EAN 2023 | Pharmacotherapeutic approach to difficult-to-treat epilepsy

Christian Brandt, MD, Bielefeld University, Medical School, Bielefeld, Germany, shares insights on the current pharmacotherapeutic options available for difficult-to-treat epilepsy. Around 1/3rd of patients with epilepsy are drug refractory, meaning they have not responded to at least two anti-seizure medications (ASMs). While the agents available for patients with refractory epilepsy are the same as those used in the first-line setting, such as lamotrigine and levetiracetam for focal epilepsy, a combinatory approach is usually tried. Healthcare providers try to give agents with complementary mechanisms of action, to improve the chances of success. Rational polypharmacy is an important area of investigation in epilepsy. Additionally, agents that are typically avoided as the first choice may be used, such as enzyme-inducing antiseizure medications and those with cognitive side effects. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.

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