ORIGINAL ARTICLE Drug-resistant epilepsy in Indian children at a tertiary-care public hospital Prarthana Kharod 1,2 & Devendra Mishra 1 & Monica Juneja 1 Received: 11 November 2017 /Accepted: 5 February 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Background Drug-resistant epilepsy (DRE), a condition in which seizures persist and seizure freedom is unlikely to be attained with further manipulation of anti-epileptic drugs, occurs in around 20% of children with epilepsy. This study was conducted with the aim to study the profile of Indian children with resistant epilepsy, using the new consensus definition of DRE. Methods All children who had been attending the Pediatric Neurology Clinic regularly for at least 6 months were reviewed between April and September 2015. Children fulfilling the ILAE Commission on Therapeutic Strategies Consensus Proposal definition of DRE were enrolled for the study. After informed consent, the records were reviewed and disease- related data was entered in the study form. The data were analyzed to determine etiological factors and treatment gaps in children with DRE. Results Fifty children (12 females) with median (range) age of 90 (11–159) months and follow-up of 17.9 (8.5–20) months were enrolled. The mean (standard deviation) age at seizure onset and start of anti-epileptic drugs (AED) were 1.8 (2.11) and 2.1 (2.09) years, respectively. The median (range) number of anti-epileptic drugs that had been tried in these children was 5 (2–9), with drug side effects leading to discontinuation in 8 (16%) patients. Only two patients had tried ketogenic diet; vagal nerve stimulation and epilepsy surgery had not been tried by any family, despite recommendation by the physicians in 7 children. Conclusions Majority of Indian children with DRE have onset of epilepsy in early infancy, and are infrequently provided access to newer non-pharmacological measures. Keywords Difficult-to-control epilepsy . Intractable epilepsy . Pharmaco-resistance Introduction Epilepsy has a prevalence of approximately 8–10 per 1000, and some of the most difficult-to-control seizure types and epilepsy syndromes occur during childhood, seen both in de- veloped as well as developing countries. Epilepsy, in which seizures persist and seizure freedom is unlikely to be attained with further manipulation of anti-epileptic drug (AED) therapy, is considered as drug-resistant epilepsy (DRE) (also known as pharmaco-resistant epilepsy and intractable epilepsy) [6], and is the main determinant of low quality of life in persons with epilepsy. The proportion of patients whose epilepsy is drug- resistant varies depending on the definition of the condition, the study methods used, and the characteristics of the popula- tion being studied [8]. When two AEDs for the correct seizure type and in adequate doses fail, there is only a 5–10% proba- bility of achieving seizure control with a third drug [4]. Although quite a few studies on refractory epilepsy in adults have been reported from India [10], scarce Indian literature is available on DRE in children [2, 12]. Early identification of intractability is important in view of availability of newer mo- dalities of therapy for DRE. A consensus definition for DRE has recently been published, which has led to the adoption of standard terminologies [6]. Therefore, we took up this study to find out the etiological correlates and clinical profile of chil- dren with DRE attending a tertiary-care public hospital. * Prarthana Kharod drprarthanakharod@gmail.com 1 Department of Pediatrics, Lok Nayak Hospital, Maulana Azad Medical College, University of Delhi, 2, BSZ Marg, New Delhi, Delhi 110002, India 2 Department of Pediatrics, GCS Medical College, Ahmedabad, Gujarat, India Child's Nervous System https://doi.org/10.1007/s00381-019-04084-5