[Childhood epilepsy which is difficult to control]

Difficult-control epilepsy (DCE) is diagnosed when response to drug therapy is slight and/or the patient's quality of life is affected. Careful evaluation is important so that DCE is not diagnosed when persistent seizures are due to diagnostic or treatment errors. DCEs are a heterogenous group of epilepsies and epileptic syndromes that have risk factors in common as well as those that are specific to each type. Childhood DCE is more frequently in the first three to four years of life. DCE presents as a secondary generalized epilepsy, multifocal epilepsy and partial epilepsy, in order of decreasing frequency. Some DCEs are cryptogenic. Others--most--are symptoms of a variety of causal agents, some of which are acquired or, less often, progressive. They are commonly associated to neurological signs and/or psychiatric impairment. New drugs have effected a noteworthy decrease in seizures in some of the most severe epileptic syndromes of childhood. Other therapeutic options, such as treatment with hormones or immunoglobulins or vagal stimulation, can sometimes prove useful. Finally, surgical treatment must be considered in some DCE cases, particularly in partial epilepsy.