Citations are important for a journal to get impact factor. Impact factor is a measure reflecting the average number of citations to recent articles published in the journal. The impact of the journal is influenced by impact factor, the journals with high impact factor are considered more important than those with lower ones. Impact factor plays a major role for the particular journal. Journal with higher impact factor is considered to be more important than other ones. Impact factor can be calculated as average number of citation divided by recent cited articles published in 2 years. Management of patients with refractory epilepsy is challenging because we do not fully understand how or why pharmacoresistance develops in a particular individual. Clinicians are constantly encountering patients who seem to have identical seizure disorders. They have the same etiology and the same lesion type and location on magnetic resonance imaging (MRI) scans, and yet, one will respond to treatment and the other will not. This situation is best illustrated by the case histories of two sisters who developed idiopathic generalized epilepsy in their teens. Electroencephalogram (EEG) findings demonstrated that they both had primary generalized spike and wave activity at the time of diagnosis. Despite apparently similar etiologies, and underlying genetics, these sisters had vastly different clinical outcomes. One sister has had only two generalized tonic–clonic convulsions in her entire life and is well controlled on carbamazepine, even though this is the wrong medication for her epilepsy syndrome. In contrast, the other sister has refractory juvenile myoclonic epilepsy (JME) and has failed multiple antiepileptic drugs (AEDs), including valproic acid, lamotrigine, and topiramate. Why did these sisters respond so differently to treatment? Is it due to genetic differences, early environmental factors, or to some unknown factor. Refractory epilepsy can have devastating consequences. Many individuals experience prolonged seizures or status epilepticus and, as a result, suffer bodily injuries requiring hospitalization. Others have shortened life spans because of the increased risk of sudden unexpected death that is associated with uncontrolled seizures. Studies have shown that patients with refractory epilepsy have significant neuropsychological, psychiatric, and social impairments that limit employment, reduce marriage rates, and decrease quality of life. A number of observational studies have attempted to identify phenotypic markers that can be used to predict refractoriness in patients with epilepsy. These include the type of syndrome, underlying etiology, patient history of seizure frequency and density, and EEG findings. Semah and colleagues (4) evaluated the ability of epileptic syndrome to predict ease of seizure control and final treatment outcome in a sample of 2,200 adult outpatients with epilepsy. The sample was stratified by syndrome and then subdivided according to whether the patients were easy to control and became seizure free on low levels of medication; difficult to control and required high doses of AEDs or multiple treatment regimens to become seizure free; or refractory to treatment. Not surprisingly, patients with idiopathic generalized seizures were most likely to become seizure free (82%) for ≥1 year and those with generalized symptomatic or cryptogenic seizures were the least likely (≈26%). More than half of the seizure-free patients in each of these groups were easy to control.
