Refractory Epilepsy: Symptoms, Causes And Treatment
Epilepsy is one of the most common nervous system disorders along with headaches. This problem involves suffering from seizures whose origin is due to a malfunction of the brain.
Depending on the age at which it appears and the number of epileptic seizures suffered, this disorder can seriously make it difficult to lead a normal and full life.
Sometimes, despite following several treatments correctly, the patient with epilepsy does not improve. This type of epilepsy is called refractory and in this article we will address it, along with its causes, symptoms and alternative treatments.
We say that a person suffers from refractory epilepsy when epileptic seizures occur very frequently and, after applying adequate treatment, no improvements are being obtained This fact seriously impedes leading a normal life, such as having healthy and full social interactions or developing autonomy, because it is not known when the next crisis will occur and on top of that there is no control over it.
To determine that a person suffers from epilepsy three criteria are taken into account, which allow defining the degree of refractoriness or resistance of the disorder to treatment. Let’s see what they are.
1. Biological refractoriness
It refers toThe biological characteristics of the person that prevent the treatment from being effective These characteristics cannot be modified directly, and usually imply that surgical treatment must be resorted to.
Some predictors that indicate that one could suffer from epilepsy that is difficult to treat are:
2. Pharmacological refractoriness
It implies that, despite using appropriate drugs for the treatment of epilepsy, improvements are not achieved.
Before considering that epilepsy is drug-resistant, it is important to evaluate whether the necessary dose of the medication has been administered, whether at least three different anticonvulsants have been used, or whether the combination of them has been appropriate.
It should also be monitored that the patient takes the medication or does not suffer from any intestinal disorder that prevents total absorption of the drug. Sometimes, it can be diagnosed as epilepsy refractory to a nutritional problem.
Once it has been determined that the pharmacological treatment has been adequately administered but that the patient does not show improvements, it is indicated that there is a high degree of resistance to this type of treatment.
3. Psychological and social refractoriness
Epileptic seizures interfere with patients’ lives. Suffering from seizures very frequently prevents you from being able to carry out day-to-day tasks and maintain satisfactory social relationships.
This criterion is taken into account, and Epilepsy is considered refractory when seizures occur every week, despite going to therapy
Symptoms
As in all epilepsies, The main symptom is suffering from epileptic seizures Seizures can occur in different ways and last from seconds to minutes. During these crises, the person does not have the ability to stop voluntarily, they can harm themselves and even accidentally hurt others.
In addition to this, other symptoms that may occur are:
The causes behind refractory epilepsy are several, and range from medical problems to bad patient habits. Among factors that influence the development of this type of epilepsy are:
Treatment
These are the different forms of treatment for refractory epilepsy.
1. Pharmacological
Usually, the first option to treat epilepsy is the administration of drugs The most used are:
Gabapentin.
Lamotrigine.
Cannabidiol.
Levetiracetam.
Oxcarbazepine.
Topiramate.
Zonisamide.
Tiagabine.
Yeah After trying several drugs and adjusting the doses, no improvements are achieved surgery should be taken as an option.
2. Surgical
Surgery is resorted to when it is considered that the pharmacological treatment is not being effective, despite being used correctly.
Surgical interventions in epilepsy involve removing the brain area that is the source of seizures
3. Diet
Another option used during treatment is following a ketogenic diet This type of diet is characterized by having foods with a large amount of fat and protein and avoiding the consumption of carbohydrates.
It has been related to the improvement of epileptic symptoms, although professional supervision is necessary in patients with this type of neurological problems.
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 soft signals are sent
2. Vagus nerve stimulation
A device is placed that sends a signal to the vagus nerve, reducing the frequency and quantity of seizures
Electrodes are placed on affected areas and signals are sent to prevent abnormal activity.
4. Closed-loop stimulation
A device is placed inside the skull which detects when there is seizure activity and produces a current that can prevent a seizure.
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 on 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. Colombian Neurological Act, 26(2), 34 – 46.
