When the first few seizure medications don’t stop or control a person’s seizures, the chances are not so good that a different medicine will be completely successful. The term 'drug resistant epilepsy’ may be used to describe a person’s epilepsy when it doesn’t respond to medicines after the first two appropriate drug trials. 

If someone doesn’t respond to the first few medicines, what other options are there?

  • Be referred to an epilepsy center: There you will see an epileptologist, who is a neurologist that specializes in epilepsy. You also may see nurses, surgeons, neuropsychologists, social workers, and other health care professionals who can help sort out what’s going on, what treatments may help, and how the epilepsy is affecting your life and your loved ones. (link to find an epilepsy center)
  • Consider some of the newer seizure medications: Even if the chances are low that other medicines may work, every person is different! Some people just need to find the right combination that won’t cause side effects but will control seizures. (link to seizure medicine page)
  • Find out if surgery for epilepsy is possible: Some people have seizures starting from one area of the brain that can be removed safely. If this type of surgery is right for you, there’s a chance it could help control and cure your epilepsy. There are other types of epilepsy surgery too, that may help if seizures are found in large areas or more than are of the brain.  Surgery
  • Look into dietary therapies: When surgery isn’t possible or instead of surgery for some people, trying a special diet may help control seizures. The types of diets currently being used are the ketogenic diet, modified atkins diet, or low glycemic diet. These diet treatments should be prescribed and followed by an epilepsy specialist, nutritionist and nurse. Dietary treatment may work in people who don’t respond to medicine. Usually people on a diet treatment still take seizure medications, however. Dietary Therapies
  • Find out if vagus nerve therapy is an option: Devices are a growing area of epilepsy treatment. Vagus nerve stimulation, called VNS Therapy™ was the first device treatment approved by the Food and Drug Administration (FDA) to treat seizures that don’t respond to medications or when surgery doesn’t work or is not possible. Vagus Nerve Therapy
  • Other types of brain stimulation or surgery: NeuroPace RNS® System: Responsive Neurostimulation was  approved by the FDA in 2013. Other devices being tested (Deep Brain Stimulation) or types of surgery, such as thermal ablation (Visualase®) may be possible. While some of these are still being tested, others may be available. Talk to you epilepsy specialist about what’s possible for you.
  • Behavioral Therapies: Sometimes people need more than just a medicine, surgery or a device. Talk to your health care team about behavioral or non-drug treatments that may help control seizures or other problems associated with epilepsy. These are usually used together with seizure medication or other treatments listed here. Some other complementary treatments are being tested. Ask your epilepsy specialist about specific treatments. Complementary Health Approaches 
  • Participate in research: If your seizures don’t respond to medicine and these other treatments aren’t right for you, consider being part of a research study. There are many different studies looking at how to treat seizures better. While these studies may not help you directly, they may lead to answers that will help you and others later on.  Clinical Trials & Research 
  • How do I know what’s right for me? There is no one treatment that’s right for everyone. Before considering other options, you must have detailed testing to help you and your epilepsy team learn as much as possible about your epilepsy. This testing will help you work with your team about the benefits and risks of different treatments. Refractory Seizures 

 

Authored by: Steven C. Schachter, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD on 7/2013
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014
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