As the name suggests, intractable epilepsy is epilepsy that is difficult to control and is quite serious. It is a classification of the epilepsy and not a type. Epilepsy is said to be intractable if different medications are not reducing or stopping the incidence of seizures.
Intractable epilepsy is also referred to as drug resistant epilepsy (DRE) or refractory epilepsy. Epilepsy is usually treated with anti-epileptic drugs (AED) also known as anti-seizure drugs or anticonvulsant drugs. These medications curb seizures but they do not cure the epilepsy. About 20% of people with epilepsy have the intractable kind. In these types of cases, several anticonvulsant drugs are prescribed at the same time.
Multiple drug resistance may be caused by allergic reactions, non-allergic intolerance or what is sometimes referred to as honeymooning. Honeymooning is simply developing tolerance to the drugs. Drug tolerance can result from having a metabolism that causes drugs to be inactive. Drug tolerance can result from having a metabolism that causes drugs to be inactive.
Other factors, such as frequency of seizures and the time of unresponsiveness during a seizure are also considered besides drug resistance.
Since intractable epilepsy is non-responsive to medication, non-drug therapies become viable treatment options. The non-pharmacological treatments may include surgery, vagal nerve stimulation and the ketonic diet.
Surgery is an excellent option for candidates who have seizures originating from one part of the brain (focal seizures). The surgery most commonly performed on adults involves removing a part of one of the temporal lobes, which is quite often the focus of the seizures. The surgical procedure may completely stop the epileptic seizures or make them more responsive to anti-seizure medications. Surgery is not a very common non-drug therapy because a majority of epilepsy sufferers are not good candidates for surgery.
Vagal nerve stimulation (VNS) is another non-drug therapy for intractable epilepsy. Even though it is very commonly used, it is not as effective as surgery. It involves implantation of a device in the chest. This device is connected to the vagus nerve, a nerve that comes from the brain, with a wire. This implant is set to give electrical charges at regular intervals.
A third non-drug therapy for intractable epilepsy is the ketogenic diet. This diet is high fat, with lots of protein, but low carbohydrates. This diet has been proven to be quite effective in a number of cases and is most commonly used in children. However, because it is not a very balanced diet, it can only be used for a short period of time, not exceeding 3 years.
There are a number of epilepsies that are considered intractable by their very nature. These include Lennox Gastaut syndrome, early infantile epileptic encephalopathy and early neonatal myoclonic encephalopathy to name a few.
Though this article may seems a little depressing, the good news is that intractable epilepsy is not very common. There is also a lot of research going on that will hopefully bring some relief to intractable epilepsy sufferers in the not so distant future.