Evaluation and management of drug-resistant epilepsy (DRE)

EEG: electroencephalography; MRI: magnetic resonance imaging; PET: positron emission tomography; ASM: antiseizure medication; GTC: generalized tonic-clonic; GLUT-1: glucose transporter-1; PDH: pyruvate dehydrogenase; TSC: tuberous sclerosis complex.

* DRE is defined as the failure of adequate trials of 2 tolerated, appropriately chosen and administered ASMs (as monotherapy or in combination) to achieve seizure freedom.

¶ A comprehensive evaluation isn't necessary in every case; based on the patient's history, previous tests, and medication trials, it may be obvious why seizures are continuing, and the initial strategy may be to optimize the ASM regimen rather than perform a lengthy and expensive evaluation.

Δ Useful strategies to mitigate seizure precipitating factors and improve adherence include regular follow-up visits, patient education, use of a seizure calendar, ASM level monitoring, review of adverse ASM effects, and avoidance of seizure triggers (eg, sleep deprivation, alcohol intake, and stress).