Despite recent advances in the management of epilepsy, some patients continue to have seizures which defy therapeutic intervention. To examine factors which may influence the successful application of therapy a survey was carried out of 103 patients, with a previous diagnosis of epilepsy, who had a seizure for which an ambulance was called. It was evident that anticonvulsants are not always used to their maximum potential or under optimal conditions. Problems which were identified in treatment included the widespread use of polypharmacy. Patients contributed to failure of seizure control by lack of compliance with therapy (29 patients) and by excessive alcohol consumption (19 patients).