ФАРМАКОРЕЗИСТЕНТНАЯ ЭПИЛЕПСИЯ: КЛИНИКО-ЭЛЕКТРОФИЗИОЛОГИЧЕСКАЯ ДИАГНОСТИКА, ПРОГНОЗИРОВАНИЕ ХИРУРГИЧЕСКИХ ИСХОДОВ И ПЕРСОНАЛИЗИРОВАННЫЕ ТЕХНОЛОГИИ НЕЙРОМОДУЛЯЦИИ

Abstract

Background. Drug-resistant epilepsy remains a major challenge in clinical neurology and functional neurosurgery. Despite the increasing availability of antiseizure medications, a substantial proportion of patients continue to experience seizures associated with cognitive, psychological, and social consequences. Contemporary management emphasizes early recognition of genuine drug resistance, comprehensive electroclinical and neuroimaging assessment, localization of the epileptogenic zone, and timely evaluation for surgical treatment. Advances in stereoelectroencephalography, high-resolution magnetic resonance imaging, minimally invasive ablation, and implantable neuromodulation have expanded opportunities for individualized treatment.

Materials and Methods. A narrative analytical review of international guidelines, randomized controlled trials, prospective cohort studies, systematic reviews, and meta-analyses was conducted. Diagnostic criteria, long-term video-EEG monitoring, epilepsy-specific neuroimaging, neuropsychological assessment, resective surgery, minimally invasive ablation, vagus nerve stimulation, anterior thalamic deep brain stimulation, and responsive neurostimulation were examined.

Results. Major mechanisms of antiseizure medication resistance, stages of presurgical assessment, principles of epileptogenic zone localization, and treatment selection criteria were systematically analyzed. Resective, ablative, and neuromodulation technologies were comparatively evaluated. Six analytical tables and an original conceptual framework, EPILEPSY-DECISION, were developed to integrate clinical, electrophysiological, structural, neuropsychological, and prognostic parameters.

Conclusion. Effective management of drug-resistant epilepsy requires early confirmation of genuine pharmacoresistance, exclusion of diagnostic and therapeutic errors, comprehensive localization of the epileptogenic zone, and timely referral for specialized surgical assessment. When complete and safe resection is not feasible, neuromodulation may provide clinically meaningful seizure reduction. Prospective validation of the proposed conceptual framework is required.