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25 Feb22

Refractory Epilepsy – What Is It?

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Epilepsy is a chronic neurological disorder, the hallmark of which is recurrent, unprovoked seizures. The seizures can last from a few seconds to a few minutes and are caused by a change in the brain’s electrical activity. These seizures can often be easily regulated with the help of a planned, healthy lifestyle and medication. Sometimes, the condition advances into a refractive/ refractory state, where medications don’t help control the seizures.

What is Refractory Epilepsy?

Refractory epilepsy is a condition where medications don’t work well, or stop working altogether, in controlling seizures. Almost one-third of people diagnosed with epilepsy advance into this stage. A number of terms such as  “drug-resistant”, or “intractable”, are also used to describe this condition. Specialists agree that in this condition, seizures are more frequent and severe enough to interfere with the individual’s quality of life. 

The International League Against Epilepsy (ILAE) believes that the term “drug-resistant epilepsy” should be used instead of “refractory epilepsy”, for which it offers the following definitions:

  1. Drug-resistant epilepsy occurs when a person has failed to become (and stay) seizure-free with adequate trials of two seizure medications (called AEDs).
  2. These seizure medications must have been chosen appropriately for the person’s seizure type, tolerated by the person, and tried alone or together with other seizure medications.

 

What might cause refractory epilepsy?

The primary indicators of refractory epilepsy are uncontrollable seizures and the ineffectiveness of seizure medications. Studies show that head injuries, infections, fever, or brain tumors are the primary contributors to causing these symptoms, especially uncontrolled seizures. However, even with the above causes, they can be brought under control, provided there is an accurate diagnosis and a subsequent treatment plan for it. In some cases, despite the right treatment, an imbalanced lifestyle can render anti-epileptic drugs ineffective. 

Sometimes though, the cause of refractory epilepsy may remain unknown, leading to the lack of a treatment plan. Lastly, in a few cases, the uncontrolled frequent seizures can last despite an accurate diagnosis, medications, and a healthy lifestyle.

Is there any treatment for it?

Your healthcare provider may suggest combinations of Anti-Epileptic Drugs to reduce the seizures and reduce their frequency. Some of the most commonly prescribed drugs are as follows:

  1. Carbamazepine
  2. Phenytoin
  3. Neurontin
  4. Lamotrigine
  5. Levetiracetam
  6. Oxcarbazepine
  7. Tiagabine
  8. Topiramate
  9. Zonisamide
  10. Valproic acid
  11. Vigabatrin

Most often, the right combination of drugs along with a healthy lifestyle can help reduce seizures. A change in diet or switching to a restrictive diet such as Keto can also help moderate refractory epilepsy. In case medical treatment plans have become 100% ineffective, then your healthcare provider will suggest undergoing surgery or opting for electrical stimulation. 

Surgery

Surgery is generally recommended to those diagnosed with refractory partial epilepsy. This is a type of epilepsy where a small part of your brain is triggering seizures which may or may not spread to the rest of your brain. In these cases, the small part of the brain that is causing the seizures can be easily removed without harming or interfering with the rest of the brain.

Statistically, there is a 70-90% chance of completely eliminating the uncontrollable seizures. This is one of the most underutilized treatments for epilepsy. Early detection of potential candidates is key to making it work. If the intervention is done early, there is a chance of avoiding any psychological consequences as well.

Electrical Stimulation

Electrical stimulation is advised for anyone who cannot be a candidate for surgery out of choice or due to the risks involved in operating. In Vagus Nerve Stimulation (VNS), a small implantable device is placed under the skin in your chest. Its wires connect to the vagus nerve in your neck which sends a current to it. Electrical stimulation can help reduce the frequency of seizures and may even lessen the severity of a seizure that has already started. Research shows that 50% of patients experience a 50% reduction in seizures, but a different side effect profile. Moreover, patients rarely become seizure-free.

Ketogenic Diet

A ketogenic diet has been shown to benefit children diagnosed with refractory epilepsy who may not qualify as candidates for surgery. Medical professionals plan a viable diet that can be followed for months or even years. Over time, it has become more palatable as well. The diet has shown improved seizure control in 50% of children and in some cases, the positive changes persisted even after the diet was discontinued. The Atkins diet which is more lenient with carbohydrate control can also be experimented with.

However daunting this condition may seem, there are several interventions, especially surgeries that offer some hope and control. Accurate diagnosis and an immediate action plan are some of the most crucial elements in controlling the seizures in the best possible way. However, there will still be some cases where the patients may not become seizure-free despite interventions. In these situations, it is advisable to introduce supportive care at home or in assisted living facilities to improve the quality of life. 

Read our blog to know more about the types of epilepsy and their causes. You may also like to read our blog on photosensitive epilepsy. For more information, follow us on Facebook, Twitter, Instagram or Linkedin.