15. Optimizing Antiepileptic Drug Therapy in 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. Nicholas P. Poolos

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch15



How to Cite

Poolos, N. P. (2014) Optimizing Antiepileptic Drug Therapy in Refractory Epilepsy, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch15

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 Neurology and UW Regional Epilepsy Center, University of Washington, Seattle, WA, USA

Publication History

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

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989



  • refractory;
  • compliance;
  • seizure exacerbation;
  • AED mechanism of action


Refractory epilepsy affects about one-third of all epilepsy patients, yet there are few evidence-based guidelines for its treatment. The likelihood of treatment success is increased by definitively establishing the epilepsy diagnosis through video–EEG monitoring, emphasizing compliance with treatment and avoiding provocation by alcohol abuse, and avoiding antiepileptic drugs (AED) that exacerbate seizures in generalized epilepsy. Persistence in trying different AED combinations sometimes arrives at a successful drug regimen, thus neither the clinician nor the patient should give up hope in this difficult to treat condition.