First of all, a definite answer: it is possible to have children. But under the guidance of a specialist and with the courage to take the risk themselves, because in reality it is often doctors who are afraid to advise epileptic patients to have children for fear of taking responsibility. 1. About whether it is hereditary. Only a very small number of types of epilepsy are hereditary. You can consult a specialist after a clear diagnosis of the type of epilepsy to see if it will be passed on to your offspring. Although there is no research data specifically on this, theoretically, the effects of medication can be disregarded as long as the pregnancy is successful. In practice, I have often encountered cases of men with epilepsy taking medication whose wives can conceive and give birth normally. Of course, whether seizures and medication affect male fertility is a separate issue. 3. For female patients, the following two factors should be considered. (1) The effect of seizures. It is often encountered that some patients with epilepsy have significantly reduced the number of seizures or stopped having seizures after pregnancy, and some patients have instead had their seizures worsen after pregnancy. In the 1990s, some foreign scholars did a retrospective analysis and found that 15% of patients had an increase in seizure frequency, 24% had a decrease in seizures, and more than half of the patients had no change in seizure frequency after pregnancy. The remaining half of the patients had no change in seizure frequency after pregnancy. Seizures that are generally less severe and of shorter duration (often less than one minute) do not affect the fetus. Severe generalized tonic clonic grand mal seizures can be harmful. On the one hand, patients are often in a state of hypoxia, which in severe cases also leads to disturbances in the internal environment of the body, and on the other hand, they may fall and collide, which can cause harm to the fetus. (There are reports of intracranial hemorrhage in the fetus caused by a fall during a seizure in a pregnant woman) (2) Effects of medications. Theoretically, any long-term use of antiepileptic medications that result in pregnancy will increase the risk, mainly including increased seizure frequency, risk of vaginal bleeding, leading to fetal malformation, and neonatal hemorrhage. However, these conditions are increased in probability (relative to a healthy pregnant woman), the vast majority of cases remain normal, and there are measures that can be taken to reduce the risk. Appropriate choice of antiepileptic drugs. Traditional antiepileptic drugs commonly used are phenytoin sodium (or dalantin), phenobarbital (or luminal), carbamazepine (or deltamethrin), and sodium valproate (or magnesium valproate, or depakene), for which there is definite evidence of effects on the fetus. The newer antiepileptic drugs commonly used are oxcarbazepine (or trilostane), lamotrigine (or lipitor), levetiracetam (or keplar), and topiramate (or tolterol), which have been used for a short time and have less relevant information, but are significantly better than the traditional antiepileptic drugs in terms of other side effects and should be considered as a priority. It is also worth pointing out that lamotrigine, which has been partially studied in the last decade, has shown no difference in its effects on the fetus compared to healthy pregnant women. In fact, my guideline in recent years has also been to choose lamotrigine first for female patients who are preparing to become pregnant while trying to control their seizures. So what should be done for female patients who are preparing to have children? The first thing is to have a plan. This is important because the fetal growth and development is almost complete in the first trimester with all the major organs, especially the nervous system. It is common that when a patient finds out she is pregnant it is often more than 2 months old, by which time the danger is likely to have already occurred. When a patient is considering pregnancy, he or she should first consult a specialist to see if he or she can stop the medication. For cases where the number of seizures is low and the degree of seizures is mild, he or she can try to gradually stop the medication (of course, always under the guidance of a specialist). If it is not possible to stop the medication, try to choose monotherapy and choose a medication and dose with fewer side effects, provided, of course, that the seizures are controlled. Also take oral folic acid supplementation 3 months before pregnancy and during the initial 3 months of pregnancy to prevent congenital neural tube development malformations (e.g. congenital spina bifida). Vitamin K supplementation near the time of birth to prevent neonatal hemorrhage. In fact, folic acid and vitamin K are now also used in healthy pregnant women, and ultrasound can be performed at 16-18 weeks of gestation to check for spina bifida, heart malformations or limb defects, and amniocentesis can be done to determine alpha-fetoprotein levels when available. Incidentally, in my own experience and from talking with doctors at several large Chinese medicine hospitals in Beijing, there is no definitive anti-epileptic herbal medicine. At the same time, I often encounter patients who are taking some unknown so-called “traditional Chinese medicine” capsules or powders, which are tested to contain Western medicine, commonly with the addition of sodium phenytoin or phenobarbital, which have significant side effects. Finally, it is important to emphasize that, according to the statistics, despite all these risks, about 90% of women with epilepsy are eventually found to have normal pregnancies and births, and the babies born are normal. In addition, 1 to 3 percent of healthy pregnant women are found to have abnormal babies, so there is no cause for undue concern.