refractory epilepsy

Full Definition

Refractory epilepsy, also known as drug-resistant or pharmacoresistant epilepsy, is defined as failure to achieve sustained seizure freedom despite adequate trials of two or more well-tolerated, appropriately chosen antiepileptic drug regimens. This condition affects approximately 30% of children with epilepsy and represents a significant clinical challenge requiring specialized management approaches. Patients with refractory epilepsy may be candidates for alternative treatments including epilepsy surgery, neurostimulation devices, dietary therapies, or investigational treatments. Early identification of drug resistance is important because continued seizures can impact cognitive development, quality of life, and long-term outcomes in pediatric patients. The definition emphasizes that drug trials must be appropriate for the seizure type and syndrome.

Usage

Usage note: Modern preference is for 'drug-resistant epilepsy' over 'refractory' in formal literature, though both terms are acceptable.

In Context

• "The child's refractory epilepsy warranted evaluation for surgical intervention." — Surgical referral note
• "Refractory epilepsy in this patient led to consideration of vagus nerve stimulation therapy." — Treatment planning discussion