Refractory Epilepsy

Epilepsy that remains uncontrolled despite the appropriate use of antiepileptic medications (AEDs) is referred to as "refractory".

There are a variety of factors that increase the risk that epilepsy will not be controlled by the use of medications alone. These include:

  • A poor response to the first 2 to 3 antiepileptic medications
  • A family history of epilepsy
  • Epilepsy that resulted from brain trauma

The following steps may be used to achieve seizure control with antiepileptic medications:

  • Increasing the medication doses to higher than normal levels
  • Trying 2 or 3 different medications if other medications are unsuccessful
  • Trying "combination therapy" with two or more antiepileptic medications. ("monotherapy" describes the use of one medication)

The majority of patients with newly diagnosed epilepsy will experience a decrease in the severity and frequency of their seizures through the appropriate use of medications. A positive response to medication usage usually occurs in the first 3 years.

Factors that increase the likelihood that epilepsy will be effectively controlled with medications include:

  • Less than 20 seizures in a 3 month period
  • People with epilepsy following a stroke

Risks of Refractory Epilepsy

Refractory epilepsy is a significant problem. People with refractory epilepsy remain susceptible to seizures and the associated anxiety and depression. Their lifestyle remains restricted, such as being unable to drive, and they are at increased risk of having cognitive dysfunction, status epilepticus, or Sudden Unexplained Death from Epilepsy (SUDEP).

If epilepsy is poorly controlled by medications, it is important to consider alternative treatment options, including epilepsy surgery or a device to control seizures, such as a vagal nerve stimulator (VNS).


Reference: National Institute of Neurological Disorders and Stroke

Last updated May 4, 2017

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

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