[Economic aspects of drug-resistant epilepsy]

Drug-resistant epilepsy is a serious source of indirect and direct public expenses. American studies have shown that the total cost per patient of treating drug-resistant epilepsy is 138,600 USD a year whereas the annual cost of treating effectively-treated epilepsy is 4,272 USD. Although the proportion of drug-resistant cases does not exceed 20% of all registered cases of epilepsy these cases are responsible for 48% of the total direct costs and 90% of indirect costs of treatment. Frequent hospitalizations and introduction of more and more complicated polytherapies contribute to the increase in direct costs whereas the main factor responsible for indirect costs is the incapacity to work. Open clinical studies on the optimization of antiepileptic treatment have shown that a considerable number of patients are still diagnosed as apparently drug-resistant. In the case of these patients frequent modification of the methods of treatment are associated with patients' justified or unjustified fear of the adverse effects of antiepileptic drugs. This leads to mood deterioration in the patients themselves and, as a consequence, to poorer quality of life of the patients and their families. Another serious economic problem is the presence of psychogenic pseudo-epileptic seizures. The factors discussed in this article increase the measurable and immeasurable psycho-social costs of epileptic seizures.