What Is the Treatment for Refractory Epilepsy?

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  • Written By: Marlene Garcia
  • Edited By: Daniel Lindley
  • Last Modified Date: 09 May 2020
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Treatment for refractory epilepsy might include surgery, implantation of a nerve stimulator, changes in diet, and recommendations for various drugs. Refractory epilepsy defines seizures that fail to respond to drug therapy commonly used to control epilepsy. Not all treatments work for every patient, and careful screening by a neurologist should be conducted before choosing alternate treatment for refractory epilepsy, especially when surgery is under consideration.

Surgery typically can only be performed on patients with partial seizures, when only one part of the brain is involved. Patients with generalized seizures, defined as seizures beginning in several areas of the brain, face more risk from an operation. Surgery might damage regions in the brain that control vital bodily functions.

Seizures occur when abnormal electrical signals start in the brain and travel to other areas of the body. These episodes might disrupt speech, render a patient unconscious, cause spastic muscle movements, or affect memory. Some patients suffer emotional effects of seizures, especially if they occur over a long period of time.

The standard treatment for the condition involves antiepileptic drugs, such as phenobarbital, which is one of the best-known medicines used to treat the disorder. These drugs might work to prevent or decrease the number of seizures, but they may not be safe for children. Some patients cannot tolerate side effects of antiepileptic medication.

They may respond to a vagus nerve stimulator, which can be implanted into the chest near the collarbone. Wires on the device can be attached to the vagus nerve in the neck to deliver electrical impulses that might prevent seizures. The timing and intensity of electrical pulses can be programmed into the stimulator. In most patients, this treatment for refractory epilepsy fails to completely stop seizures, but might decrease the number of episodes.

The ketogenic diet works for some people, but how the diet controls seizure remains unclear. Patients treated for refractory epilepsy through diet restrict the amount of carbohydrates they eat and get up to 90 percent of all calories from fat and protein. Vomiting and nausea are common side effects of the diet, along with fatigue. Careful monitoring of electrolytes, blood counts, and kidney and liver functions represents typical safeguards during ketogenic diet therapy.

These alternative treatments might be sought in lieu of drugs for growing children diagnosed with epilepsy. Many antiepileptic medications weaken bones by reducing density. They might also cause harmful effects on developing brains. In adults, the drugs could interfere with contraceptive medication used to prevent pregnancy and increase the risk of birth defects.


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