Epilepsy, commonly known as “crohn’s disease” or “sheep epilepsy”, is a common neurological disorder. Repeated seizures not only affect the patient’s growth and development, cognitive function, learning and memory, but also seriously affect their physical and mental health, work, marriage and social life, etc. Therefore, early, active and regular treatment of epilepsy is of great importance to the patient, family and society. With the progress of science and technology and medical development, people’s understanding of epilepsy has been deepened and new anti-epileptic drugs have been introduced. It is now believed that about 70% of patients with epilepsy can have their seizures controlled after regular anti-epileptic drug treatment, and 50% to 60% of them can be cured after 2-5 years of treatment, and patients can work and live like normal people. This has greatly encouraged clinicians and patients with epilepsy and has increased their confidence in treatment. However, it should be noted that there are currently about 5-6 million patients with active epilepsy in China (those with seizures in the last 5 years), and about 400,000 new patients with epilepsy are added each year, yet only 37% of patients with active epilepsy receive medication, a treatment gap of 63%. Accordingly, it is estimated that about 4 million patients with active epilepsy are not receiving timely treatment. In particular, more than two-thirds of epilepsy patients in rural areas of China do not receive reasonable treatment. Patients are afraid to take effective anti-epileptic drugs because they are afraid that anti-epileptic drugs will “stimulate the brain” and “become stupid” if taken for a long time. The most important thing is that you should be able to find the right medicine for you. The most important thing is that the epilepsy is still not effectively controlled after spending a lot of time and money on street advertisements. The main reason for this is to promote the general knowledge and importance of formal treatment of epilepsy. At present, the treatment of epilepsy is mainly western medicine, including traditional drugs (such as sodium phenytoin, phenobarbital, carbamazepine, valproic acid, etc.) and new antiepileptic drugs (such as topiramate, oxcarbazepine, lamotrigine, levetiracetam, etc.), and there are more than ten kinds of drugs. The general principle of drug selection is that the correct classification of seizures and epilepsy syndromes is the basis for rational drug selection. If this is ignored, not only will seizure control not be achieved, but sometimes the seizures will be aggravated. For example, valproate is the drug of choice for generalized seizures (including akathisia, myoclonic and generalized tonic-clonic seizures), while carbamazepine is the drug of choice for partial seizures. In idiopathic epilepsy, only monotherapy is usually required and can be effective at low to moderate doses, while in symptomatic epilepsy, some monotherapy is not effective and a combination of two or more drugs is required. If the type of seizure is misjudged, resulting in inappropriate selection of antiepileptic drugs, the seizure may be aggravated. For example, atonic seizures are sometimes mistaken for complex partial seizures and carbamazepine is mistakenly used, which can lead to aggravation of atonic seizures. In addition, the patient’s age (children, adults, and elderly), gender, the presence of other co-morbidities and the use of other drugs, the side effects of antiepileptic drugs, and price should also be considered in rational drug selection. For example, if infants and young children cannot swallow pills, the application of syrup preparations is not only beneficial for children to take but also convenient to control the dose. When selecting medications for children, attention should be paid to choosing medications that do not affect cognitive function, memory, or attention span. The elderly have more co-morbidities, more combined medications, and more drug interactions, and they are more sensitive to antiepileptic drugs and have more prominent side effects. Therefore, when choosing antiepileptic drugs for elderly patients with epilepsy, drug side effects and drug-drug interactions must be considered. For women with epilepsy of childbearing age, attention should be paid to the effects of antiepileptic drugs on hormones, libido, femininity, pregnancy, childbirth, and teratogenicity. Traditional antiepileptic drugs (e.g., phenytoin sodium, phenobarbital) have some clinical efficacy, but have more side effects such as gingival hyperplasia, increased hair, high teratogenicity, hyperactivity, and inattention, which are not easily tolerated by patients. New antiepileptic drugs (such as oxcarbazepine, lamotrigine, topiramate, levetiracetam, etc.) are not only clinically effective, but also have fewer side effects and are easily tolerated by patients. For example, oxcarbazepine and lamotrigine, along with their antiepileptic effects, can also improve patients’ cognitive function and state of mind, and have a lower teratogenic rate. Levetiracetam has few drug-drug interactions, a rapid onset of action, and a good safety profile. In addition, antiepileptic drugs generally need to be taken for 2 to 3 years or even longer, so the price of antiepileptic drugs is not an issue to be ignored. Although new antiepileptic drugs have good efficacy and fewer side effects, they are more expensive and difficult to promote popularization, especially in rural and remote areas. Is it better to treat epileptic patients with one drug or a combination of multiple drugs for better efficacy? It is currently advocated that monotherapy should be used first for newly diagnosed epileptic patients, which can result in complete control in 60% of new patients, especially in idiopathic epilepsy. If monotherapy is not effective, then a combination of drugs should be considered. In patients who have been treated with polypharmacy, the problems of polypharmacy can be addressed by scaling back some of the secondary therapeutic agents through blood level monitoring. Since drug-drug interactions often exist when combining drugs, rational drug selection should try to combine drugs with different mechanisms of action and little or no drug-drug interactions. Rational drug combinations should be used with the ultimate goal of the best clinical outcome and the least economic burden on the patient. The ideal goal of epilepsy treatment should be complete seizure control without significant drug toxicities. However, this goal is sometimes difficult to achieve, and some patients do not have complete seizure control even after applying the maximum dose of medication. In such patients, the main goal of treatment is to minimize or suppress seizures that have a malignant effect on the patient’s quality of life (e.g., generalized grand mal seizures) and to avoid drug side effects as much as possible. The physician should make reasonable recommendations to the patient with epilepsy, but try to avoid imposing excessive restrictions on the patient’s daily life. Medication should also minimize interference with daily life. For example, sodium valproate needs to be taken three times a day, while Depakene is a valproic acid extended-release agent that can be taken one to two times a day, with little interference with daily life and good compliance. The doctor should make the epileptic patient have a better quality of life as much as possible while treating epilepsy. In conclusion, the drug treatment of epilepsy is a long-term practical process, doctors and patients as well as family members should have full patience and love, patients should have regular follow-up, doctors should individualize treatment according to the specific situation of each patient, and supplemented with scientific life guidance, both sides fully cooperate in order to achieve satisfactory results.