Identifying patients with refractory epilepsy
Determining the point at which epilepsy is considered refractory can be challenging. With the many AEDs now available, the question is how many AEDs—alone or in combination—to try before turning to nonpharmacologic options. Typically, patients with refractory epilepsy have shown limited success with any single AED or combination of AEDs. Brodie and Kwan suggested a staged approach to epilepsy therapy that includes considering nonpharmacologic options after 2 to 3 well-tolerated AEDs fail to produce adequate seizure control. Furthermore, evidence from clinical studies indicates that there are clinical and diagnostic predictors that identify patients at risk for refractory epilepsy. By recognizing these markers, you may help patients with refractory epilepsy get early and appropriate treatment and encourage improved health outcomes.