Abstract
OBJECTIVE: Drug-resistant epilepsy (DRE) affects approximately one-third of people with epilepsy (PwE) despite advancements in anti-seizure medications and presents significant challenges in epilepsy care. This Delphi consensus study aimed to examine key aspects of DRE, including its definition, predictors, and therapeutic strategies. METHODS: A steering committee consisting of clinicians and researchers with expertise in epilepsy was responsible for formulating the statements. A total of 22 statements were developed across four thematic areas. Expert opinions from 99 Italian epileptologists were collected over two structured rounds of voting. RESULTS: The study highlighted a certain disagreement on the current International League Against Epilepsy definition of DRE, with experts advocating for a definition that better incorporates individual complexities. Strong agreement emerged on the importance of quality of life, psychiatric comorbidities, and multidimensional care in defining therapeutic success. SIGNIFICANCE: The findings of this study underscored the need for a patient-centered perspective of drug resistance and therapeutic success. Enhancing collaboration across specialties is critical for refining clinical practices and addressing unmet needs for PwE. PLAIN LANGUAGE SUMMARY: About one in three people with epilepsy continues to have seizures despite trying several anti-seizure medications. This study asked Italian epilepsy experts for their opinions on how to define and manage drug-resistant epilepsy. The experts agreed that treatment success should not be measured by seizure control alone but also by improvements in quality of life. They also recommended more personalized care that considers each patient's unique condition.