Refractory epilepsy: symptoms, causes and treatment

A neurological disorder that is resistant to therapy and continues to produce epileptic seizures.

Epilepsy is one of the most common nervous system disorders along with headaches. This problem involves suffering seizures whose origin is a malfunction of the brain.

Depending on the age at which it appears and the number of epileptic seizures suffered, this disorder can make it very difficult to lead a normal and full life.

Sometimes, despite several treatments being followed correctly, the patient with epilepsy does not improve. This type of epilepsy is called refractory epilepsy.and in this article we will discuss it, along with its causes, symptoms and alternative treatments.

What is refractory epilepsy?

We say that a person suffers from refractory epilepsy when epileptic seizures occur very frequently and, after appropriate treatment, no improvement is being obtained.. This fact seriously prevents people from leading a normal life, such as having healthy and full social interactions or developing autonomy, because they do not know when the next seizure will occur and on top of that they have no control over it.

In order to determine that a person suffers from epilepsy three criteria are taken into accountThese criteria define the degree of refractoriness or resistance of the disorder to treatment. Let us see what they are.

Biological refractoriness

Refers to theThe Biological characteristics of the person that prevent the treatment from being effective.. These characteristics cannot be modified directly, and usually mean that surgical treatment is necessary.

Some predictors that indicate that one could suffer from an epilepsy that is difficult to treat are:

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

2. Pharmacological refractoriness.

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

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 the combination of anticonvulsants has been appropriate.

It should also be monitored that the patient is taking the medication or does not suffer from any intestinal disorder that would prevent full absorption of the drug. that prevents full absorption of the drug. Sometimes it may be diagnosed as refractory epilepsy due to a nutritional problem.

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

3. Psychological and social refractoriness

Epileptic seizures interfere with patients' lives. Frequent seizures make it impossible to carry out daily tasks and maintain satisfactory social relationships.

This criterion is taken into account, and an epilepsy is considered to be refractory when the seizures occur every week, in spite of going to therapy..

Symptoms

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

In addition to this, other symptoms that may occur are:

• Loss of consciousness.
• Loss of sphincter control.
• Staring into a void.
• Suddenly falling to the floor.
• Stiffening.
• biting the tongue

Causes of this type of epilepsy

The causes behind refractory epilepsy are various.They range from medical problems to bad habits of the patient. Among factors that influence the development of this type of epilepsy are:

• Cerebrovascular disease.
• Brain tumors.
• Sustained stress.
• Unhappiness at home.
• Emotional problems.
• personality problems
• Brain injuries.
• Neurodegenerative diseases.
• Generalized epileptic syndromes.
• Poor adherence to pharmacological treatment.
• Erratic lifestyle: drug use, irregular sleep schedules, etc.

Treatment

These are the different forms of treatment for refractory epilepsy.

1. Pharmacological

Usually, the first option to treat epilepsies is the administration of drugs.. The most commonly used are:

• Gabapentin.
• Lamotrigine.
• Cannabidiol.
• Levetiracetam.
• Oxcarbazepine.
• Topiramate.
• Zonisamide.
• Tiagabine.

If after trying several drugs and adjusting the doses, no improvement is achieved.surgery should be considered as an option.

2. Surgical

Surgery is resorted to when it is considered that the pharmacological treatment is not being effective, in spite of being used correctly.

Surgical interventions in epilepsy involve removing the brain area that is the origin of the seizures..

3. Diet

Another option used during treatment is following a ketogenic diet. This type of diet is characterized by having foods with a high amount of fats and proteins and avoiding the consumption of carbohydrates.

It has been related to the improvement of epileptic symptoms, although in patients with this type of neurological problems it is necessary the supervision of a professional.

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 over certain parts of the brain and very mild signals are very mild signals are sent..

2. Stimulation on the vagus nerve

A device is placed that sends a signal to the vagus nerve, decreasing the frequency and quantity of seizures..

3. Deep brain stimulation

Electrodes are placed in affected areas and signals are sent to prevent abnormal activity.

4. Closed-loop stimulation

A device is placed inside the skullIt detects when there is seizure activity and produces a current that can prevent a seizure from occurring.

Bibliographic references:

• Carrizosa-Moog, J. and Cornejo-Ochoa, William. (2003) What is refractory epilepsy? Iatreia, 16(2), 163 - 167.
• Bender del Busto, Juan E.. (2007). REFRACTORY EPILEPSY. Habanera Journal of Medical Sciences, 6(1) Retrieved July 30, 2019, from http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2007000100010&lng=es&tlng=es.
• Reyes-Botero, G. and Santiago-Uribe, C. (2010) Refractory epilepsy. Acta Neurológica Colombiana, 26(2), 34 - 46.