Pharmacoresistant epilepsy. Clinical lecture

A.S. Kotov, K.V. Firsov, E.A. Sandu

M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow

The article analyzes the definition of the concept pharmacoresistant epilepsy (PRE). The social significance of this disease is noted. The article also gives a detailed description of various types of PRE (genetic traits, morphological substrates, clinical phenomena, some typical biomarkers). Further study prospects of these predictors for the early detection of persons with PRE, as well as the main diagnostic methods in patients with pharmacoresistant epilepsy, including non-invasive and minimally invasive procedures of pre-surgical diagnosis are described. The main surgical treatment methods (resective and functional) are given, the method and types of invasive and non-invasive brain stimulation are considered. There are the main types of therapeutic diets in patients with PRE, such as the classic ketogenic diet, medium-chain triglyceride ketogenic diet, the modified Atkins diet, low glycemic diet. Adding that, the article gives the basic principles of pharmacological therapy for PRE. It is particularly noted that in pharmacoresistance, it is necessary to take into account not only the impossibility of achieving a sustained remission of seizures but also the presence of significant adverse events that, even in achieved remission, can force the patient to refuse to take an antiepileptic drug.

Keywords: epilepsy, pharmacoresistance, predictors, diagnosis, treatment, electrical stimulation.

For citation: Kotov A.S., Firsov K.V., Sandu E.A. Pharmacoresistant epilepsy. Clinical lecture. RMJ. 2021;6:33–39 (in Russ.).