Faced with the treatment of pediatric epilepsy, parents often do not know how to choose: long-term medication, worrying about side effects and out-of-control disease; choose surgery, and fear of damage. Recently, I was invited to write an article and answer a series of questions about the surgical treatment of pediatric epilepsy, hoping to enlighten the majority of children and parents. What kind of pediatric epilepsy is suitable for surgical treatment? In the past, epilepsy treatment focused more on the characterization of the disease, i.e., to clarify “whether you have epilepsy or not”. However, there has not been much in-depth investigation into the questions of “why do you have epilepsy”, “where does it occur”, and “where is the specific lesion”. With surgical treatment, clinicians began to focus on the origin of the epilepsy, i.e., where the lesion was located within the skull. Surgery is a way to suppress or remove these “troublemakers”. In general, 70% of patients with epilepsy can be effectively controlled with medication. Surgery is for the remaining 30% of patients whose medication is not effective, or what is known clinically as drug-refractory epilepsy. Continued medication despite ineffective drug therapy is not only unhelpful for disease management, but may also lead to a range of adverse outcomes. In infants and children, poorly controlled epilepsy can lead to significant neurodevelopmental impairments, including cognitive, behavioral, psychosocial, and psychiatric disorders. Epilepsy can induce mental retardation and cause severe mental retardation. Toxic payoffs can also occur with high doses of medication. If this group of children is treated early with surgery, it may be curative or remitting. This can be combined with a number of medications to control and reduce seizures and reduce the impact of the disease on the child’s growth and development. What is the definition of “medication-refractory epilepsy”? The traditional definition of “drug-refractory epilepsy” is that two years of regular medication with no effect is considered drug-refractory epilepsy. Clinical studies have found that if the epilepsy is clearly staged and targeted medications are used, the first medication is 40% effective. If this drug is ineffective, a combination of two drugs is needed, which may have a 20-30% effect. If a third drug is used, it is only 10% effective. It can be seen that with more than two drugs, the effect of drug control is poor. Therefore, for children with epilepsy, targeted medication after clear epilepsy typing, regular medication for 6 months, and the combination of two drugs is ineffective, can be considered drug-refractory epilepsy.