Intellectual abnormalities play an important role in childhood epilepsy. The use of IQ tests during follow-up is important for early detection of children with low IQ, early intervention, and timely treatment. The following factors affecting the intelligence of children with epilepsy should be taken into account. Primary epilepsy generally has a good prognosis and can be completely controlled with medication, with a higher IQ than secondary epilepsy. In addition to biological factors, there are also social factors. Children with primary epilepsy often have fear and anxiety and are unable to attend school, resulting in low IQ. Some antiepileptic drugs also have an effect on intelligence, such as phenobarbital, sodium phenytoin, sodium valproate, and benzodiazepines, which can impair memory, motor speed, and mental development. Some congenital factors such as craniosynostosis, genetic and metabolic defects are common causes of epilepsy and mental retardation, which are difficult to treat and serious. Among the postnatal factors, mental retardation is related to the severity of central nervous system infection and the presence of complications, and it heals well if the cause can be eliminated. Febrile convulsions secondary to epilepsy tend to cause mental retardation, so febrile convulsions in infancy should be actively managed and prevented, and the attack should be immediately controlled with drugs to avoid permanent brain damage after the convulsion. In infants and toddlers, the onset of febrile seizures is more severe than in older children, and in older children, it is more severe. This is related to the characteristics of brain development in infants and young children, because the brain tissue metabolism is active during infancy, cell differentiation and myelin formation are vigorous, most vulnerable to convulsive brain injury. The younger the age of onset, the earlier the onset, the more pronounced the low IQ. The clinical seizure type is closely related to intelligence, and the intelligence of children with different types of epilepsy varies, and the type of epilepsy is a major factor affecting intelligence. Complex partial seizures have a greater impact on IQ, while simple partial seizures have a smaller impact. Infantile spasms and other epileptic syndrome seizures are difficult to treat and have significantly lower IQ, while petit mal seizures have a better prognosis. The duration of seizures, the frequency of seizures, the control of symptoms, and the regularity and timeliness of treatment are closely related to intelligence. For pediatric epilepsy, early diagnosis, determination of seizure type, timely and reasonable medication, and elimination of the cause are the keys to prevent mental retardation and prognosis. The prognosis is not only related to the control of seizures, but also to the social or psychological adaptation. In addition to the use of appropriate antiepileptic drugs for the treatment of children with epilepsy, the child’s family should be counseled and the child’s intelligence should be followed up to improve the child’s IQ level.