Advances in Therapy for Refractory Epilepsy.

Annu Rev Med

Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA; email:

Published: November 2024

AI Article Synopsis

  • Drug-resistant epilepsy (DRE) affects one-third of epilepsy patients, defined by lack of seizure control despite adequate trials of two antiseizure medications (ASMs), and leads to significant health risks.
  • The gold standard treatment for DRE is resective brain surgery, though laser ablation presents a less invasive option with varying effectiveness.
  • For those unsuitable for surgical options, neuromodulation devices and dietary therapies may help reduce seizures, and ongoing research into genetic therapies offers hope for more tailored treatments.

Article Abstract

Drug-resistant epilepsy (DRE) is defined as failure to achieve sustained seizure control with adequate trials of two appropriate antiseizure medications (ASMs). DRE affects one-third of patients with epilepsy and is associated with significant morbidity and mortality. Newer ASMs provide pharmacological therapy that is better tolerated but not necessarily more effective than older ASMs. Resective brain surgery is the gold standard to treat DRE and achieve seizure freedom, with laser ablation offering an alternative with less morbidity but lower effectiveness. For patients who are not candidates for resection or ablation, multiple neuromodulation options can reduce seizure burden. These neuromodulation devices have shown comparable effectiveness in randomized clinical trials, but the results vary in open-label follow-up cohorts, as do the risks of complications and associated costs. Dietary therapies can help, particularly in pediatric genetic epilepsies. Innovative genetic therapy approaches are being pursued, offering the promise of precision medicine.

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Source
http://dx.doi.org/10.1146/annurev-med-050522-034458DOI Listing

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