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. 2025 Oct;10(5):1311-1322.
doi: 10.1002/epi4.70085. Epub 2025 Jul 25.

Redefining drug-resistant epilepsy: Insights from an Italian Delphi consensus study

Federico Vigevano  1 , Irene Bagnasco  2 , Giancarlo Di Gennaro  3 , Oriano Mecarelli  4   5 , Simona Lattanzi  6
Affiliations

Redefining drug-resistant epilepsy: Insights from an Italian Delphi consensus study

Federico Vigevano et al. Epilepsia Open. 2025 Oct.

Abstract

Objective: Drug-resistant epilepsy (DRE) affects approximately one-third of people with epilepsy (PwE) despite advancements in anti-seizure medications and presents significant challenges in epilepsy care. This Delphi consensus study aimed to examine key aspects of DRE, including its definition, predictors, and therapeutic strategies.

Methods: A steering committee consisting of clinicians and researchers with expertise in epilepsy was responsible for formulating the statements. A total of 22 statements were developed across four thematic areas. Expert opinions from 99 Italian epileptologists were collected over two structured rounds of voting.

Results: The study highlighted a certain disagreement on the current International League Against Epilepsy definition of DRE, with experts advocating for a definition that better incorporates individual complexities. Strong agreement emerged on the importance of quality of life, psychiatric comorbidities, and multidimensional care in defining therapeutic success.

Significance: The findings of this study underscored the need for a patient-centered perspective of drug resistance and therapeutic success. Enhancing collaboration across specialties is critical for refining clinical practices and addressing unmet needs for PwE.

Plain language summary: About one in three people with epilepsy continues to have seizures despite trying several anti-seizure medications. This study asked Italian epilepsy experts for their opinions on how to define and manage drug-resistant epilepsy. The experts agreed that treatment success should not be measured by seizure control alone but also by improvements in quality of life. They also recommended more personalized care that considers each patient's unique condition.

Keywords: Delphi consensus study; drug‐resistant epilepsy (DRE); epilepsy management; uncontrolled epilepsy.

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Conflict of interest statement

FV has received speaker's or consultancy fees from UCB, Neuraxpharm, and Ethypharm. He has also served on advisory boards for Angelini, UCB, Neuraxpharm, and Ethypharm. GDG has received speaker's or consultancy fees from Angelini Pharma, Eisai, UCB Pharma, Lusofarmaco, GW pharmaceuticals. He has also served on advisory boards for Angelini Pharma, Arvelle Therapeutics, BIAL, Eisai, Neuraxpharma end UCB Pharma. OM has received speaker's or consultancy fees from Angelini Pharma, Jazz Pharmaceuticals, UCB Pharma, and Lusofarmaco. He has also served on advisory boards for Angelini Pharma. SL has received speaker's or consultancy fees from Angelini Pharma, Eisai, GW Pharmaceuticals, Medscape, and UCB Pharma. She has also served on advisory boards for Angelini Pharma, Arvelle Therapeutics, BIAL, Eisai, GW Pharmaceuticals, NewBridge Pharmaceuticals, Rapport Therapeutics, and UCB Pharma. IB and GDG declare no conflicts of interest. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

FIGURE 1
FIGURE 1
Graphical representation of Delphi results from Area 1.
FIGURE 2
FIGURE 2
Graphical representation of Delphi results from Area 2.
FIGURE 3
FIGURE 3
Graphical representation of Delphi results from Area 3.
FIGURE 4
FIGURE 4
Graphical representation of Delphi results from Area 4.
See this image and copyright information in PMC

References

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