Whilst for most patients with epilepsy, seizures come under control easily, in about one-third of adult and childhood cases, seizures continue to occur despite antiepileptic drug (AED) treatment. Comparatively little study has been undertaken to examine the causes of resistance to treatment. Cases are labelled medically refractory, are possibly considered for surgery or gravitate in specialist clinics, receiving successive novel or trial AEDs. More recently, increasing attention has been paid to the possible mechanisms of resistance to AED treatment, partly as a result of consideration of similar problems in cancer. Only a rational understanding of the underlying mechanisms can provide solutions to the problem of drug resistance. In this chapter, the problem and potential causes are considered.
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