Clinical Predictors of Drug-Resistant Epilepsy in Adults: An Analytical Observational Study

Background Drug-resistant epilepsy (DRE) remains a significant clinical challenge, with many adults experiencing persistent seizures despite adequate trials of antiseizure medications. Early identification of factors associated with DRE is essential for timely intervention and optimized management. Objectives The research aimed to examine the demographic, clinical, and behavioral factors involved with DRE in adults and to establish the difference in the severity of seizures, treatment adherence, and illness-specific characteristics of the patients with and without DRE. Methods An analytical observational study was conducted on 460 adults with epilepsy in Lahore, Pakistan. Data were collected using structured questionnaires, including the National Hospital Seizure Severity Scale (NHS3) and the Medication Adherence Rating Scale (MARS). Associations were analyzed using Spearman correlations, Mann-Whitney U-tests, Kruskal-Wallis tests, and multivariate regression, with p < 0.05 considered statistically significant. Results Among the participants, 300 (65.2%) had DRE. Patients with DRE showed higher seizure severity (NHS3: 15.42 ± 4.86 vs 11.18 ± 3.95, p < 0.001) and lower medication adherence (MARS: 5.92 ± 2.11 vs 8.74 ± 1.96, p < 0.001) than drug-responsive patients. DRE was positively correlated with seizure severity (r = 0.28, p < 0.001) and negatively with adherence (r = -0.22, p < 0.001). Younger adults (18-30 years) exhibited the highest seizure severity and lowest adherence, while adults >60 years had the opposite trend. Multivariate regression identified seizure severity, low adherence, younger age, male gender, longer disease duration, and seizure type as independent predictors of DRE. Conclusion High seizure severity, poor adherence, younger age, and certain seizure characteristics are strongly associated with DRE. Early monitoring, adherence support, and individualized interventions may reduce the burden of persistent seizures in adults.