American Journal of Clinical Medicine Research
ISSN (Print): 2328-4005 ISSN (Online): 2328-403X Website: Editor-in-chief: Dario Galante
Open Access
Journal Browser
American Journal of Clinical Medicine Research. 2014, 2(1), 26-31
DOI: 10.12691/ajcmr-2-1-7
Open AccessArticle

Predictors and Typical Clinical Findings of Refractory Epilepsy

E. Viteva1,

1Department of Neurology, University of Medicine, Plovdiv, Bulgaria

Pub. Date: February 07, 2014

Cite this paper:
E. Viteva. Predictors and Typical Clinical Findings of Refractory Epilepsy. American Journal of Clinical Medicine Research. 2014; 2(1):26-31. doi: 10.12691/ajcmr-2-1-7


Purpose: Our purpose was to identify the predictors of refractory epilepsy (RE) and the typical clinical findings in Bulgarian patients with RE. Patients and Methods: We studied 70 adult patients with refractory epilepsy and 70 patients with pharmaco sensitive epilepsy. The Liverpool Seizure Severity Scale was completed by 84.29% of the patients with RE. Results: The typical clinical findings and significant predictors of RE on univariate analysis were: high initial seizure frequency (OR = 2.45), heredity for epilepsy (OR = 8.90), febrile seizures (OR = 4.50), partial epilepsy (OR = 5.98), low or lacking seizure reduction with the first AED (OR = 44.0), clusters of seizures and/or epileptic status in the disease course (OR = 16.5), childhood onset (OR = 8.0), great number of ineffective antiepileptic drugs (AED) – OR = 232.88, poly therapy (OR = 61.0). On multivariate analysis significant predictors of RE were poly therapy (B = 4.86), childhood onset (B = 2.79), and great number (> 4) of ineffective AED (B = 5.44). Frequent clinical findings were: moderate seizure severity, high seizure frequency despite the prescribed treatment, polymorphic seizures. Conclusion: The most significant predictors of RE are: great number of ineffective AED, treatment with poly therapy, and early disease onset. This conclusion may be useful for a timely identification of patients with epilepsy who are likely to be refractory to medical therapy.

predictor refractory epilepsy clinical finding typical

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Hitiris N, Mohanraj R, Norrie J, Sills GJ, Brodie MJ. Predictors of pharmaco resistant epilepsy. Epilepsy Res. 2007. 75 (2-3): 192-6.
[2]  Panov G. Comparative clinical, neuro-physiological and psychiatric assessment of patients with refractory and well-controlled epileptic seizures [thesis]. Pleven: Medical University, 2004.
[3]  Callaghan BC, Arnaud K, Hesdoffer D, Hauser WA, French JA. Likelihood of seizure remission in an adult population with refractory epilepsy. Ann Neurol. 2007. 62 (4): 382-9.
[4]  Mc Intyre D, Gilby K. Parahippocampal networks, intractability and the chronic epilepsy of kindling. Adv Neurol. 2006. 97: 77-83.
[5]  Raffo E. Critères de pharmaco-résistance d’une épilepsie: les critères du neuropédiatre. Rev Neurol (Paris). 2004. 160 Spec №1: 5S48-52.
[6]  Starreveld E, Guberman A. The spectrum of intractable epilepsy: a proposed scale. Adv Neurol. 2006. 97: 493-6.
[7]  Naidenov А. Risk factors for the development of pharmaco resistant epilepsy in childhood. Epilepsy today. 2007. 1: 63-7.
[8]  Cekov St. Epilepsy. Main characteristics, diagnostic, and therapeutic principles. Varna: Zograff. 2003: 327-9.
[9]  Altunbaşak S, Herguner O, Regik Burgut H. Risk factors predicting refractoriness in epileptic children with partial seizures. J Child Neurol. 2007. 22 (2): 195-9.
[10]  Andrade D, Zumsteng D, Sutula T, Wennberg R. Clinical aspects of temporal/limbic epilepsy and their relationship to intractability. Adv Neurol. 2006. 97: 39-44.
[11]  Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology. 2001. 56 (11): 1445-52.
[12]  Bordet R. Epilepsies partielles pharmacoresistantes: les critères du pharmacologue. Rev Neurol (Paris). 2004. 160 Spec №1: S36-42.
[13]  Brodie MJ. Diagnosing and predicting refractory epilepsy. Acta Neurol Scand Suppl. 2005. 181: 36-9.
[14]  Casetta I, Granieri E, Monetti VC, et al. Early predictors of intractability in childhood epilepsy: a community-based case control study in Copparo, Italy. Acta Neurol Scand. 1999. 99 (6): 329-33.
[15]  De Saint-Martin A, Hirsch E. Les épilepsies partielles pharmacorésistantes. Quels sont les critères de pharnacorésistance pour le neuropédiatre? Rev Neurol (Paris). 2004. 160 Spec № 1: 5S43-7.
[16]  Farrell K, Wirrel E, Whiting S. The definition and prediction of intractable epilepsy in children. Adv Neurol. 2006. 97: 435-42.
[17]  French JA. Refractory epilepsy: clinical overview. Epilepsia. 2007. 48 (Suppl 1): 3-7.
[18]  Gelisse P, Crespel A. Critères de gravité des épilepsies partielles pharmacorésistantes chez l’adulte. Rev Neurol (Paris). 2004. 160 Spec №1: 5S71-9.
[19]  Jallon P. Epidemiology of drug-resistant epilepsy. Rev Neurol (Paris). 2004. 160 Spec №1: 5S22-30.
[20]  Kwan P, Sander JW. The natural history of epilepsy: an epidemiological view. J Neurol Neurosurg Psychiatry. 2004. 75 (10): 1376-81.
[21]  Silfevnius H. Cost and cost-effectiveness of epilepsy surgery. Epilepsia. 1999. 40 (Suppl 8): 32-9.
[22]  Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol. 1999. 110 (7): 1245-51.
[23]  Panov G. Refractory epilepsy. Bulgarian Neurology. 2003. 3 (2): 98-101.
[24]  Mohanraj R, Brodie MJ. Diagnosing refractory epilepsy: responses to sequential treatment schedules. Eur J Neurol. 2006. 13 (3): 277-82.
[25]  Perucca E. Pharmacoresistance in epilepsy: how should it be defined? CNS drugs. 1998. 10: 171-9.
[26]  Sander JW. The prognosis of epilepsy. Outcome 2005. The National Society of epilepsy. E-epilepsy Library of articles: 329-34.
[27]  Chengyun D, Guominq L, Elia M, Catania MV, Qunyuan X. Expression of multidrug resistance type 1 gene (MDR1) P-glycoprotein in intractable epilepsy with different aetiologies: a double-labelling and electron microscopy study. Neurol Sci. 2006. 27 (4): 245-51.
[28]  Del Campo J. Neocortical epilepsies: aspects distinguishing intractable from benign neocortical epilepsies. Adv Neurol. 2006. 97: 105-116.
[29]  Tripathi M, Padhy UP, Vibha D, et al. Predictors of refractory epilepsy in north India: a case-control study. Seizure. 2011. 20 (10): 779-83.
[30]  Chabolla D. Medically refractory seizures. Jacksonville Medicine 2000; dcms-footer. htm: 1-12.
[31]  Fang PC, Chen YJ, Lee IC. Seizure precipitants in children with intractable epilepsy. Brain Dev. 2008. 30 (8): 527-32.
[32]  Sillanpää M, Schmidt D. Early seizure frequency and aetiology predict long-term medical outcome in childhood-onset epilepsy. Brain. 2009. 132 (Pt 4): 989-98.
[33]  Rasheva M, Milanova M, Radeva M, Atanasova D. Assessment of new AEDs as add-on therapy in patients with resistant partial epilepsies. Bulgarian Neurology. 2004. 4 (4): 173-8.
[34]  Genton P. Définition de la pharmacorésistance: le point de vue de l’épileptologue. Rev Neurol (Paris). 2004. 160 Spec №1: 5S53-60.
[35]  Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005. 76: 534-9.
[36]  Hui AC, Wong A, Wong HC, Man BL, Au-Yeung KM, Wong KS. Refractory epilepsy in a Chinese population. Clin Neurol Neurosurg. 2007. 109 (8): 672-5.
[37]  Reynolds E. Treating refractory epilepsy in adults. BMJ. 2006. 332 (7541): 562-3.
[38]  Sillanpää M, Haataja L, Shinnar S. Perceived impact of childhood onset epilepsy on quality of life as an adult. Epilepsia. 2004. 45 (8): 971-7.