For Management of Medically Refractory Epilepsy, use the highest-yield facts to drive concrete treatment decisions. Pay particular attention to Medically refractory definition: failed ≥2 appropriate AEDs; <5% chance 3rd medication achieves control, Ketogenic diet: highly successful for Lennox-Gastaut, induces ketosis/mild acidosis, and Cannabidiol (CBD): FDA-approved for Lennox-Gastaut and Dravet syndromes when choosing therapy, counseling about risk, planning monitoring, and deciding when closer follow-up or escalation is needed.

Medically refractory definition: failed ≥2 appropriate AEDs; &lt;5% chance 3rd medication achieves controlKetogenic diet: highly successful for Lennox-Gastaut, induces ketosis/mild acidosisCannabidiol (CBD): FDA-approved for Lennox-Gastaut and Dravet syndromesVagus nerve stimulation (VNS): 33-40% achieve ≥50% seizure reduction; &lt;3% seizure-freeVNS side effects: neck tingling, hoarseness, cough, dyspnea; 1% vocal cord paralysis/transient facial weakness; 1-2% infection risk