Patient: Description of condition (major epilepsy? Symptoms, onset time): When I was 16 years old, I had one sudden grand mal seizure during sleep, and two years later I had another seizure, two to three times a year, at first during sleep, and as I grew older, the number of seizures increased and became irregular. He was seen in a specialist hospital, had an EEG, MRI was normal, and treatment with oral phenytoin sodium for 4 years was ineffective. He was treated with oral phenytoin sodium for 4 years, but the treatment was ineffective. He was re-admitted to carbamazepine 0.2mg three times a day, and his grand mal seizures were controlled. Sometimes 2 tablets of eszopiclone were added before sleep. The treatment lasted for 12 years. In recent years, the number of petit mal seizures has increased, sometimes several times a day, which has seriously affected my life. Three months ago, under the doctor’s guidance, I changed again to magnesium valproate extended-release tablets 0.25g twice a day, plus 2 eszopiclam tablets at night, but the treatment was ineffective. And symptoms such as nausea, dizziness and drowsiness appeared. Now the magnesium valproate is reduced by half, and the nausea, dizziness and drowsiness disappeared. Minor seizures are still the same. I have a history of pediatric meningitis. How should I go about the diagnosis and treatment? Reply: As described in your medical history, it is indeed refractory epilepsy or complex epilepsy, and there is a certain degree of difficulty in treatment. I don’t know what level of hospital and specialty you are attending. The reason for the poor efficacy is the following: 1. insufficient drug dose or blood concentration; 2. insufficient control of the time of taking the drug; 3. improper selection of second-line drugs. It is recommended that you go to a local specialist hospital or specialist outpatient clinic and have an ambulatory EEG and blood concentration measurement to clarify the cause or foci, frequency of onset and specific time of onset to facilitate the selection of drugs and adjustment of drug dose. If you find an experienced specialist, he or she will make the above judgments and adjust accordingly. We wish you early control of your disease and improve your quality of life.