The first thing many patients ask me when they learn they have epilepsy is: Can I have surgery? They think that surgery is the only way to get a “cure” and that once they have surgery, they will never need to take medication again. In fact, this is a misunderstanding. The causes of epilepsy are classified as idiopathic and symptomatic. Idiopathic epilepsy is epilepsy whose cause cannot be found by current means, and is often related to genetics and has no indication for surgery. At the current level of medical care, each of these causes accounts for about half of the cases. Therefore, most patients cannot undergo surgery. In the remaining 20% of patients, only half of the patients do not need long-term medication after surgery, and the other half need long-term medication to control their seizures. In other words, surgery is not the first choice for epilepsy treatment, regardless of the condition, not to mention the fact that surgery causes new damage to the brain. Especially in epilepsy due to systemic diseases, surgery should be treated with caution. Male, now 15 years old. 4 years old suddenly fell to the floor at noon while eating and became pale, followed by recurrent seizures, blurred and blackened vision in both eyes, staring, blurred consciousness, sometimes panic-like, with bilateral upper limb extension. There were also frequent headache attacks, a few minutes each time, without nausea and vomiting, and more seizures in the morning and evening. Long-term treatment with multiple antiepileptic drugs, but irregular medication and poor control. He had one seizure every two months. Two years ago, he underwent “left frontal cortex cautery and subchondral multiple transverse fibrillotomy”, and the seizures did not change after the operation. Now the seizures are mainly characterized by eye fixation, dullness, and head rotation to the left or right for 1 minute. Seizures occur once a month. There is a loss of consciousness convulsion once every 6 months. One year ago, he was hospitalized in the Infectious Diseases Department for fever and facial rash suspected of typhoid fever, but treatment was ineffective. She was diagnosed with “lupus erythematosus” after positive tests for ENA peptide antibodies and anti-keratin, and her symptoms disappeared after treatment with hormones and immunosuppressants. The above treatment has been discontinued and only antiepileptic medication is maintained, and the seizures are the same as before. This is a case of failed surgical treatment. The patient’s symptoms showed that the epilepsy originated in the occipital lobe, but the EEG discharge was in the frontal lobe, and the localization was unclear on imaging. As a rule, this patient was not suitable for surgery. However, the family strongly demanded a “one-stroke cure”, so with unclear localization, relying on intraoperative cortical EEG to remove the discharges, the results were naturally poor. At the same time, from the whole course of the disease, the patient’s seizures are the brain manifestation of a systemic disease, and comprehensive treatment is needed to achieve the best results. It should not be assumed that the condition will be controlled by removing only the local brain.