I. Basic principles and considerations for the selection of antiepileptic drugs (AEDs) 1. The selection of drugs based on seizure type and syndrome classification is a basic principle in the treatment of epilepsy and also needs to be individualized taking into account co-morbidities, co-medications, the age of the patient and the wishes of his or her patient or guardian; 2. If seizures still occur despite reasonable use of first-line antiepileptic drugs, the diagnosis of epilepsy needs to be critically evaluated; 3. Patients are recommended to The same manufacturer’s drug is fixed unless the prescriber, in consultation with the patient and his or her guardian, deems it appropriate. There are differences in bioavailability and pharmacokinetics of different antiepileptic preparations, so care needs to be taken to avoid reduced efficacy or increased side effects; 4. Monotherapy is recommended whenever possible; 5. If the first antiepileptic drug chosen fails in treatment because of adverse reactions or continued seizures, another drug should be tried If the second drug is still ineffective, the first or second drug should be slowly withdrawn based on relative efficacy, adverse effects, and drug tolerance before starting another drug; 7. If the combination therapy does not benefit the patient, the treatment should be returned to the most acceptable regimen (monotherapy or combination therapy) to achieve the best balance of efficacy and tolerance of adverse reactions; 9. 10. For epilepsy syndromes and refractory epilepsy that are difficult to treat, referral to an epilepsy specialist is recommended. (1) The decision to start antiepileptic drug therapy requires a full discussion with the patient or his/her guardian, weighing the risks and benefits and then deciding, taking into account the epilepsy syndrome and prognosis; (2) Usually, the second seizure (3) Antiepileptic drug therapy should be initiated after the first unprovoked seizure and discussed with the patient or guardian in the following cases: (1) the patient has symptoms of neurological deficit; (2) the EEG suggests clear epileptiform discharges; (3) the patient or guardian believes that the risk of another seizure cannot be tolerated; and (4) brain imaging shows structural damage. Drugs, if the diagnosis of epilepsy syndrome is unclear, the decision should be made based on the type of seizure; 3. Principles of drug discontinuation About 60-70% of patients with epilepsy can achieve seizure freedom after antiepileptic drug treatment. Usually, patients with epilepsy who have been seizure-free for more than 2 years have the possibility of medication reduction and discontinuation. However, whether and how to reduce discontinuation requires a comprehensive consideration of the patient’s type of epilepsy (etiology, seizure/syndrome classification), previous treatment response, and the patient’s personal situation, careful assessment of the risk of recurrence of medication discontinuation, determination of a low risk of recurrence of medication reduction and discontinuation, and adequate communication with the patient or his/her guardian about the risk/benefit of medication reduction versus When the risk of relapse is determined to be low, and the risk/benefit ratio of medication reduction versus continuation is adequately communicated to the patient or guardian, gradual withdrawal of the antiepileptic drug may be considered. The following precautions should be taken when withdrawing medications: 1. The EEG should be reviewed before the medication is reduced, and preferably again before discontinuing the medication. Most epileptic syndromes require an EEG without epileptiform discharges to be considered for drug withdrawal, and the long-range EEG needs to be reviewed periodically (every 3-6 months) during the drug withdrawal process, and if epileptiform discharges occur again during the withdrawal process, the dosage reduction needs to be stopped. Those with structural brain abnormalities or some specific syndromes (e.g., JME, etc.) should be extended to 3-5 years seizure-free; 3. The process of medication reduction should be no less than 6 months for monotherapy; no less than 3 months for each antiepileptic drug reduction in polypharmacy, with only one drug withdrawn at a time; 4. Possible drug withdrawal-related syndromes when withdrawing benzodiazepines and barbiturates and/or reappearance of seizures, the withdrawal should last no less than 6 months. 5. If seizures reoccur during withdrawal, the drug should be returned to the dose once before the reduction and medical advice should be given. 6. If seizure recurrence occurs within a short period of time after discontinuation, previous medication should be resumed and followed up; seizures with triggers after 1 year of discontinuation can be observed, attention should be paid to avoid triggers, and antiepileptic drugs can be withheld; if there are more than 2 seizures per year, the treatment plan should be evaluated again to determine the treatment plan.