[Refractory partial epilepsy: what are the neuropediatrician's criteria for drug resistance?]

Despite the emergence of new antiepileptic drugs, 10 to 20% of children with epilepsy, half of whom have localization-related epilepsy, remain refractory to drug treatment. Careful syndromic identification is essential before retaining the diagnosis of intractable childhood epilepsy in order to optimize treatment and avoid iatrogenic worsening. The use of appropriate associations of new antiepileptic drugs should lead to better control in some situations, but further studies are still necessary. A significant number of children with medically intractable localization-related epilepsy may benefit from surgical treatment. Because of the cognitive consequences of epilepsy in children, the question of the appropriate time for surgery is still debated; the current trend is for early surgery in children. For many authors, intractability can be assessed after 18 months of evolution, and retained when seizures persist at a frequency of one or more a month despite more than two correctly administered antiepileptic drugs. In case of epileptogenic encephalopathy, time to surgery may be shorter. Early predictive criteria of intractability have been identified by several cohort studies and include the presence of frequent seizures at disease onset, status epilepticus, with the prevalence of certain etiologies such as encephalitis or neuronal migration disorders. Conversely, some children may develop late intractability after an early benign course; the identification or early predictive criteria is still unclear in this situation.