Drug-resistant epilepsy: Definition, pathophysiology, and management

Boulenouar Mesraoua; Francesco Brigo; Simona Lattanzi; Bassel Abou-Khalil; Hassan Al Hail; Ali A Asadi-Pooya

doi:10.1016/j.jns.2023.120766

Drug-resistant epilepsy: Definition, pathophysiology, and management

J Neurol Sci. 2023 Sep 15:452:120766. doi: 10.1016/j.jns.2023.120766. Epub 2023 Aug 14.

Authors

Boulenouar Mesraoua¹, Francesco Brigo², Simona Lattanzi³, Bassel Abou-Khalil⁴, Hassan Al Hail⁵, Ali A Asadi-Pooya⁶

Affiliations

¹ Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar. Electronic address: boulenouar.mesraoua@wanadoo.fr.
² Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
³ Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
⁴ Vanderbilt University Department of Neurology, Nashville, TN, USA. Electronic address: bassel.abou-khalil@vumc.org.
⁵ Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar. Electronic address: halhail1@hamad.qa.
⁶ Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.

PMID: 37597343
DOI: 10.1016/j.jns.2023.120766

Abstract

There are currently >51 million people with epilepsy (PWE) in the world and every year >4.9 million people develop new-onset epilepsy. The cornerstone of treatment in PWE is drug therapy with antiseizure medications (ASMs). However, about one-third of PWE do not achieve seizure control and do not respond well to drug therapy despite the use of appropriate ASMs [drug-resistant epilepsy (DRE)]. The aims of the current narrative review are to discuss the definition of DRE, explain the biological underpinnings and clinical biomarkers of this condition, and finally to suggest practical management strategies to tackle this issue appropriately, in a concise manner.

Keywords: Drug resistance; Epilepsy; Seizure; Treatment.

Publication types

Review

MeSH terms

Drug Resistant Epilepsy* / diagnosis
Drug Resistant Epilepsy* / drug therapy
Humans
Seizures