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Redefining drug-resistant epilepsy: Insights from an Italian Delphi consensus study
Federico Vigevano1, Irene Bagnasco2, Giancarlo Di Gennaro3
1Head of Paediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, Italy.
Epilepsia Open
|July 25, 2025
Summary
Drug-resistant epilepsy (DRE) affects many people with epilepsy (PwE). Experts suggest a personalized approach to DRE, emphasizing quality of life and multidimensional care beyond seizure control for better treatment success.
Area of Science:
- Neurology
- Epileptology
Background:
- Drug-resistant epilepsy (DRE) impacts approximately one-third of people with epilepsy (PwE), posing significant challenges in management despite advances in anti-seizure medications.
- Current definitions and therapeutic strategies for DRE require refinement to better address patient complexity.
Purpose of the Study:
- To examine key aspects of DRE, including its definition, predictors, and therapeutic strategies through a Delphi consensus study.
- To gather expert opinions from Italian epileptologists on defining and managing DRE.
Main Methods:
- A steering committee of epilepsy experts formulated 22 statements across four thematic areas.
- Two rounds of structured voting were conducted with 99 Italian epileptologists.
Main Results:
- Disagreement exists regarding the current International League Against Epilepsy definition of DRE, with a call for definitions incorporating individual complexities.
- Strong consensus was reached on the importance of quality of life, psychiatric comorbidities, and multidimensional care in evaluating therapeutic success for DRE.
Conclusions:
- A patient-centered perspective is crucial for defining drug resistance and therapeutic success in epilepsy.
- Enhanced interdisciplinary collaboration is essential for improving clinical practices and meeting the unmet needs of people with epilepsy.
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