Patients diagnosed with drug-refractory epilepsy should undergo evaluation with long-range digital video EEG monitoring, detailed imaging, necessary laboratory tests, and genetic-metabolic screening for differential diagnosis and definitive etiology. High-resolution MRI is preferred, including T1, T2, flair sequences, axial, coronal, hippocampal imaging, and thin-layer scans if necessary. CT scan can be added when calcification and other lesions are suspected. If available, the degree of cognitive, psychological and social impairment should be properly assessed. Children should also be monitored dynamically for intellectual and growth development. Further therapeutic measures should be determined based on these findings. For patients with drug-refractory epilepsy who have a clear epileptogenic focus and the epileptogenic focus is located in a non-critical functional area of the brain, resective surgery should be considered as early as possible. This includes resection of the epileptogenic focus, lobectomy, and multileaf resection of the cerebral hemispheres. Even for those whose families are temporarily unable to undergo resective surgery, long-range video EEG monitoring or evaluation at a comprehensive epilepsy center should be actively performed to objectively evaluate the risks and outcomes of surgery and provide a basis for further treatment in the future. In particular, early surgical treatment is recommended for temporal lobe epilepsy and partial epilepsy with resectable epileptogenic foci, for drug-refractory epilepsy with predictable surgical outcome. Even in partial drug-refractory epilepsy without structural changes in imaging, if the epileptogenic focus can be localized by means of high-resolution MRI, functional imaging or intracranially embedded electrodes, early surgical treatment should be considered. 2. Ketogenic diet Patients who are not suitable for surgical treatment or are temporarily not considering surgical treatment can apply this therapy under the joint guidance of physicians and dietitians. Palliative surgical procedures include corpus callosotomy and subcallosal transection to reduce the frequency and degree of seizures by blocking the transmission of epileptiform discharges. The corpus callosotomy is divided into the first two-thirds of the segment and the whole segment. For children with “drop seizures” (including tonic, myoclonic, and atonic seizures) and frequent generalized seizures (catastrophic epilepsy) that severely affect the child’s growth and intellectual development, full-section callosotomy can be used, and if the child has focal lesions in non-functional areas, they should be removed together to improve the treatment outcome. Subcallosal transection is mainly used for patients with epileptogenic foci located in important functional areas of the brain that are not suitable for resective surgery. VNS, DBS and electrocortical stimulation are performed by wrapping the electrical extremities of the stimulator around the vagus nerve or implanting them in the intracranial target (anterior thalamic nucleus, hippocampus, etc.), while the other end of the pulse generator is implanted subcutaneously in the chest to achieve continuous or reflex weak pulse electrical stimulation. The treatment of epilepsy is achieved by continuous or reflex weak pulsed electrical stimulation. The treatment effect has been reported to reduce seizures by 50% in 50-60% of patients. The aim of these treatments is to reduce seizures and improve quality of life, but they are currently expensive, so the risk-to-benefit ratio of patients should be carefully evaluated before implementation. 5. Further antiepileptic drug therapy includes the application of new antiepileptic drugs and attempts at multidrug combinations. In the past two decades, new antiepileptic drugs have emerged, and some drugs with completely different mechanisms from traditional antiepileptic drugs have been put on the market, providing the possibility for patients with refractory epilepsy to try drug therapy again. In addition, patients who have failed surgery, diet therapy, and neuromodulation should also try the possibility of drug therapy again. 6. Corticosteroid therapy is mainly used for some children with drug-refractory epilepsy, such as infantile spasms, Landau-Kleffner syndrome, etc. 7. Others: intravenous immunoglobulin, etc. In conclusion, the choice of treatment for drug-refractory epilepsy should be based on a comprehensive evaluation of diagnosis, prognosis, treatment outcome, treatment risks and costs.