Table 1.

Strategies to manage the refractory patient.

Strategy	Current and future treatments	Ref.
Polytherapy	Add-on traditional AED
	Change drug target (e.g., from GABA to NMDA or vice versa)
	Increase CNS levels by manipulation of MDR1 (e.g., verapamil) or by BBB healing (e.g., dexamethasone)
Surgery	Temporal or extratemporal resections	[83]
	Removal of drug-resistant brain after diagnosis with PET/verapamil
Ketogenic diet	Endogenous or exogenous molecules that mimic the effects of the diet without compliance issues
Anti-inflammatory agents	If target is well defined (BBB? Drug passage across the BBB?) develop specific molecules to treat seizures, resistance to drugs and/or multiple-drug resistance in epileptic individuals	[54–56]

AED: Antiepileptic drug.