The more seizures before treatment, the worse the patient’s prognosis, and antiepileptic drugs (AEDs) can prevent recurrence in 50% to 90% of newly diagnosed epilepsy patients, so active treatment is always advocated for patients with multiple or frequent seizures. On the other hand, antiepileptic drugs have more or less side effects, and for the first seizure in newly diagnosed epilepsy, is it necessary to start taking antiepileptic drugs for the first time? To answer this question, we need to understand that the concept of risk of recurrence of epilepsy, and that a risk assessment for recurrence of epilepsy is needed. A. Risk of recurrence in patients with epilepsy Risk of recurrence of initial non-induced epileptiform seizures: The risk of recurrence after initial non-induced epileptiform seizures in patients with epilepsy varies due to the different observation subjects, follow-up time and study methods in various studies. The average recurrence rate was 42%, and 60% to 70% of patients had a recurrence within 6 months after the initial seizure. The risk of recurrence for ≥2 seizures and the corresponding risk of recurrence were 43% and 61%, respectively, suggesting that ≥2 seizures are more likely to recur. What are the factors that influence the recurrence and prognosis of epilepsy? The factors that influence recurrence in early epilepsy can be a guiding factor in determining the timing of medication use. However, the factors affecting the recurrence of epilepsy are complex and varied. The more definite factors include symptomatic epilepsy, abnormal EEG discharges, especially focal epileptic waves, first seizure that manifests as a continuous status epilepticus or cluster seizures, partial seizures, positive family history of epilepsy, seizures during sleep, and history of febrile convulsion. A large number of studies have also shown that patients with symptomatic epilepsy and those with a high number of seizures before treatment were found to have a poor prognosis. Third, the timing of initial treatment for epilepsy patients, how to choose? The timing of initial or early medication for patients with epilepsy is very complex and requires specific analysis based on each patient’s situation to achieve individualized treatment. The following principles should be grasped when timing initial medication for patients with epilepsy: 1. Immediate AEDs treatment can reduce but not eliminate the risk of seizure recurrence and has no impact on the long-term “seizure-free” epilepsy “The first non-induced epileptic seizures are generally not recommended to be treated with AEDs; 2. Some patients with first non-induced epileptic seizures should be immediately treated with AEDs if they have a clear wind (including imaging abnormalities, neurological deficits, etc.), EEG abnormalities (especially focal epileptic wave-like abnormalities), first occurrence as persistent status epilepticus or clusters of seizures; 3. treated with AEDs; 3. Late age of onset, partial seizures, high number of seizures before treatment, multiple seizure types, seizures during sleep, positive family history, and previous induced epileptiform seizures (e.g., febrile convulsions) may be factors affecting the recurrence or prognosis of epilepsy, and AEDs should also be given in principle if the above risk factors are present, especially if ≥2 risk factors are present. Therefore, the epilepsy disease diagnosis is a very detailed and complex process, and after the initial diagnosis of epilepsy, it is important to visit an epilepsy specialist clinic for recurrence risk assessment. Among these examination items, EEG, preferably including awake + sleep EEG, and cranial MRI examination are the core examination means to clearly understand whether there are abnormal discharges in EEG, whether there are structural abnormalities in the cranial brain, etc. After comprehensive analysis and assessment, if necessary, early selection of After comprehensive analysis and evaluation, appropriate antiepileptic drugs will be selected as soon as necessary.