Abstract
There are still patients with epilepsy and uncontrolled seizures despite established treatment. It is dangerous, the risks depend on the type of seizure.
It could be health and life-threatening. A refractory epilepsy may progressively impair brain structure and function.
Patients are at higher risk of comorbidities, including injuries and accidents, higher mortality and psychosocial consequences. The goal of treatment is a patient without seizures.
Only remission (5 years without seizures) reduces the described risks to the level of the general population. The task of the neurologist is to review the examinations and treatments selected so far, to plan the next management with which the patient and/or his/her legal guardian is familiar.
The documentation must include a working balance sheet and AEDs gradual testing plan, or other treatments. In a patient with persistent seizures, the documentation must show an effort to classify their type, determine the cause of epilepsy and its type, eventually epileptic syndrome.
It is necessary to search for, confirm or eliminate known comorbidities, because preventative measures can prohibit their formation. In the case of already confirmed comorbidities, we treat them, if necessary in cooperation with specialists from other fields and the general practitionar.
There are models for predicting pharmacoresistance that can be used by clinicians. Current epileptology is proactive and seeks to protect patients quality life years.
One of the most important factor in a good therapeutic relationship between neurologist/patient with epilepsy is trust and the hope that there is still much to offer.