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There are varied opinions about this definition but for this discussion we will define a patient as refractory when: 1) an anticonvulsant (AC) has been used as monotherapy, the high end of the "therapeutic" blood level has been achieved for the AC and the patient continues to have the same or an increased number of seizures (szs); 2) a patient that has developed side effects from an AC that now precludes its use; or 3) the patient that has been well controlled for months or years and recently has had a significant increase in sz frequency.