Refractory epilepsy risks ‘need to be given greater attention’

Posted Jul 14 2014 in Brain science; genetics

A new critical review has highlighted the fact that not enough attention is currently being given to the risks associated with uncontrolled and progressive epilepsy – also known as refractory epilepsy.

Eight international epilepsy experts from Europe, the United States, and South America met on May 4th 2013 to present, review and discuss a wide-ranging body of data, concepts and literature on the consequences of refractory epilepsy, with the findings of their analysis having now been published in the journal Epilepsy & Behavior.

Looking at global data trends from numerous patient bodies, the team – which included researchers from the US, Austria, Brazil and Ireland – observed that patients with refractory epilepsy require the overwhelming majority of time, effort and focus from treating physicians, despite representing a minority of the total patient population.

Cases of epilepsy are categorised as refractory or uncontrolled when they fail to respond to antiepileptic drugs or other treatments. This affects around 30 to 40 per cent of all people experiencing epileptic seizures.

Although risks associated with diagnostic procedures and medical/surgical treatments for this form of epilepsy are well-documented, the experts suggested they are usually smaller than the danger posed by long-term uncontrolled seizures.

Since refractory epilepsy may be progressive, it carries risks of structural damage to the brain and nervous system, as well as comorbidities such as osteoporosis and fractures, and an increased likelihood of mortality.

Moreover, the condition is associated with several psychological consequences such as depression and anxiety, plus educational and social impairments. Meanwhile, underlying epileptogenic processes that occur in these patients can bring further neuropsychiatric defects, which appear to be independent of the effects of the ongoing seizures themselves.

“Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly more aggressive treatments. Future research should focus not only on controlling seizures, but also on preventing these consequences,” the researchers concluded.

People are generally defined as having drug-resistant epilepsy when they have failed to stay seizure-free with adequate trials of two seizure medications chosen appropriately for their specific symptoms.

Posted by Steve Long

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