Refractory seizures: Try additional antiepileptic drugs (after two have failed) or go directly to early surgery evaluation?

Abstract

The goal of antiepileptic therapy is to achieve long-term seizure freedom with minimal or no adverse effects. Current evidence suggests that in many patients who have failed two appropriate antiepileptic drugs (AEDs) because of lack of efficacy, the chance of subsequent seizure freedom with further drug manipulation is low (reports ranging from as little as a few percent to nearly one-fourth of patients). Achieving this may require repeated drug manipulations. Surgery, in appropriately selected candidates, may render up to 70% of patients seizure-free when temporal resection is done, although frontal resection may have only a 25% yield. Both courses of actions (further drug trials and surger..