10. Evaluation of the Patient with Medically Refractory Epilepsy

  1. John W. Miller MD, PhD Director, UW Regional Epilepsy Center, Professor of Neurology and Neurological Surgery2 and
  2. Howard P. Goodkin MD, PhD The Shure Professor of Neurology and Pediatrics, Director, Division of Pediatric Neurology3
  1. Gregory L. Holmes

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch10



How to Cite

Holmes, G. L. (2014) Evaluation of the Patient with Medically Refractory Epilepsy, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch10

Editor Information

  1. 2

    University of Washington, Seattle, WA, USA

  2. 3

    Department of Neurology, University of Virginia, Charlottesville, VA, USA

Author Information

  1. Department of Neurological Sciences, University of Vermont, Burlington, VT, USA

Publication History

  1. Published Online: 10 JAN 2014
  2. Published Print: 14 FEB 2014

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989



  • refractory epilepsy;
  • antiepileptic drugs;
  • medication compliance;
  • neuroimaging;
  • neurogenetics;
  • epilepsy surgery


Approximately a third of patients with epilepsy continue to have seizures despite multiple trials of antiepileptic drugs. Refractory epilepsy can have significant adverse effects on the physical, psychological, cognitive, social, educational, and vocational well-being of the individual and thus represent a major public health concern. Clinicians caring for individuals with refractory seizures should regularly re-evaluate the patients to be certain they are treating epileptic seizures rather than nonepileptic behaviors and they are treating the correct seizure type and syndrome with the correct antiepileptic drug. Assessing medication compliance and precipitating factors triggering seizures is important in determining whether the patient is truly medically intractable. There should be an ongoing effort to determine the correct etiology of the epilepsy as treating the underlying cause of the seizures may be far more effective than concentrating solely on treatment of the seizures. Identifying seizure triggers and encouraging compliance may dramatically improve seizure control. Finally, patients who have refractory epilepsy despite the best efforts of the clinician should be referred to tertiary epilepsy centers where the patient can undergo a comprehensive evaluation for etiology of the epilepsy and be assessed for possible epilepsy surgery or experimental therapeutics.