Intractable epilepsy

Doctors diagnose intractable epilepsy when seizures continue despite trying at least two appropriate anti-seizure medications.

To understand the cause and plan treatment, the following tests may be used:

• Brain MRI (Magnetic Resonance Imaging): To check for structural problems in the brain
• EEG (Electroencephalogram): To detect abnormal brain activity and seizure patterns
• Video EEG monitoring: A longer EEG done in the hospital to watch and record actual seizures
• PET or SPECT scan: Imaging tests that look at brain function, often used before surgery
• Neuropsychological testing: To assess memory, language, and thinking skills
• Genetic testing: If a genetic epilepsy syndrome is suspected

1. Anti-Seizure Medications (ASM)

Doctors may try newer ASMs (e.g., cenobamate, brivaracetam, etc.) after failure of two standard drugs.

2. Epilepsy Surgery

If seizures originate from one brain region, surgery may remove or disconnect that area (e.g., temporal lobectomy, lesionectomy, hemispherotomy, corpus callosotomy).

3. Neuromodulation

Vagus Nerve Stimulation (VNS)

• Implants in the chest deliver pulses to the vagus nerve. 

Deep Brain Stimulation (DBS)

• Electrodes stimulate target areas like the anterior thalamic nucleus. 

4. Ketogenic Diet

A high-fat, low carbohydrate, adequate-protein diet altering energy metabolism; widely used in children with intractable epilepsy (e.g., Dravet syndrome, Lennox-Gastaut syndrome, or GLUT-1 deficiency).