From the perspective of medical treatment, drug-refractory epilepsy is characterized by clinical seizures that are difficult to control with medication and may be accompanied by certain psychiatric, cognitive and behavioral abnormalities that affect the patient’s daily work and life. At present, there is still a lack of a uniform standard for this worldwide. However, the following aspects should be fully considered. 1. Observation of the type of drug therapy: Clinical data show that if monotherapy does not result in good seizure control, it is unlikely that further application of 2 or 3 antiepileptic drugs will result in complete seizure control. If three appropriate antiepileptic drugs alone or in combination fail, then the hope of further drug therapy is less than 5%. 2. Observation of the duration of drug therapy: Excessively prolonged seizures can aggravate the damage to the central nervous system, followed by severe psychosocial and physical disability. More importantly, prolonged uncontrolled seizures increase the risk of accidental death. The more you take medication, the better the results. 75% of patients can control their seizures with medication, especially benign pediatric epilepsy, and if you insist on controlling your epilepsy with medication for more than 2 years without seizures, you can gradually reduce the amount of medication until you stop taking it. However, 25% of patients who are not treated with medication become refractory to epilepsy, and surgery is the best option for refractory epilepsy. Approximately 20-30% of patients present with drug refractory epilepsy and require preoperative evaluation for epilepsy surgery. Surgical treatment of epilepsy is highly specialized and requires a multidisciplinary approach involving neurology, neurosurgery, neuroimaging, neuropsychology, and neurorehabilitation. Therefore it needs to be done in an experienced epilepsy center. Surgical approaches in epilepsy surgery can be divided into resective and palliative surgery. Excisional surgery is the most performed and most established surgical procedure with the aim of achieving complete clinical remission of seizures and eradication of epilepsy. It mainly includes temporal lobectomy, neocortical resection, multiple lobectomy, and cerebral hemisphere resection. Palliative surgery aims to reduce or alleviate seizures, but not to completely relieve them. They mainly include corpus callosotomy, multiple submural transection, and low-power electrocoagulation thermal cautery. Oral antiepileptic drugs need to be continued after epilepsy surgery with regular follow-up. Epilepsy surgery has been performed in China for more than 10 years, and satisfactory surgical results have been achieved in some of the larger epilepsy centers. There have been a large number of factual cases proving that surgery is a better option for refractory epilepsy, but not all patients with refractory epilepsy are suitable for surgery and have to be evaluated on a patient-by-patient basis to see if the patient’s condition is suitable for surgery.