Sánchez-Alvarez J C, Serrano-Castro P, Cañadillas-Hidalgo F
Servicio de Neurología. Hospital Universitario Virgen de las Nieves, Granada, España.
Rev Neurol. 2002;35(10):931-53.
Between 25 33% of epileptic patients continue to present epileptic seizures in spite of adequate treatment with antiepileptic drugs (AED). This fact has led to a gradual development of new AED, a progressive expansion of epilepsy surgery and a great amount of interest in the overall knowledge of patients with refractory or AED resistant epilepsy.
Refractory epilepsy (RE) can be defined as the persistence of correctly diagnosed epileptic seizures that recur so often that they interfere in patients daily lives, after having received treatment with two best choice AED and an association at maximum tolerable doses for two years, which can be less in very acute crises. There exist factors that allow us to forecast a bad prognosis and diagnostic or therapeutic mistakes that point to a pseudorefractory condition must always be excluded. In treating this disorder, we must confirm that there are seizures, as well as the existence or absence of lesions as a substratum, and guarantee suitable treatment with some basic guidelines. Surgery is currently an efficient, safe form of therapy in a group of patients with RE and must be proposed as early as possible when it is suitably indicated, since it eliminates a high percentage of the seizures. If surgery or other alternative treatment does not control the seizures, in the long run therapy should be optimised to try to eliminate the most aggressive seizures and the chronic intoxication by AED in order to provide a better quality of life.
New therapeutic resources are needed to prevent the negative irreversible consequences of uncontrolled epileptic seizures
尽管使用抗癫痫药物（AED）进行了充分治疗，但仍有25%至33%的癫痫患者继续出现癫痫发作。这一事实导致了新型AED的逐步研发、癫痫手术的不断扩大以及对难治性或AED耐药性癫痫患者全面了解的浓厚兴趣。
难治性癫痫（RE）可定义为在接受两种最佳选择的AED并以最大耐受剂量联合治疗两年后（在非常急性的发作中时间可缩短），正确诊断的癫痫发作持续频繁复发，干扰患者日常生活。存在一些因素可让我们预测不良预后，必须始终排除指向假性难治状态的诊断或治疗错误。在治疗这种疾病时，我们必须确认癫痫发作的存在，以及作为基础的病变的有无，并保证遵循一些基本指南进行适当治疗。目前，手术是一组RE患者有效、安全的治疗方式，在有适当指征时应尽早提出，因为它可消除高比例的癫痫发作。如果手术或其他替代治疗无法控制癫痫发作，从长远来看，应优化治疗，试图消除最严重的癫痫发作以及AED引起的慢性中毒，以提高生活质量。
需要新的治疗资源来预防未控制的癫痫发作带来的负面不可逆后果
