Drug-Resistant epilepsy: Mechanisms, Pathogenesis

Despite the development of new antiepileptic drugs (AEDs),~ 20%_30% of people with epilepsy remain refractory to treatment and are said to have drug resistant epilepsy (DRE). This multifaceted condition comprises *intractable seizures , *neuro biochemical changes , *cognitive decline , *psychosocial dysfunction , DRE management is complicated by the heterogeneity among this patient group. The underlying mechanism of DRE is not completely understood. Relate to both the intrinsic characteristics of the particular epilepsy (associated syndrome, lesion initial response to AED and the number and type of seizure prion to diagnosis) and other pharmacological mechanism of resistance is important. The four current hypotheses behind pharmacological resistance are the transporter , target , network and intrinsic severity. We have challenge in managing patients with DRE and this requires a multidisciplinary approach. Physicians, surgeons, psychiatrists, neuropsychologists, pharmacists, dietitians, and specialist nurses. Attention to comorbid psychiatric and other diseases in paramount. Attention to seizure threshold and psychoactive drugs. Attention to risk factors drugs and patients.Attention to psychopathology and epilepsy. Attention to excitatory/inhibitory mechanisms. Attention to pseudo pharmacoresistance. Attention to AEO compliance and tolerability. Some of the reasons for drug resistance lie in the way physicians treat this issue. The last word is treat the causes drug resistant epilepsy must be highlight.