When epilepsy is called drug-resistant
Drug-resistant epilepsy is usually defined as failure of two appropriately chosen and tolerated antiseizure medicines to achieve sustained seizure freedom. The definition assumes the diagnosis is correct and the medicine has been taken as prescribed.
Before accepting that label, the review checks whether the events are truly epileptic seizures, whether the epilepsy type and syndrome are correct, whether doses are adequate, and whether sleep, alcohol, missed doses or drug interactions are contributing.
Related: Neurology → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
What a specialist review changes
A structured seizure diary, witness account and video where available are more useful than a list of events. EEG and MRI are reviewed for focal abnormalities, and medication is checked for interactions and side effects.
Some patients have non-epileptic attacks, syncope, sleep-related events or migraine variants. Others have a surgically treatable focal lesion. Distinguishing these is the main purpose of a specialist review.
- Confirm the event type and epilepsy syndrome
- Review adherence, triggers and sleep
- Re-read EEG and MRI with the clinical story
- Check interactions and cumulative side effects
Advanced treatment options
Options may include a carefully chosen third medicine, a different drug class, or referral for epilepsy surgery evaluation when seizures are focal and a lesion is identified. Dietary therapy and device-based treatments are considered in selected patients.
The discussion is individualized: seizure type, age, pregnancy plans, driving, work, bone health and mood all matter. Dr. Yadav explains the potential benefits and limitations without promising seizure freedom.
Access and booking
Appointments are at Kathmandu Neurology Clinic & Cognitive Center, 117 Lal Durbar Marg, Kathmandu, opposite Yak & Yeti Hotel. Call +977-9747736624 or use /book-appointment. Bring prior reports, imaging and a medication list.