2024/11/12 by Lara Jehi · 22 citations
Biochemistry, Genetics and Molecular Biology · Medicine · #Ablation #Central nervous system #Clinical trial #Drug Resistant Epilepsy #Epilepsy #Epilepsy research and treatment #Epilepsy surgery #Genetics and Neurodevelopmental Disorders #Intensive care medicine #Internal medicine #Medicine #Neurological disorders and treatments #Neuromodulation #Psychiatry #Randomized controlled trial #Refractory (planetary science) #Surgery
paper · doi:10.1146/annurev-med-050522-034458
published in Annual Review of Medicine 76(1), 389-402 (Annual Reviews)
openalex publication_date 2024/11/12 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
Drug-resistant epilepsy (DRE) is defined as failure to achieve sustained seizure control with adequate trials of two appropriate antiseizure medications (ASMs). DRE affects one-third of patients with epilepsy and is associated with significant morbidity and mortality. Newer ASMs provide pharmacological therapy that is better tolerated but not necessarily more effective than older ASMs. Resective brain surgery is the gold standard to treat DRE and achieve seizure freedom, with laser ablation offering an alternative with less morbidity but lower effectiveness. For patients who are not candidates for resection or ablation, multiple neuromodulation options can reduce seizure burden. These neuromodulation devices have shown comparable effectiveness in randomized clinical trials, but the results vary in open-label follow-up cohorts, as do the risks of complications and associated costs. Dietary therapies can help, particularly in pediatric genetic epilepsies. Innovative genetic therapy approaches are being pursued, offering the promise of precision medicine.