According to the latest epidemiological survey, there are about 8-9 million epilepsy patients in China, and there are still 400,000 new epilepsy population every year. 70%-80% of these patients can have their seizures controlled or relieved with regular medical treatment, but 20%-30% are gradually developing into refractory epilepsy, which shows that there should be no less than 1 million refractory epilepsy patients in China. Appropriate surgical treatment can alleviate and reduce seizures in patients with epilepsy, and has the opportunity to cure them radically. The following is an explanation of the concept of refractory epilepsy, the timing of epilepsy surgery and the series of epileptogenic foci and indications for surgery, which we hope will be of some reference value to the majority of epilepsy patients. In principle, drug therapy is preferred for epilepsy treatment, and the determination of refractory epilepsy is based on the efficacy of drug therapy. Since the 1980s, the principle of monotherapy for epilepsy has been gradually accepted. If reasonable monotherapy fails (still more than 4 seizures per month), other antiepileptic drugs can be switched or added. Studies have shown that after failure of regular treatment with the application of two drugs, the likelihood of successful treatment with the application of a third drug will be less than 15% to 10%. In contrast, the likelihood of remission with further medication after failure of three medications is less than 5%. In addition, although there are more than a dozen new antiepileptic drugs, and clinical trials have confirmed their effectiveness, only about one-third of patients with refractory epilepsy benefit from them. Failure of formal treatment with the application of two antiepileptic drugs essentially establishes refractory status, and surgical treatment is initially considered. Another important reason for failure of drug therapy is the short- and long-term systemic and neurological toxicity caused by the drugs. In this case, even if the drug therapy works well, the patient has to abandon the drug therapy due to severe adverse effects, and this type of patients is also suitable for surgical treatment. At present, the management of epilepsy medication in China is quite unregulated. The so-called “traditional Chinese medicine” that many patients take is often mixed with several western drugs, and the blood concentration does not reach the effective range. Even if these patients have been taking drugs for several years without control, they should not be immediately diagnosed with refractory epilepsy and selected for surgery. The definition of refractory epilepsy has a clear definition of seizure frequency, but does not take into account the severity of seizure symptoms. Clearly there are significant differences in clinical severity between seizure types and seizure patterns. For example, more aggressive treatment options must be considered for patients with clinical seizures with loss of consciousness, convulsive seizures, drop seizures, seizures of long duration, seizures with psychiatric symptoms, seizures with the potential to cause accidental injury or death, and daytime seizures. In contrast, for those with relatively mild clinical seizure symptoms, surgical treatment may not be considered first. Surgery in children with epilepsy should be approached with great caution; refractoriness persists for most adults with epilepsy. However, for a small proportion of patients, particularly in childhood epilepsy, a tendency for clinical seizures to resolve on their own with age has been observed during long-term follow-up. For example, benign late-onset occipital lobe epilepsy in childhood is often refractory in childhood, but can remit around puberty. The concept of stage-refractory epilepsy has therefore been proposed, a phenomenon that is mainly due to the possible re-regulation of the function of excitatory and inhibitory systems in the brain with age to achieve homeostasis. Certainly the persistent epileptic discharges and frequent seizures during the interictal period in children are also capable of producing significant toxic effects on brain development, affecting cognitive function and increasing susceptibility to further seizures. At the same time, brain tissue during this period is highly plastic, and the function of surgically removed tissue can be compensated by other sites, thus greatly reducing the incidence of postoperative neurological deficits.