What Is Refractory Epilepsy?
If your doctor says you have refractory epilepsy, it means that medicine isn't bringing your seizures under control. You might hear the condition called by some other names, such as uncontrolled, intractable, or drug-resistant epilepsy.
Your doctor can try certain things to help keep your seizures under better control. For instance, they might try different combinations of drugs or a special diet.
Your doctor may also put a device under your skin that sends electrical signals to one of your nerves, called the vagus nerve. This may cut the number of seizures you get.
Surgery that removes a part of the brain that causes your seizures may also be an option. With any of these treatments, you may still need to take epilepsy medicine throughout your life.
It's natural to feel anxious when the doctor tells you your epilepsy isn't getting better with the medicine you're taking. You don't have to go through it alone, though. It's important to reach out to family and friends to get the emotional support you need. You might also want to join a support group, so you can talk with other people who are going through the same things you are.
Doctors don’t know why some people have refractory epilepsy and others don't. You can have refractory epilepsy as an adult, or your child might have it. About 1 in 3 people with epilepsy will develop it.
The symptoms of refractory epilepsy are seizures despite taking anti-seizure medication. Your seizures could take different forms and last from a few seconds to a few minutes.
You may have convulsions, which means you can't stop your body from shaking.
When you have a seizure, you may also:
- Black out
- Lose control of your bowels or bladder
- Stare into space
- Fall down suddenly
- Get stiff muscles
- Bite your tongue
Getting a Diagnosis
Your doctor has several ways to diagnose refractory epilepsy. They may ask you questions such as:
- How often do you have seizures?
- Do you ever skip doses of your medicine?
- Does epilepsy run in your family?
- Do you still have seizures after taking medicine?
Your doctor may also give you a test called an electroencephalogram. To do this, they'll place metal discs called electrodes on your scalp that measure brain activity.
Other tests might include a CT scan of your brain. It's a powerful X-ray that makes detailed pictures of the inside of your body.
You might also need to get an MRI of your brain. It uses magnets and radio waves to make pictures of your brain.
If you need surgery to treat refractory epilepsy, these tests can help doctors find out where your seizures are starting.
Your doctor will most likely want you to report your symptoms regularly. They may try several drugs at different doses.
Questions for Your Doctor
- What might be causing my seizures?
- Which tests are needed to diagnose refractory epilepsy?
- Should I see an epilepsy specialist?
- What treatments are available for refractory epilepsy?
- What precautions should I take to avoid getting injured during a seizure?
- Are there any limits on my activities?
Medications. Your doctor may take a second look at the drugs you're taking. They may suggest another medicine, either alone or combined with other drugs, to see if it helps you have fewer seizures.
Many drugs can treat epilepsy, including:
- Cannabidiol (Epidiolex)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Oxcarbazepine (Trileptal)
- Tiagabine (Gabitril)
- Topiramate (Topamax)
- Zonisamide (Zonigran)
Surgery. If you still have seizures after trying two or three anti-epilepsy drugs, your doctor might recommend brain surgery.
It can help a lot if your epilepsy only affects one side of your brain. Doctors call that refractory partial epilepsy.
A surgeon removes the area of your brain that's responsible for your seizures.
It's natural to worry about brain surgery and to wonder if it will affect the way you think or if you'll seem like a different person afterward. Talk with your doctor about what to expect if you choose the surgery or if you don't, so you can weigh the risks and benefits. A lot of people who have the surgery say that getting free of seizures -- or at least making them less common and less intense -- makes them feel much better.
The surgeon usually operates on an area of your head that's behind your hairline, so you won't have noticeable scars.
After it's done, you'll probably need to stay in an intensive care unit of the hospital for a few days. After that, you'll move to a regular hospital room, where you may need to stay for up to 2 weeks.
You should take it easy for a while after you get back home, but you'll probably be able to return to a normal routine in 1 to 3 months. Even with the surgery, you might need to take seizure medication for a few years. You might need to stay on the drugs for the rest of your life.
Talk to your doctor about any side effects you might have from the surgery. You can ask them to put you in touch with other people who've had the surgery, so you can better understand what to expect.
Diet. The ketogenic diet helps some people with epilepsy. It's a high-fat, low-protein, low-carb diet. You have to start it in a specific way and follow it strictly, so you need a doctor's supervision.
Your doctor will watch closely to see whether or when you can lower any of your medication levels. Because the diet is so specific, you may need to take vitamin or mineral supplements.
Doctors aren't sure why the ketogenic diet works, but some studies show that children with epilepsy who stay on the diet have a better chance of reducing their seizures or their medications.
For some people, a modified Atkins diet may work, too. It's slightly different from the ketogenic diet. You don't have to restrict calories, protein, or fluids. Also, you don't weigh or measure foods. Instead, you track carbohydrates.
People with seizures that are hard to treat have also tried a low-glycemic-index diet. This diet focuses on the type of carbs, as well as the amount, that someone eats.
Electrical stimulation, also known as neuromodulation. This technology works directly on your nerves. It changes or controls nerve activity by sending electrical signals or medicine to a specific area. Methods include:
- Cortical stimulation. Temporary electrodes are placed on the surface of your brain. The doctor sends a signal through them at a level low enough that you won’t notice. If it helps, they can be replaced with permanent electrodes for continuous stimulation.
- Closed-loop stimulation. The doctor implants a device under your scalp and within your skull. It’s connected to two electrodes placed either on the surface of your brain, in the brain, or both. The electrodes record your brain waves. When the neurostimulator detects seizure-like activity, it sends a small electrical current to your brain that can stop, shorten, or maybe prevent the seizure.
- Deep brain stimulation. The doctor implants thin electrodes deep into certain areas of your brain and a pulse generator under your collarbone. Wires under your skin connect the two. The pulse generator sends signals to disrupt abnormal patterns of brain activity.
- Vagus nerve stimulation (VNS). The doctor puts a device that looks like a heart pacemaker under your left collarbone. It connects to the vagus nerve in your neck through a wire that runs under your skin. The device sends a current to the nerve, which may cut down on the number of seizures you get or make them less intense.
Clinical trials. You may want to ask your doctor if you could take part in a clinical trial. These trials test new drugs to see if they're safe and if they work. They're often a way for people to try new medicine that isn't yet available to everyone.
Taking Care of Yourself
Stress can sometimes trigger seizures. Talking to a counselor is a great way to find solutions to manage your stress.
Try going to a support group, too. You can talk with people who know what you're going through and who give advice from their own experience.
What to Expect
Even though you have refractory epilepsy, it's still possible to get your seizures under control. It may be a matter of switching to a different treatment.
Your doctor may find a different drug combination that helps. Getting electrical stimulation of the vagus nerve means fewer seizures for about 40% of people who try it. And if a brain surgeon can remove the part of the brain that's causing seizures, the seizures may stop, or at least happen less often and become less intense.
As you are finding out what works best, you'll need to a strong network of family and friends who can offer emotional support, especially if your seizures prove hard to control. Having a trusted person to listen can be a great comfort when you're going through something tough.
Ask your doctor for information on support groups in your area. You can also find out about support groups by going to the website of the Epilepsy Foundation.