Abstract
Three hundred inpatients with intractable epilepsies are classifed according to the international classification. Most intractable epilepsies and epileptic syndromes are temporal lobe epilepsies, frontal lobe epilepsies of localization-related epilepsies, Lennox-Gastaut syndrome of cryptogenic or sympto-matic generalized epilepsies and syndromes, symptomatic generalized epilepsies with nonspecificetiology of symptomatic generalized epilepsies, and severe myoclonic epilepsy in infancy of epilepsies and syndromes undetermined as to whether they are focal or generalized. Factors making epilepsies in-tractable are as follows: 1) severe seizure propensity showing drug-therapy resistance, 2) underlying organic brain damages, 3) existence of factors making drug-therapy difficult like psychotic symp-toms, idiosyncrasy for drug, lack of familiar and social supports, self-induced seizure, 4) mis-diagnosis and -treatment. In Lennox-Gastaut syndrome, widely extending epileptogenesis from cortico-thalamic circuit to midbrain and lower brain stem is supposed to be related to pathop hysiological mechanisms regarding intractability by the results of long-term follow-up studies. In temporal lobe epilepsies the formation of abnormal epileptogenic networks involving hippocampus is supposed to be related to the intractability by the neuropathology of surgically resected specimens in temporal lobe epilepsies. As to the treatment, drug therapy in patients with intractable epilepsies should be reevalutaed and then epilepsy surgery should be considered if there are indications for surgery. Lastly I would like to stress the need of comprehensive care system by multidisciplinary team.
