Brain & Nervous System Epilepsy An Overview of Intractable Epilepsy By Lana Barhum facebook linkedin Lana Barhum has been a freelance medical writer for over 10 years. She shares advice on living well with chronic disease. Learn about our editorial process Lana Barhum Medically reviewed by Medically reviewed by Doru Paul, MD on July 02, 2019 Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center. Learn about our Medical Review Board Doru Paul, MD Updated on August 28, 2019 Print Table of Contents View All Symptoms Causes Diagnosis Treatment Coping Intractable epilepsy is diagnosed when someone has had years of uncontrolled seizures. This means medication no longer works well enough to control their episodes, and their seizures are frequent, severe, and affecting their quality of life. Research shows that up to 40 percent of people who have epilepsy will eventually develop intractable epilepsy, also called drug-resistant epilepsy or refractory epilepsy. Verywell / Cindy Chung Symptoms The main symptoms of intractable epilepsy are continuing seizures even when taking anti-seizure drugs. Seizures will vary in intensity and frequency and can last minutes or seconds. They are caused by electrical imbalances in the brain and hyperactive neurons. Some people with intractable epilepsy may have convulsions, which means they cannot stop shaking. Seizures may also cause: BlackoutsLoss of bladder or bowel controlStaring into spaceFallingStiff musclesBiting the tongue Symptoms may be more prominent in children, as this type of epilepsy is estimated to affect 10 percent to 20 percent of children with epilepsy, according to one report in The Indian Journal of Pediatrics. Causes Normal epilepsy drugs may not work well for many reasons, including: The seizures simply become stronger than the medication when given at medically safe dosage.Poor compliance with medication (missing doses)Complicating factors, such as extreme stress, sleep deprivation, and illnessAdditional medical conditions, including syncope (a temporary loss of consciousness related to insufficient brain blood flow): Evidence shows that the two conditions are often confused, but there are instances of people having both conditions. One study reported in BMC Neurology found that up to 41.1 percent of those with epilepsy had drug-resistant epilepsy, and of those, 65.9 percent had both syncope and epilepsy.Brain abnormalitiesGenetic causesMedication tolerance: In this case, a medication generally works for a few months and then symptoms return. The cycle will repeat with a new medication. Medications just don’t help some people: Some people may need more than one medication to control seizures, but those additional medications don’t always stop seizures altogether. One study reported in the New England Journal of Medicine found that people who have many seizures prior to starting treatment, or who have inadequate responses to initial treatments, are more likely to develop intractable epilepsy. In some cases, side effects were to blame, and patients had to discontinue treatment, and in other cases, the drugs themselves were not successful. Diagnosis Typically, you must be diagnosed with epilepsy for a considerable amount of time before it can be labeled intractable. Your doctor will consider factors such as: How often you have seizuresHow well you've stuck to your treatment regimenIf you still have seizures when properly medicated Much like when you went through the initial diagnostic process for epilepsy, you can expect a variety of tests and scans once your epilepsy is declared intractable. These can include: Electroencephalogram (EEG)Computerized tomography (CT) scanMagnetic resonance imaging (MRI) These scans may help your doctor identify previously unknown factors that may influence future treatment decisions, which may involve surgery or an implant. Treatment Antiepileptic drugs (AEDs), as single or combination treatments, are a first-line of treatment prescribed to manage seizures. When one medication does not work, another is attempted. Unfortunately, the success rate becomes reduced after numerous AED failures. Generally, after multiple AED failures, doctors will start looking at other ways to treat and manage seizures. Additional treatment options after medication failure may include lifestyle changes, VNS therapy, and surgery. According to one report in the New England Journal of Medicine, after two failed therapies, the success rate for the third treatment is very low—around 4 percent. Diet Changes Some research has shown the ketogenic diet may lessen the number of seizures for some people. This diet is a high-fat, low-carbohydrate one that involves strict monitoring by a dietitian. It usually prescribed for children whose seizures are not responding to medications. One study reported in the Iranian Journal of Pediatrics shows a success rate of 58.4 percent in children whose epilepsy was previously not well-managed with medication. 2:13 The Ketogenic Diet and Epilepsy The Ketogenic Diet for Epilepsy Improving Sleep Seizures are sensitive to sleep patterns. When people with epilepsy don’t sleep well, it is more likely they will have seizures. Lack of good quality sleep may also increase the frequency and length of seizures. It is, therefore, important to develop consistent sleep habits, including getting at least eight hours of sleep every night and going to bed and getting up at the same times. 10 Ways to Sleep Better Tonight VNS Therapy Vagus nerve stimulation (VNS) therapy involves a small electric device, much like a pacemaker. The device is implanted under the skin of the chest and sends electrical impulses to the brain through the vagus nerve, which is in the neck. The goal of treatment is to reduce the frequency and intensity of seizures. Surgery Surgery in the brain can control seizures and may involve: Implanting a device to treat seizuresRemoving the area of the brain causing seizuresDisrupting nerve pathways that promote seizure impulses Surgery to treat intractable epilepsy is not for everyone. It is only an option if the part of the brain causing the seizures can be identified. Moreover, the area to be removed must not be one that affects important functions, such as speech, touch, and movement. VNS for Seizure Prevention Coping Intractable seizures are difficult to live with. You may not be able to drive, go to work, or take part in activities you enjoy because of your seizure risk. You may have to face considerable lifestyle changes, at least until you find treatments that reduce your seizure frequency. It's important to develop healthy coping strategies for multiple aspects of your life—emotional, physical, social, and practical. Don't think of a diagnosis of intractable epilepsy as an endpoint. It doesn't mean treatments won't work for you, just that you haven't found the right ones yet. Keep working with your doctor to find something that helps. Living Your Best Life With Epilepsy A Word From Verywell Intractable epilepsy does not always remain medication-resistant. One of the many available treatments may help you manage your symptoms. Additionally, you may benefit from improving your lifestyle. Even without new or specific therapies and/or lifestyle changes, some people’s epilepsy does improve and can eventually be managed by medicine. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Aneja, Jain P. Refractory epilepsy in children. Indian J Pediatr. 2014 Oct;81(10):1063-72. DOI: 10.1007/s12098-014-1533-1. Krauss GL, Sperling MR. Treating patients with medically resistant epilepsy. Neurol Clin Pract. 2011 Dec; 1(1): 14–23. DOI: 10.1212/CPJ.0b013e31823d07d1. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000 Feb 3;342(5):314-9. DOI: 10.1056/NEJM200002033420503. Sinha S, Siddiqu KA. Definition of intractable epilepsy. Neurosciences (Riyadh). 2011 Jan;16(1):3-9. Ungar A, Ceccofiglio A, Pescini F, et al. Syncope and epilepsy coexist in ‘possible’ and ‘drug-resistant’ epilepsy (Overlap between Epilepsy and Syncope Study - OESYS). BMC Neurology. 2017 Feb 28;17(1):45. doi: 10.1186/s12883-017-0822-5.