True intractable epilepsy is the metaphorical equivalent of the bar across the front door. Difficulty controlling seizures can result from seizures that are “too strong” to be controlled by medication, or by intolerance of medication. All medications have potential side effects, but some people experience them with greater frequency and intensity than do others. This can be in the form of allergy or of non-allergic intolerance, for example, severe stomach upset from medicine. It is distressing and discouraging to break out in a rash to a half-dozen AEDs in a row, and it limits therapeutic options. Seizures that might be easy to treat with medicine become hard to treat when the best medicines are off-limits. Multiple drug resistance is a condition in which people are resistant to multiple medications. Some people with multiple drug resistance have a type of metabolism that quickly inactivates or isolates drugs, causing them to be less effective.

Another common experience in treating refractory epilepsy is “honeymooning,” or as it is officially known, developing medication “tolerance.” In this situation, a new drug works for a few months and then becomes ineffective. The cycle repeats with each new medication. Such patients can end up on a stressful “rotation diet” of different medicines. It is another form of drug resistance.

Continue on to Approach to Intractable Seizures

Topic Editor: Robert S. Fisher, MD, PhD
Last Reviewed: April 21, 2009