Most of the epilepsies that occur in children are relatively straightforward to manage, including suppression of the seizures. However, in at least 30% of children, seizures will not be fully controlled by one or two antiepileptic drugs (AEDs); these children may also have additional physical, educational or behavioural problems. This population is often labelled as having a “difficult” or an “intractable” epilepsy. The approach to these children must always begin with ensuring that the diagnosis of epilepsy is accurate, that the correct seizure type or types and epilepsy syndrome have been identified and that an underlying cause has been considered. Treatment must be holistic, considering the child as a person and not just someone having seizures; the AED regimen must be appropriate and not excessive; and surgery must always be considered a viable option.
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