For Management of Medically Refractory Epilepsy, prioritize 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 control; Ketogenic diet: highly successful for Lennox-Gastaut, induces ketosis/mild acidosis; Cannabidiol (CBD): FDA-approved for Lennox-Gastaut and Dravet syndromes; Vagus nerve stimulation (VNS): 33-40% achieve ≥50% seizure reduction, &lt,3% seizure-free; VNS side effects: neck tingling, hoarseness, cough, dyspnea, 1% vocal cord paralysis/transient facial weakness, 1-2% infection risk