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Current Principles in the Management of Drug-Resistant Epilepsy

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Abstract

Drug-resistant epilepsy is associated with poor health outcomes and increased economic burden. In the last three decades, various new antiseizure medications have been developed, but the proportion of people with drug-resistant epilepsy remains relatively unchanged. Develo** strategies to address drug-resistant epilepsy is essential. Here, we define drug-resistant epilepsy and emphasize its relationship to the conceptualization of epilepsy as a symptom complex, delineate clinical risk factors, and characterize mechanisms based on current knowledge. We address the importance of ruling out pseudoresistance and consider the impact of nonadherence on determining whether an individual has drug-resistant epilepsy. We then review the principles of epilepsy drug therapy and briefly touch upon newly approved and experimental antiseizure medications.

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Authors and Affiliations

  1. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Nathan A. Shlobin

  2. Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands

    Nathan A. Shlobin & Josemir W. Sander

  3. UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, Box 29, London, WC1N 3BG, UK

    Josemir W. Sander

  4. Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK

    Josemir W. Sander

  5. Department of Neurology, West China Hospital, Sichuan University, Chengdu, China

    Josemir W. Sander

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Nathan A. Shlobin received no funding. Josemir W. Sander is based at the NIHR University College London Hospitals Biomedical Research Centre, which receives a proportion of funding from the UK Department of Health’s Research Centres funding scheme. He receives research support from the Dr Marvin Weil Epilepsy Research Fund, from the UK Epilepsy Society, and the Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, the Netherlands.

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Nathan A. Shlobin has no disclosures to report. Josemir W. Sander reports personal fees from Eisai, UCB, GW, Arvelle, and Zogenix, and grants from UCB outside the submitted work.

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NAS conducted the literature search and data analysis and drafted the manuscript. JWS formulated the concept for the article and provided critical intellectual input. Both authors have read and approved the final submitted manuscript and agree to be accountable for the work.

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Shlobin, N.A., Sander, J.W. Current Principles in the Management of Drug-Resistant Epilepsy. CNS Drugs 36, 555–568 (2022). https://doi.org/10.1007/s40263-022-00922-4

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