The timing of surgery for epilepsy patients has always been a concern for epilepsy patients and an important question to be answered by medical professionals involved in epilepsy, as surgical treatment too early tends to lose the opportunity for non-surgical treatment to bring about complete remission, while intervention too late inevitably aggravates neurological impairment. The choice of the timing of surgical treatment is therefore particularly important. This article is a review of the choice of the timing of surgery in patients with epilepsy, in the hope that it will be helpful to patients with epilepsy. In principle, if regular medication is still refractory after more than 2 years of observation, all patients should be considered for surgical treatment. Since each patient’s condition is different and the situation is different, the specific situation should also be analyzed. First, domestic and international studies have shown that early surgery is indicated if prolonged seizures have produced or are about to produce serious psychosocial problems. These conditions include seizures that have affected school employability and marital status, and depression, anxiety, poor psychological adaptation, social isolation, suicidal tendencies, etc. In addition, seizures have begun to cause language and cognitive dysfunction, etc. Since most of these abnormalities are reversible in the early stages, it is only as the seizures continue and the disease progresses that they gradually enter the irreversible stage and can be carried from childhood into the adult stage. Therefore, aggressive and effective surgical treatment in the early stages of these abnormalities can reduce long-term somatic and psychosocial problems and improve the quality of life of the epileptic patient. Secondly dynamic or progressive types of epilepsy should be operated on promptly to prevent progression to refractory and serious consequences. Is the patient destined for a refractory outcome at the onset of the disease? Or does it eventually progress to refractory over time? The answer to this question has very important clinical implications: if refractoriness is not predetermined, then it can be prevented from progressing to refractory by aggressive treatment early in the onset of the disease; of course, if the type of epilepsy is destined to have poor results with regular medication at the outset, early surgery should also be performed in order to avoid serious adverse consequences. It is worth noting that some types of epilepsy understandably do not progress to refractory; for example, the prognosis for idiopathic epilepsy is generally good, and individual syndromes do not even require treatment. In contrast, some highly refractory childhood-onset epilepsies, such as WEST syndrome, severe myoclonic epilepsy in infants, Lennox-Gastaut syndrome, and Rasmussen encephalitis, comprise progressive epilepsy syndromes with frequent epileptic electrical activity resulting in a state of progressive brain dysfunction, especially Rasmussen encephalitis, which, after a clear diagnosis and short-term drug Those who are ineffective in treatment can then be considered for surgical treatment. The relationship between it and hippocampal sclerosis has been debated for more than 100 years, and recent structural and functional imaging studies have shown that frequent clinical seizures can cause neuronal dysfunction and neuronal apoptosis, aggravating hippocampal sclerosis, suggesting that most medial temporal lobe epilepsies are progressive and should be treated surgically in due course. Finally, the ignition effect of the epileptogenic foci should be considered. Current animal experimental models have found that the continuous stimulation of the primary foci causes the gradual generation of new epileptogenic foci in the corresponding parts of the contralateral cerebral hemisphere, i.e. secondary epileptogenic foci. In the initial stage of secondary epileptogenic foci, their epileptic discharges are closely linked to the primary epileptogenic foci, and after several seizures, the secondary epileptogenic foci can act as an independent seizure generating foci. Therefore, timely surgical treatment is important to prevent the formation of new epileptogenic foci that can cause exacerbation of epilepsy.