About 30% of the people with epilepsy have refractory epilepsy and do not respond well to anti-epileptic drugs. Stichting Epilepsy Instellingen Nederland (SEIN) is a tertiary referral centre for epilepsy and many of the referred people have epileptic seizures that do not respond to first line anti-epileptic drug treatment. This may be due to – solitary or concurrent – non-epileptic seizures, a wrong epilepsy diagnosis or to resistance to anti-epileptic medication. Understanding the cause and triggers of seizures is essential for finding the best treatment. Failure of first line drugs urges trials of second line drug treatment, alternative therapies and epilepsy surgery. The latter needs optimal delineation of the epileptogenic brain tissue. Treatment of refractory epilepsy requires a broad-spectrum approach including psychosocial aspects and co-morbidities. This research priority studies causes and triggers of epileptic and non-epileptic seizures, treatment optimisation through new drug trials, alternative treatment options and epilepsy surgery with optimal focus localisation and understanding the effect of epilepsy on psychosocial functioning and co-morbidities.
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