Neuropsychiatric Disease and Treatment (Jul 2021)
Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
Abstract
Deborah Guery,1 Sylvain Rheims1– 3 1Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France; 2Lyon’s Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France; 3Epilepsy Institute, Lyon, FranceCorrespondence: Sylvain RheimsDepartment of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, 59 Boulevard Pinel, Bron Cedex, 69677, FranceTel +33 4 72 35 79 00Email [email protected]: Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients’ quality of life.Keywords: drug resistant epilepsy, epilepsy surgery, antiseizure drugs, comprehensive care
