14. Recognizing Intractability to Antiepileptic Medication

  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. Bassel W. Abou-Khalil

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch14



How to Cite

Abou-Khalil, B. W. (2014) Recognizing Intractability to Antiepileptic Medication, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch14

Editor Information

  1. 2

    University of Washington, Seattle, WA, USA

  2. 3

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

Author Information

  1. Epilepsy Center, Vanderbilt University School of Medicine, Nashville, TN, USA

Publication History

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

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989



  • epilepsy intractability;
  • drug-resistance;
  • remission and relapse;
  • treatment algorithm;
  • epilepsy surgery


Approximately one third of patients with epilepsy will not become seizure-free with antiepileptic drug (AED) therapy. Predictors of drug resistance include the epilepsy syndrome diagnosis and the presence of certain structural lesions. However, early response to AED therapy is one of the most important predictors, with decreasing odds of seizure freedom after failure of every additional drug. Accordingly, drug-resistance is defined as failure of adequate trials of two tolerated and appropriately chosen AED schedules. This determination should prompt re-evaluation of the diagnosis of epilepsy and consideration of surgical therapy in a subset of patients with surgically remediable epilepsy syndromes.