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You are a specialist in advanced treatment of epilepsy. Dr. Anton Titov, MD. What is refractory epilepsy? What are the latest advances in treatment of refractory epilepsy? Yes. Refractory epilepsy is when anti-epileptic medications don’t work. Dr. Tracey Milligan, MD. Anti-epileptic medications work for the vast majority of patients with epilepsy. They are able to control the epileptic seizures. These are two-thirds of all epilepsy patients. A patient may have epilepsy, and you would never know it. Because they take an epilepsy medication every day. They do not have epileptic seizures. That leaves two-thirds of the population with epilepsy. Dr. Tracey Milligan, MD. But in that other one third of patients with epilepsy anti-epileptic medications don’t work. When anti-epileptic medications don’t work, then we call that refractory epilepsy. We have to try two anti-epileptic medications. Dr. Tracey Milligan, MD. We have given our best effort to each epilepsy medication to work. The patient has taken a medication every day. The patient has been able to take a therapeutic dose of medication. Despite all efforts, if two anti-epileptic medications haven’t worked, then it is a refractory epilepsy. Another term for refractory epilepsy would be drug-resistant epilepsy. It means the same thing. What can be done for patients with refractory epilepsy? Dr. Anton Titov, MD. What to treat refractory epilepsy successfully? A patient may have a drug-resistant epilepsy. We then hope that the epilepsy is due to a specific lesion in the brain. It is a little bit ironic. Because when anti-epileptic medications don’t work in a patient, we perform a brain MRI. Dr. Tracey Milligan, MD. We hope that their brain MRI is abnormal. We hope that a picture of the brain on MRI will show us maybe a little tumor. We hope it is a benign tumor like a meningioma. Or we hope to see a little vascular malformation, like a cavernous angioma malformation. There is something that we can see on the MRI. That is a likely source of the epileptic seizures. Neurosurgical operation could be curative in such situation. If the epilepsy-generating focus can be safely removed with surgery. They may never have another epileptic seizure again. Those are wonderful things. Dr. Tracey Milligan, MD. We may be able to help patients at an advanced epilepsy center like the one we have here. We can help patients when anti-epileptic medications do not work at all. Dr. Tracey Milligan, MD. We can use a neurosurgical technique to remove the epileptic seizure focus. This will hopefully allow patients to be epileptic seizure-free. It can perhaps cure patients of epilepsy. Dr. Anton Titov, MD. That would be a wonderful result certainly! It happens in many cases.