Refractory epilepsy: symptoms, causes and treatment

Epilepsy is one of the most common nervous system disorders along with headaches. This problem involves seizures that originate from a defective brain.

Depending on the age at which it appears and the number of epileptic seizures you have, this disorder may prevent you from leading a normal, full life.

Sometimes, despite the correct follow-up of various treatments, the epileptic patient does not improve. This type of epilepsy is called refractory, And in this article, we’ll discuss it, along with its causes, symptoms, and alternative treatments.

    What is intractable epilepsy?

    It is said that a person suffers from intractable epilepsy when epileptic seizures occur very frequently and, after proper treatment, no improvement is obtained. This fact seriously prevents them from leading normal lives, such as having healthy and full social interactions or developing autonomy, because it is not known when the next seizure will occur and they have no control over it.

    To determine that a person has epilepsy three criteria are taken into account, Which make it possible to define the degree of refractoriness or resistance of the disorder to treatment. Let’s see what they are.

    1. Biological refractoriness

    Refers to ‘the biological characteristics of the person that prevent the treatment from being effective. These characteristics cannot be directly changed and usually involve the need for surgical treatment.

    some predictors that indicate that you may have difficult to treat epilepsy are:

    • First crisis before 2 years.
    • Massive spasms.
    • Abnormal electroencephalogram.
    • Signs of intellectual disability.
    • Delay in cognitive development.
    • Abnormal physical examination.
    • Deformities of the hippocampus and cerebral cortex.

    2. Pharmacological refractory

    This implies that, despite the use of appropriate drugs for the treatment of epilepsy, no improvement is obtained.

    Before considering epilepsy to be drug resistant, it is important to assess whether the required dose of the drug has been administered, whether at least three different anticonvulsants have been used, or whether their combination was appropriate.

    Precautions should also be taken to ensure that the patient is taking the medication or is not suffering from any intestinal disorder. which prevents full absorption of the drug. It can sometimes be diagnosed as epilepsy refractory to a nutritional problem.

    Once it has been determined that the pharmacological treatment has been administered correctly but the patient shows no improvement, it is indicated that there is a high degree of resistance to this type of treatment.

    3. Psychological and social refractory

    Epileptic seizures interfere with the lives of patients. Having seizures very often prevents you from being able to carry out daily tasks and maintain satisfactory social relationships.

    This criterion is taken into account, and epilepsy is considered refractory when seizures occur every week, despite treatment.


      As with all epilepsies, the main symptom is suffering from epileptic seizures. Seizures can occur in different ways and last from a few seconds to a few minutes. During these seizures, the person does not have the ability to stop voluntarily, can injure himself and even injure others accidentally.

      In addition to this, the other symptoms that can occur are:

      • Loss of consciousness.
      • Loss of sphincter control.
      • Staring into the void.
      • Suddenly fall to the ground.
      • Be stiff.
      • Bite your tongue.

      Causes of this type of epilepsy

      The causes of intractable epilepsy are various, And they range from medical problems to bad patient habits. Some of the factors that influence the development of this type of epilepsy include:

      • Cerebrovascular disease.
      • Brain tumors.
      • Stress maintained.
      • Woe to the house.
      • Emotional issues.
      • Personality issues.
      • Brain injuries.
      • Neurodegenerative diseases.
      • Generalized epileptic syndromes.
      • Little respect for pharmacological treatment.
      • Erratic lifestyle: drug use, irregular sleep schedules …


      These are the different forms of treatment for intractable epilepsy.

      1. Pharmacological

      Usually the first option to treat epilepsy is the administration of medication. The most used are:

      • Gabapentina.
      • Lamotrigine.
      • Cannabidiol.
      • Levetiracetam.
      • Oxcarbazepine.
      • Topiramate.
      • Zonisamide.
      • Tiagabina.

      I after trying several drugs and adjusting the doses, no improvement is obtainedSurgery should be considered as an option.

      2. Surgical

      Surgery is used when pharmacological treatment is considered not to be effective, even though it is being used correctly.

      Surgical interventions in epilepsy they involve removing the area of ​​the brain that is causing the seizures.

      3. Diet

      Another option used during treatment is on a ketogenic diet. This type of diet is characterized by foods high in fat and protein and avoiding the intake of carbohydrates.

      It has been linked to improvement in epileptic symptoms, although in patients with these types of neurological problems professional supervision is necessary.

      4. Electrostimulation

      Electrical stimulation or electrostimulation is a technology used to treat neurological problems. With this technique, the nerves are directly stimulated, sending electrical signals to the defective area. Some methods used:

      1. Cortical stimulation

      Electrodes are placed on parts of the brain and very soft signals are sent.

      2. Stimulation in the vagus nerve

      A device is placed that sends a signal to the vagus nerve, decrease in frequency and number of seizures.

      3. Deep brain stimulation

      The electrodes are placed in the affected areas and signals are sent to prevent abnormal activity.

      4. Closed circuit stimulation

      A device is placed inside the skull, Which detects when there is activity of a seizure and produces a current which can prevent a seizure.

      Bibliographical references:

      • Carrizosa-Moog, J. and Cornejo-Ochoa, William. (2003). What is refractory epilepsy? Iatréia, 16 (2), 163-167.
      • Bender de l’Busto, Juan I .. (2007). Refractory epilepsy. Havana Journal of Medical Sciences, 6 (1) Retrieved July 30, 2019 from
      • Reis-Botero, G. and Santiago-Uribe, C. (2010) Refractory epilepsy. Colombian Neurological Report, 26 (2), 34-46.

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