Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology

Epilepsy Behav. 2022 Jul;132:108739. doi: 10.1016/j.yebeh.2022.108739. Epub 2022 May 25.


The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.

Keywords: Elderly-onset epilepsy; Idiopathic generalized epilepsies; Medication; Refractory seizures; Self-limited epilepsies of childhood; Therapy.

Publication types

  • Review

MeSH terms

  • Aged
  • Child
  • Drug Resistant Epilepsy* / epidemiology
  • Drug Resistant Epilepsy* / etiology
  • Electroencephalography
  • Epilepsies, Partial* / diagnosis
  • Epilepsy* / complications
  • Epilepsy* / epidemiology
  • Epilepsy, Generalized* / diagnosis
  • Humans
  • Syndrome

Supplementary concepts

  • Epilepsy, Idiopathic Generalized