Ali A. Asadi-Pooya, M.D.

  1. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
  2. Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran

Drug resistant epilepsy is an epilepsy syndrome in which seizures persist and seizure freedom is very unlikely to be attained with further manipulation of antiepileptic drug therapy. In some patients with drug-resistant epilepsy, resective epilepsy surgery may produce seizure freedom. However, some patients are not good candidates for resective surgery. For example, symptomatic (structural-metabolic) generalized epilepsies, including Lennox-Gastaut and other catastrophic childhood-onset generalized epilepsy syndromes, are notoriously resistant to medical treatment. When these patients become adults, most continue to experience drug-resistant disabling seizures as well as cognitive, psychiatric, and behavioral problems. Usually there is no resectable epileptogenic lesion and therefore, resective and potentially curative surgery is not an option for these patients. Alternative treatments, including surgical procedures such as vagal nerve stimulation (an antiepileptic device) or corpus callosotomy, can palliate the severity of seizures in these conditions. The decision regarding which procedure might be best for an individual should take into account multiple factors, including the patient’s predominant seizure types and their role in affecting his/her quality of life, severity of seizures, the risks and potential benefits from each procedure, cost, and probably the most important factor, the patient’s expectations.