Epilepsy is a common neurological disorder in children. The annual incidence of epilepsy in China is 35/100,000 population, with a prevalence rate of 4‰~7‰, and about 60% of epilepsy starts in childhood. With the continuous development of clinical and EEG, imaging, molecular genetics and antiepileptic drugs, as well as the improvement of diagnosis and treatment, 70%~80% of children with epilepsy can be completely controlled, and most of them can live and study normally. In this article, we describe the diagnosis and treatment routine of epilepsy in children. Epilepsy is a chronic brain disorder characterized by the persistence of persistent brain changes capable of producing seizures and corresponding neurobiological, cognitive, psychological, and social consequences. The diagnosis of epilepsy is generally confirmed by the clinical presence of 2 (>24 h apart) nonprovoked seizures. This is the commonly used and clinically operable diagnostic method. Common causes of epilepsy in children The causes of epilepsy are often divided into 3 categories: ① Idiopathic: epilepsy in which the relevant structural changes and metabolic abnormalities in the brain have not been found, but are more closely related to genetic factors; ② Symptomatic (secondary): epilepsy with clear brain lesions or metabolic disorders; ③ Cryptogenic: epilepsy in which the cause has not been found, although symptomatic epilepsy is suspected. The International League Against Epilepsy classifies the causes of epilepsy into 6 categories: genetic, structural, metabolic, and unknown causes, which have not been widely recognized. Ancillary tests in children with epilepsy EEG is the most important adjunct to diagnose seizures, determine the type of seizure and epilepsy, and is a routine test for patients with epilepsy. Neuroimaging If available, cranial MRI is recommended routinely. However, in small focal cortical dysplasia, which is often not detected until after 1.5 years of age, a repeat cranial MRI is required after 1.5 years of age if there is a high clinical suspicion of focal cortical dysplasia. head CT examinations are only able to detect grosser structural abnormalities and have an advantage over MRI in showing calcified or hemorrhagic lesions. Other ancillary tests including blood biochemistry, cerebrospinal fluid, screening for genetic metabolic disorders, chromosomal testing, and genetic analysis are important in finding the cause of epilepsy and should be performed according to the child’s choice of condition. Key points of diagnosis of epilepsy in children ①Whether the seizure is unprovoked; ②Classification of seizure types based on clinical seizures and EEG performance based on the diagnosis of seizures; ③Diagnosis of epilepsy syndrome based on the child’s age, symptomatology, EEG and other factors; ④Determination of the cause; ⑤Examination and overall assessment of the child’s individual development and related organ functions should be performed. Key points in the treatment of epilepsy in children The treatment of epilepsy should follow both general treatment principles and take into account individualized differences. The treatment of epilepsy includes pharmacological treatment, surgical treatment, and ketogenic diet treatment. When choosing a treatment plan, the characteristics of each child with epilepsy such as etiology, seizure type/syndrome classification, co-morbidities and family factors should be fully considered for individualized and comprehensive treatment. If there is a clear etiology, etiologic treatment should be actively performed. The basic principles of drug therapy 1. Antiepileptic drugs should be selected according to seizure type, syndrome and family environment. If the syndrome cannot be diagnosed, drugs should be selected according to the seizure type. 2. Firstly, monotherapy. 3. Take medication according to the pharmacokinetics of each drug. 4. Monitor blood levels regularly if necessary. 5. If there is a need for drug replacement, the transition should be gradual. 6, the course of treatment should be long, generally need to treat at least 2 consecutive years without seizures, and the EEG epileptiform discharges completely or basically disappeared, before the gradual reduction of drugs. 7. Slowly discontinue the medication, the process of reducing and discontinuing medication generally requires more than 3~6 months. 8. Regular follow-up visits should be made throughout the treatment process to monitor the possible adverse reactions of drugs such as allergy, liver function impairment, and hematologic involvement. The classification of antiepileptic drugs is divided into traditional antiepileptic drugs and new antiepileptic drugs. Traditional antiepileptic drugs mainly include phenobarbital, valproic acid, carbamazepine, phenytoin sodium, clonazepam; new antiepileptic drugs mainly refer to those marketed after the 1990s and currently available in China, including lamotrigine, levetiracetam, oxcarbazepine, topiramate, zonisamide, etc. Epilepsy surgical treatment Those with clear epileptogenic foci (such as focal cortical dysplasia) and poor results of medical treatment should go to a specialized epilepsy center for preoperative evaluation of epilepsy surgery, and if they are suitable for epilepsy surgery, they should undergo surgical treatment. However, surgical treatment is, after all, invasive, and the risks and benefits of surgery should be evaluated at a specialized epilepsy center before epilepsy surgery is performed.