Objective: Epilepsy is a common disorder affecting approximately 1% of the population.It is estimated that about 20- 30% of the patients become refractory to proper medical therapies. Such cases are often termed intractable. Intractable epilepsy (IE) is a serious condition in children, leading to significant impairment in quality of life, as well as behavioral and psychiatric problems.In this review, we tried to define intractability, mention the causes of intractable epilepsy and its predictive factors in children, and outline the management and various treatments of intractable epilepsy.

Background: This study was performed in children aged <15 years, at the Pediatric Neurology Clinic of Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. The objective of this study was to recognize the main predisposing factors that result in uncontrolled seizures in patients so that we can start the treatment accurately. Methods: There were two groups of patients; group I, consisted of 51 patients, with minimum refractory seizures of one episode per month while taking at least two antieplieptic drugs, and group II, comprised of 80 well-controlled patients chosen at random, who had no fit within 6 months after starting the treatment. Results: Factors affecting the occurrence of refractory seizures included age <1 year, multiple seizures before starting the treatment, male gender, myoclonic seizures, neurologic defects, neonatal and daily seizures, and first abnormal electroencephalogram and brain computerized tomo­graphy scan. Conclusion: There are several factors that can predict development of uncontrolled seizures.  Knowledge of these factors helps us to discriminate our patients and pay more attention to those at risk of developing uncontrolled seizures.    

Introduction: A bioresonance-based complementary treatment for corneal ulcers is described to determine whether an electromagnetic fi eld can improve intractable corneal ulcers. Case Presentation: The patient was a 65-year-old man who was suff ered from corneal ulcer. The wound was burned fi ve times with laser surgery; however, there was no signifi cant improvement in the patient’ s condition. He had been treated for a year with electromagnetic frequency complements. Conclusions: Since bioresonance therapy can heal the corneal ulcer in this patient, we advised patients to perform this treatment.

Background and Objective: Migraine is a common neurological disorder affecting one billion people worldwide, causing disability, reduced quality of life, and high economic costs. Medical treatments have often limited efficacy and side effects. Non-pharmacological options such as trigeminal nerve stimulation with devices such as Cefaly® offer alternatives. This study assesses effectiveness of Cefaly®'s in reducing uncontrolled migraine symptoms alongside standard medications. Methods: This study included 20 patients with migraine, with or without aura, intractable to conventional treatments. Participants used the Cefaly® device in addition to regular medication for external trigeminal nerve stimulation on the forehead. Migraine frequency, severity, and duration were assessed over one month using pre- and post-intervention questionnaires, with data analyzed by nonparametric methods due to the small sample size. Results: The proportion of participants experiencing severe attacks dropped from 45% to 15% (P = 0.037). The frequency of attacks was reduced, with the percentage of participants having 3-5 attacks per month falling from 75% to 45%, and those with more than 5 attacks per month declining to 0% (P = 0.038). Attack duration also decreased, with a reduction in attacks lasting 12-24 hours from 35% to 20%, and those lasting more than 24 hours from 45% to 15% (P = 0.002). Conclusion: Cefaly® could effectively reduce the severity, frequency, and duration of headaches in patients who do not respond conventional treatments, suggesting it as a promising non-pharmacological option. Further research with larger samples and longer follow-up is needed to confirm these findings and assess long-term efficacy.

Recent advances in our knowledge of the basic mechanisms of epilepsy have derived from increasing ability to carry out detailed investigations on patients surgically treated for refractory epilepsy. Clinical as well s experimental perioperative investigations divide into three phases: before the surgical intervention (pre-operative studies), during the surgical intervention (intra-operative studies), and on the period when the brain tissue that has to be removed is available for further studies (post-operative studies). Before surgery, structural and functional neuroimaging methods could be used to study the pathophysiological mechanisms of seizures in patients with intractable epilepsy. During epilepsy surgery, it is possible to insert electroencephalogram electrodes and microdialysis probes into the brain tissues to evaluate constituents of micromilieu and study brain bioelectrical activities. Surgical resection provides tissue that can be used for electrophysiological, morphological, and molecular biological investigations. To take advantage of these opportunities, carefully designed experimental and clinical protocols are crucial to compare the data from various studies to characterize abnormalities in the epileptic brain in order to improve our understanding of intractable epilepsy as well as brain function.

Objective: This review summarizes some patterns of pre-surgical evaluation of epilepsy in children with medically refractory seizures. Epilepsy surgery is a valuable therapeutic option for many children with intractable epilepsy. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the area of ictal onset and initial seizure propagation (the epileptogenic zone).EEG monitoring continues to prove indispensable in pre-surgical planning of refractory epileptic patients by defining the epileptogenic zone. Technological progresses in both structural and functional neuroimaging techniques have led many medical centers to consider surgical treatment of epilepsy. In children undergoing pre-surgical evaluation, the goals of neuroimaging studies include the identification of structural abnormalities in the brain, eloquent regions of the brain including language, memory, and sensorimotor functions, and the relation of these regions to the potential epileptogenic region. Neuropsychological testing plays a crucial role in assessing the potential impact of surgery on cognitive function of the patients and helps in lateralizing the cerebral hemisphere dominant for verbal and nonverbal function in older children. The Wada test is an invasive procedure to determine language dominance and can be used to assess the risk of postoperative memory deficits in children with temporal lobe epilepsy. Some children scheduled for resection still need to undergo further precise localization of the epileptogenic zone and functional mapping with invasive EEG monitoring through intracranial subdural grid and/or depth electrodes. Epilepsy surgery has the potential of changing the life quality of children by improving or eliminating seizures in carefully selected patients.

Objective: The aim of the present study was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy.Materials & Methods: Twenty one children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at least four seizures per month and a trial of at least three anticonvulsants without becoming seizure-free. The subjects received the diet over a 6-month period.Results: Three months after diet initiation, 15 patients (71.4%) remained on the diet and 12 (57.1%) had > 50% seizure reduction. Eleven patients (52.4%) completed the 6-month study and 8 (38.1%) chose to remain on the diet afterward. At 6 months, 9 patients (42.8%) had > 50% seizure reduction. The diet was more effective in cryptogenic epilepsy (p=0.032). Most complications were transient and successfully managed by careful follow-up and conservative strategies.Conclusion: The modified Atkins diet is an effective and well- tolerated therapy for intractable childhood epilepsy.