Is drug resistant partial epilepsy progressive

OBJECTIVES: Approximately one third of the patients with epilepsy are drug resistant. For decades it has been speculated whether repetition of the seizures might potentially lead to progression of the disorder. DEVELOPMENT: In recent years four levels of evidence (experimental, imaging, epidemiological and neuropsychological) suggest that in at least some types of epilepsy the disorder may progress. In various experimental models of epilepsy it has been shown that the persistence of seizures led to biochemical, structural and cellular changes which are persistent and progressive. However, it is difficult to extrapolate these results to human epilepsy. Studies using magnetic resonance volume measurements and spectroscopy have shown that in temporal lobe epilepsy the lesion seems to progress over the years. However, epidemiological and clinical studies do not consistently show a worsening pattern of seizures over the years of epilepsy duration. In fact, recent evidence has shown that drug resistance may occur from the beginning of the disorder. CONCLUSIONS: Neuropsychological studies in patients with drug resistant epilepsy, especially in those with mesial temporal lobe epilepsy, show deterioration of certain cognitive aspects (mainly memory) in relation to the duration and frequency of the partial and secondarily generalized seizures. In case progression of a epilepsy syndrome might be anticipated, this would undoubtedly lead to relevant consequences. If this is so, the therapeutic approach should be more aggressive than at present and might offer early curative treatment, such as epilepsy surgery or neuroprotective drugs, which might halt the progress of the disorder.