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The Management of Pharmacologically Refractory Epilepsy

Evelien Carrette, MSc, PhDs, Kristl Vonck, MD, PhD, and Paul Boon, MD, PhD.

In patients with pharmacologically refractory epilepsy, continued drug trials with newer anti-epilepsy drugs (AEDs) or combinations of drugs are unlikely to achieve complete freedom from seizures. Prompt referral to an epilepsy center is mandatory for optimal clinical management that is tailored to the patient’s specific situation. This management needs to take into account the type, severity, and frequency of seizures in addition to the environment and social context of the patient. Alternative treatment modalities for patients with refractory epilepsy include epilepsy surgery, vagus nerve stimulation (VNS), experimental deep brain stimulation (DBS) protocols, dietary treatments, and inclusion in Phase III trials with new AEDs or immunological therapies such as corticosteroids. All options have specific advantages and drawbacks with regards to outcomes and side-effects.

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