Epilepsy is a disorder of the Central Nervous System which causes the brain to act differently or abnormally. In this disorder one may experience seizures, loss of awareness and certain sensations. It is one of the most common neurological disorders and can affect people of any age or race. In most cases, Epilepsy can be managed and controlled using anti-epileptic drugs but in some cases, patients fail to gain from these. This type of epilepsy is known as Refractory Epilepsy or Drug Resistant Epilepsy.

Epilepsy Facts (World Health Organization)
● Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
● Nearly 80% of people with epilepsy live in low and middle income countries.
● It is estimated that up to 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated.

Refractory Epilepsy or Drug Resistant Epilepsy, as the name suggests is that form of epilepsy in which the patient doesn’t respond to drug therapy as expected. Some other names by which this treatment is known are medically refractory epilepsy, intractable or pharmacoresistent epilepsy. It is rather surprising to know that as many as 20-40% cases of Epilepsy are refractory Epilepsy. However it is recommended that a patient takes a few drug trials before refractory epilepsy is established just to be sure so that the further treatment can be hence recommended by the doctors.

Treatment for Refractory Epilepsy patients:
● Once Refractory Epilepsy is established, doctors may refer the patient for a presurgical evaluation that is generally done at an Epilepsy centre or healthcare facility. This is done in order to find out whether or not the patient is suitable for epilepsy surgery epilepsy operation. If surgery is the way to go, then two options are available-resective procedure and disconnective procedure.
● In case, the patient is not a suitable candidate for surgery or if the patient declines an epilepsy surgery or surgery for epilepsy the next step could be either a proper diet program or vagus nerve stimulation.

Vagus nerve stimulation is a procedure in which a pacemaker type of a device is implanted in the chest area to send electrical impulses to the vagus nerve. This inhibits the generation of seizures through the brain.

It has been a known fact that diet can help with Epilepsy and may reduce the occurrence of seizures. Those who do not benefit from medication or drugs thus rely on a high fat content low carbohydrate content diet. Some diets which epilepsy patients swear by include ketogenic diet, MCT-ketogenic diet, modified Atkins diet and others.

Refractory Epilepsy is not totally incurable but one has to undergo trials and different forms of treatments to be able to identify which fits best in their case. Deep brain stimulation as well as responsive neurostimulation is approved in certain countries and may prove beneficial for Refractory epilepsy patients.

Prevention
As per estimates 25% of epilepsy cases can be prevented.
● Preventing head injury can prevent post traumatic epilepsy.
● Adequate perinatal care during childbirth can prevent epilepsy caused by birth injury.
● Avoiding high fever in children.
● Avoidance or timely treatment of infection of the central nervous system.

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