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