Management of intractable epilepsy.

Intractable epilepsy is a common problem confronting the paediatrician.Although there is little epidemiological data available, it is esti- mated that 10 to 20% of childhood epilepsies are intractable.'Intractability here is taken to mean epilepsy that is not controlled after an adequate (see below) trial of first line conventional anti- epileptic drugs treatment, singly and in com- bination.It is not the frequency of seizures as such that defines them as intractable, but rather their resistance to control by treatment.When confronted with a child with appar- ently intractable epilepsy, three questions need to be considered: (1) Does the patient have epilepsy?(2) What is the underlying cause/ diagnosis?(3) Is the epilepsy truly intractable?