Causes and Risk Factors of Drug-Resistant Epilepsy in Children

OBJECTIVES: Epilepsy, the tendency to have recurrent unprovoked seizures, is the most common chronic neurological disorder worldwide. About 20% to 40% of children with epilepsy suffer from refractory seizures, causing neurological, cognitive, and psychosocial impairments. Identifying the factors contributing to pediatric refractory seizures can help neurologists effectively prevent, diagnose, and treat their patients. MATERIALS & METHODS: In this cross-sectional study, 2 to 16 years old children with refractory seizures (drug-resistant epilepsy) were assessed regarding their demographic and seizure-associated characteristics. RESULTS: Children with refractory seizures had a significantly higher rate of neonatal asphyxia, hospitalization after birth, neonatal seizures, and seizure in the first year of life, history of infantile spasm, and symptomatic epilepsy. Furthermore, polymorphic seizures and brain MRI abnormalities were significantly more frequent among them. Several different mechanisms have been suggested for explaining intractability in epileptic patients. None of the mechanisms can explain all patients. The most common underlying etiologies for seizures in the intractable group were hypoxic-ischemic damage, cerebral dysgenesis, and genetic disorders. CONCLUSION: Seizure intractability results from a tremendous deleterious change in the brain’s structure. Early identification of the risk factors and prediction of patients likely to have pharmaco-resistant epilepsy will allow more aggressive treatment and earlier specialized intervention.