الفهرس 
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Abstract
Interest to ascertain the relationship between inflammatory cytokines, immune system dysregulation, and the pathogenesis of refractory epilepsy is an everlasting scientific concern.
This thesis was designed aiming at covering the following areas in the theoretical part : (1) overview on Epilepsy , (2) An overview on Refractory epilepsy, (3) Review the relation between Immune system in epilepsy & refractory epilepsy.
The practical part aimed at:(1) Evaluation of the patients with refractory epilepsy , (2) determine different poor prognostic factors (PPFs) that influence the epileptic refractoriness, (3) determine the level of IL-6 in patients with refractory epilepsy, (4) search for possible relations between its level and different factors influencing the epileptic refractoriness, (5) search for pseudorefractory patients among the refractory patients.
The first group of results aimed at estimation of the poor prognostic factors (PPFs) that influence the epileptic refractoriness, that revealed that the most encountered factors were: earlier age of onset of epilepsy, longer duration of epilepsy, Frequency of seizures /month, Partial seizures with 2ry generalization (50%), TLE (66.7%), Multiple seizure types (15%), past history of Febrile seizure (20%), past history of Status epilepticus (55%), Co-morbid MR(30%) , Co-morbid depression (25%), Past history of birth injury (15%), past history of head trauma (10%), positive family history of epilepsy (50%), idiopathic epilepsy (45%), abnormal brain imaging (50%), abnormal VEEG findings (80%) and AEDs polytherapy . 90% of the patients had multiple poor prognostic factors which was statistically highly significant. 20% of the refractory
group were Pseudo- refractory . The identification of these factors will ultimately lead to better management as well as possible prevention of RE.
The second group of results aimed at determining the level of IL-6 in patients with refractory epilepsy and the relations between its level and different factors influencing the epileptic refractoriness. Data revealed that:
• The mean value of interictal IL-6 was higher in the refractory group than in the control group and the difference was statistically highly significant.
• There was no statistically significant correlation between IL-6 levels and age of patients &age of onset of epilepsy.
• There was statistically significant correlation between IL-6 levels and duration of epilepsy &frequency of seizures per month.
• The mean serum level of IL-6 was found to be higher in patients with CPS compared with other seizure types with a high statistically significant difference. and IL-6 level was higher in patients with TLE than in patients with FLE with statistically significant difference. But no statistically significant relation between IL-6 level and multiple seizure types found.
• The mean value of IL-6 was statistically higher in patients with history of Status epilepticus, co-morbid MR, co-morbid depression and positive Family history of epilepsy.
• The mean value of IL-6 level was higher in patients with Multiple PPFs than in patients with single PPF with high statistically significant difference was found.
• The mean value of IL-6 level was the highest in patients with Cerebral Trauma than other causes but with no statistically significant difference.
• The mean value of IL-6 level is statistically higher in patients with High TLC and patients with Positive CRP.
• The mean value of IL-6 level is higher in patients with abnormal Brain Imaging than in patients with normal Brain Imaging but with no statistically significant difference.
• The mean value of IL-6 level is statistically higher in patients with abnormal VEEG. Also, there was a higher level of IL-6 in patients with Localized abnormalities than in patients with generalized abnormalities, however, no statistically significant difference was found.
• There was no statistically significant correlation between IL-6 levels and Number of AED drugs used.
• The mean value of IL-6 was statistically higher in patients with true refractoriness than in patients with pseudo refractoriness.
The findings of the present study raise a possible role for IL-6 as a clinically significant inflammatory biomarker in refractory epilepsy and support the hypotheses that there is a chronic inflammatory process underlying pathophysiology of refractory epilepsy. So we can speculate that in the future inflammatory process will receive more attention in treatment strategies for intractable epilepsy.