[Mechanisms of drug resistance in epilepsy]

Epilepsy can be classified as a multifactor neurological disease which affects ca. 1% of the world's population. Approximately 30% of epileptic patients do not favourably respond to antiepileptic drug treatment, but--on the other hand--the mechanism of drug-resistance has not been satisfactorily elucidated so far. Cortical dysplasia, hippocampal sclerosis, ion channel and receptor mutations and autoimmune processes can all contribute to the development of drug-resistant epilepsy. Furthermore, a crucial role of the overexpression of ABC transporters in eliminating rapidly antiepileptic drugs from the central nervous system and, on the other hand, the insensitivity of the epileptogenic tissue to some sodium channel blockers and GABA-mimetic agents have been strongly suggested. Further progress in elucidating the molecular basis of epilepsy and a rational polytherapy with novel and classic antiepileptic drugs, along with the development of diagnostic tools, may significantly contribute to better prognostication in this disease. The present paper briefly summarizes contemporary views on drug resistance in epilepsy, being particularly concerned with its neurobiological background.