[Drug-resistant partial epilepsy: pharmacological criteria]

Despite the number of new antiepileptic drugs marketed in the last decade, one third of epilepsies have remained refractory to medical treatment. The term of pharmacoresistance remains controversial and a diagnosis algorithm should be proposed to distinguish pseudoresistance related to the pathology and patient or to the treatment. Beyond resistance to the first prescribed antiepileptic, a lack of response to the sequential use of several monotherapies or antiepileptic drug associations should lead to the diagnosis of drug-resistance, when all causes of pseudoresistance have been ruled out. The presence of predicting factors or etiological factors should also be integrated into this decisional algorithm. Such a diagnostic process identifying real drug-resistant epilepsy is necessary to progress in knowledge of the pathophysiology and in treatment strategy of this category of epilepsy.