Once diagnosed with epilepsy, patients are faced with the choice of treatment, whether to choose medication or surgery. Usually, medication for epilepsy requires long-term uninterrupted medication for at least 3 years, but most of the patients I have treated in the clinic usually look surprised and incredulous when they are told that they need to take medication for a long time, and some even show disbelief, and then ask if there are other easy methods, such as surgical removal of the lesion, to achieve a cure that never recurs. In fact, the choice of medication or surgery needs to be considered from many aspects: First, most patients are not willing to take medication for a long time. First of all, most patients do not want to take medication for a long period of time. They are worried about the effects of long-term medication on their body and the poor effect of medication. With the exception of some patients who are afraid of the risks of surgery, most patients will voluntarily request surgical treatment, hoping for a complete cure that will never recur and to get rid of their dependence on drugs. Secondly, as a treatment provider, surgeons are also quite interested in surgery. One can imagine the sense of accomplishment when a cut is made and the patient’s seizure disappears immediately; moreover, with regular exercise, the status of the surgeon in the industry will also be enhanced. Furthermore, most hospitals in China are self-sustaining and have profit motives as well as impulses. Surgery is fast and profitable, and more likely to gain the attention of the leadership. Therefore, the three parties, doctors and patients, have a common need and the indications for surgery are easily relaxed artificially. The question is, is surgery really the first choice in the treatment of epileptic patients? Recently, I have attended several international epilepsy conferences. With the increasing number of reports related to epilepsy surgery abroad and the increasing success rate of being seizure-free after surgery, on the surface it seems as if epilepsy surgery is becoming more common and has become the first choice for epilepsy treatment. However, as a senior internist, I feel that this can only be an illusion, at least for now. The true pathogenesis of epilepsy is not yet fully understood. The main concept of pharmacological treatment is based on these mechanisms, either to reduce the firing phenomenon of nerve cells, or to slow down or even block the conduction of firing, to suppress the production of symptoms or to reduce the symptoms during seizures, and ultimately to reduce the impact of seizures on brain and other organ functions. Epilepsy surgery reduces or disappears seizures by removing the foci of epileptic discharges and cutting off the firing network, or by cutting off the contact between the two hemispheres to reduce the transmission of symptoms from one side to the other during seizures. This shows that the key to epilepsy surgery is to clarify the pathways of the epileptic foci, or networks. In fact, their foreign counterparts are also very cautious about epilepsy. They do a lot of careful work, exploration of the patient’s preoperative epileptic lesion localization. Except for very simple cases, for most patients, the surgeon will choose many tests, including long-range EEG, different sequences of cranial MRI, PET-CT, subdural and deep electrode monitoring, magnetoencephalography, high-frequency discharge monitoring, evoked potentials, etc., with the ultimate goal of localizing the epileptic focus, assessing whether the procedure will have a significant impact on the patient’s brain function, reducing blindness during surgery, and To reduce the risk of neurological impairment (e.g., paralysis, inability to speak, loss of sensation) after surgery. In cases where surgery is truly inappropriate, it is not performed. However, even with this caution, they still report a small number of patients with incorrect surgical sites or irreversible damage to the patient. Of course, a sea of preoperative tests means incurring a sea of costs. But the good news is that there are insurance companies. Domestic counterparts are making the same attempts and efforts. However, for economic reasons, technical reasons, and subjective reasons, epilepsy surgery is not as effective as in developed countries. According to authors in developed countries, the results after epilepsy surgery vary greatly by seizure type, with an overall seizure-free (including those who continue to take medication and discontinue it after surgery) ratio of about 70%, and the rest of the patients simply having fewer or ineffective seizures, or even an increase in seizures. Based on the above understanding, whenever a patient asks me: can he be treated surgically? I will answer from the following aspects, so that he can have a clear understanding of his situation before making his own choice. 1. The type of seizure is the basis for deciding whether surgery is possible. Only focal seizures are considered for surgery, and whole brain lesions are not available. 2. The frequency of seizures. Very sparse seizures (for example, 1-2 per year) make little sense for surgery. One of the reasons is the difficulty in detecting the localization of epileptic lesions, another reason is to understand: epilepsy surgery is not immediately after the drug can be stopped, most patients even completely seizure-free, but also to adhere to the medication for more than 2 years, so patients with sparse seizures regardless of surgery or not, need to take medication for a long time, do not do surgery to take medication and after surgery to take the same time, the impact on the body surgery instead, so unless There are progressive lesions in the brain (such as tumors, etc.), is not supposed to surgery. 3, the response to drug treatment. Most patients can get their seizures under control by taking medication, but some patients ask for surgery just because they find it troublesome or want to “cure” the disease. Doctors should not disregard the health of the patient because of the impulse of profit, after all, there are various risks in surgery. 4, economic reasons. The more detailed the preoperative examination, the higher the possibility of no seizure after surgery, but need economic support. If the economic conditions are poor, I personally think that unless a simple case, it is recommended to suspend the consideration of surgery, because the preoperative need a large amount of money, intraoperative complications may occur, postoperative costs, without strong economic backing, I am afraid that the prognosis is not good. Of course, there are other aspects of the problem, and different patients have their own problems, so I won’t go into them again. I always encourage my patients: medicine is constantly evolving, and we need to see hope. In recent years, several new drugs have come on the market, and in addition to being more effective than the old ones, the new drugs have fewer side effects. Instead of having surgery without being very sure of the efficacy, try switching to other new drugs and wait for the future when the technology is more mature. However, surgery should be considered if the lesion is clear, or if the medication is not well controlled, if frequent seizures affect work life, or if there are progressive lesions in the brain, etc.