Reasons for redefining DRE
The current definition of DRE has increased awareness of the value of prompt referrals for presurgical evaluation of individuals whose epilepsy did not respond to antiseizure medications. However, as the incidence of DRE remains high, we may need to revisit DRE to steer new research and clinical efforts towards more effective, rational, and precise treatments. We propose to revisit the DRE concept to incorporate the following elements.
DRE is not a binary concept: Partial / incomplete response of seizures to a treatment may still have a benefit clinically as well as in research, i.e., optimizing combination therapies. DRE based on failure to two treatments may not preclude response to another treatment. Understanding the mechanisms of DRE and of drug effects may help reveal strategies to implement combination or more targeted therapies for DRE.
To frame DRE in alignment with the heterogeneity of clinical presentations of epilepsies, their etiologies, and mechanisms, across the lifespan, in a manner that will accelerate time to DRE diagnosis and interventions in vulnerable populations.
To consider the heterogeneous and dynamic changes in mechanisms and expression of drug resistance across time, individuals, etiologies, epilepsies, and their treatments, to allow for precision treatments.
To consider the complexity of mechanisms underlying DRE (epilepsy, individual, comorbidities, treatments, environment) and their interactions, with a goal towards steering research into mechanism-informed diagnostic, monitoring, and therapeutic approaches for DRE.
To harmonize preclinical and clinical research towards the development of more effective therapeutic strategies for DRE.