Specialty Focused Recordings: Seizures and Epilepsy-Epilepsy In Developmentally Disabled Adult

Video Transcription

Video Summary

Dr. Rupert X. Conde discusses treatment options for epilepsy that remains uncontrolled despite medication, with particular attention to adults with developmental disabilities. Drug-resistant epilepsy is defined as failure to achieve sustained seizure freedom after adequate trials of two appropriate, tolerated, and properly used antiseizure medications. Because later medication trials have a low chance of success, clinicians should consider other approaches.<br /><br />For adults with developmental disabilities, genetic testing can identify a cause, guide targeted treatment, inform prognosis and counseling, and reduce unnecessary investigations. Testing may include epilepsy gene panels or broader sequencing.<br /><br />Treatment goals are both seizure control and manageable side effects, with decisions made collaboratively. Options include epilepsy surgery, neuromodulation (responsive neurostimulation, vagus nerve stimulation, or deep brain stimulation), and ketogenic diets. Surgery may offer the best chance of seizure freedom for carefully selected patients, though it is underused and requires extensive evaluation. Neuromodulation can reduce seizures when resection is unsuitable, while ketogenic diets may help some people but can be difficult to maintain.<br /><br />The speaker emphasizes supporting patients’ autonomy and comfort, even when seizure freedom is not achievable. The discussion also addresses surgery and medication during pregnancy, driving restrictions, medical cannabis, and distinguishing nonepileptic seizures from epilepsy.

Keywords

drug-resistant epilepsy

developmental disabilities

genetic testing

epilepsy surgery

neuromodulation

responsive neurostimulation

vagus nerve stimulation

ketogenic diet

nonepileptic seizures