The pathogenesis of epilepsy is mainly due to abnormal development of brain structures or immaturity, resulting in abnormal ion channels for nerve cell activity, abnormal function of neurotransmitters or their receptors, and abnormalities of metabolism-related enzyme systems. Because of the many causes of epilepsy and its classification types, how to accurately diagnose epilepsy is important for treatment selection and prevention determination, but there are still many pitfalls in the diagnosis of epilepsy, and many clinicians and even neurologists can easily fall into that trap, not to mention patients and patients’ families who lack medical knowledge and need to be cautious. The following are common pitfalls in the epilepsy diagnosis process. 1. A clinical seizure, but a “normal” EEG or no epileptiform discharges, cannot completely rule out epilepsy. This phenomenon can be seen in low frequency of epileptiform discharges, small lesions, deep lesions, and missed judgments by EEG analysts. The absence of clinical seizures and the presence of epileptiform discharges on the EEG cannot always be diagnosed as epilepsy. There are a few healthy subjects who have never had clinical seizures, but have epileptiform discharges on the EEG, even explosive or paroxysmal discharges. Most of them are temporary and disappear over time, or they may be present throughout life without seizures. The frequency of epileptiform discharges does not necessarily correlate positively with the severity of clinical seizures. For example, in BECT, there are frequent epileptiform discharges in the interictal period, but their seizures are rare; while some epilepsies, such as frontal lobe epilepsy, have frequent seizures but few EEG epileptiform discharges, and even no epileptiform discharges are recorded during the seizure period. 4. Normal or non-epileptic abnormalities are misdiagnosed as epileptiform discharges. In the EEG judgment, attention should be paid to differentiate epileptiform discharges from normal wave patterns, which are easily misjudged as abnormalities: 1. Isolated slow waves in the posterior head: mostly seen in normal children and adolescents with large triangular slow waves in the occipital region, shaped like sharp slow or spike slow waves, which are easily judged as epileptiform discharges. 2. 2, hump wave during sleep: in children, the wave amplitude is higher, protruding from the background wave, sometimes misjudged as epileptiform spike wave issuance. 3, two-finger glove wave: an abnormal waveform of non-epileptiform discharge during sleep, shaped like a two-finger glove, with the thumb part being the last sleep spindle wave and the remaining four-finger part becoming a triangular slow wave. See in deep brain tumor, Parkinson’s syndrome and psychosis, easy to misjudge as spiny slow wave. 4, slow wave evolution phenomenon: in children hyperventilation gradually appear brain wave frequency slowing down, wave amplitude increasing, continuous or paroxysmal slow wave rhythm, as long as the two sides symmetry should be normal, paroxysmal easy to misjudge as epileptiform discharge. 5, flash myoclonic response: in the intermittent flash stimulation appears with the flash stimulation frequency of muscle potential, easy to misjudge as spike wave rhythm issuance, actually for flash stimulation head and face myoclonus artifact. 5, epileptiform discharges misjudged as normal wave type: commonly have complex partial seizures appear paroxysmal fast wave rhythm or low flat easily misjudged as normal, epileptiform discharge rhythm is also easy to misjudge as normal wave type. 6. Non-specific abnormalities are misdiagnosed as epileptiform discharges 7. In clinical work some physicians are not familiar with EEG and diagnose epilepsy as long as there are abnormalities in the report. The above 7 points are common pitfalls in the diagnosis of epilepsy. We should take them as a warning and carefully interpret the many different phenomena in the clinic in order to make a correct decision on the diagnosis of epilepsy.