History of focal epilepsy and criteria for medical intractability

In this article the issues surrounding the definition of medical intractability have been discussed. Acceptable seizure control is primarily defined by the patient. If in a given living situation the number of seizures a patient is having (even if quite small) is interfering to the point that they are willing to consider epilepsy surgery as a treatment modality, there is unacceptable seizure control. More difficult is the definition of what constitutes an adequate trial of anti-epilepsy drugs. A consensus is that patients should have had at least trials to toxicity, toxicity as defined by patients' signs or symptoms (and not by drug levels), of at least two major anti-epilepsy drugs. Trials of combined therapy are not necessary. The natural history of these patients is such that if they have not been controlled with adequate trials of drugs within 2 years, they are unlikely (< 10% probability) to enter a long-term permanent remission of their seizures. These patients are medically intractable.