavioral issues, including anxiety, depression, or aggression
• Injury risk due to sudden seizures (e.g., falls or burns)

Intractable epilepsy can have many different causes. Sometimes, the exact reason is unknown.

Common causes include:

• Structural brain abnormalities (e.g., cortical dysplasia, tumors, strokes, or brain injury)
• Genetic conditions (e.g., Dravet syndrome, TSC, or other epilepsy syndromes)
• Brain infections (e.g., meningitis, encephalitis)
• Brain injuries before or during birth (perinatal injury)
• Metabolic or mitochondrial disorders
• Prolonged febrile seizures in early childhood, in some cases

Risk factors that may increase the chance of intractable epilepsy:

• Seizures starting at a very young age
• Multiple seizure types
• Poor response to the first two anti-seizure drugs
• Neurological or developmental delays

In many cases, intractable epilepsy cannot be completely prevented, especially when it is caused by genetic or unknown factors.

However, some steps may reduce the risk:

• Proper care during pregnancy and birth to avoid brain injury
• Preventing head trauma by using helmets and seatbelts
• Prompt treatment of brain infections (like meningitis or encephalitis)
• Managing febrile seizures carefully in young children
• Early diagnosis and treatment of epilepsy may reduce the chance of it becoming drug-resistant

Even if epilepsy can't be prevented, getting the right care early can make a big difference.