Epilepsy is one of the most common pediatric neurological disorders, and many of the many epilepsy syndromes are seen only in the pediatric population. The diagnosis of pediatric epilepsy is based on history and electroencephalography (EEG). Physical examination and imaging studies can help determine the cause of the disease. The history of pediatric epilepsy is often provided by the parents of the child, but they may not always be present when the child has a seizure. It is best to ask for an eyewitness description of the seizure, and if the child has had several seizures, the parents may be asked to describe in detail the one that they observed most closely, rather than talking about the events of each seizure in a generalized manner. For parents to provide a history of a few points worthy of attention, one is easy to exaggerate the condition, for example, when asked about the duration of the convulsions, often exaggerated time, because the image of convulsions for parents is fear, sometimes convulsions are only 2 ~ 3 minutes, the parents will be said “more than 10 minutes,” or even longer, the physician may wish to remind, “You came into the office from the time you came into the room,” “you have been in a number of seizures, it is best to ask witnesses to describe the seizure, you can ask the parents to describe in detail the most carefully observed, rather than generalizing each time. This time the physician may remind, “You have been in the clinic for about x minutes, is it that long?” Parents will then make some corrections. In addition, when parents describe their condition, they often answer according to their own imagination. For example, when asking about the medical history of a child with focal benign epilepsy with centrotemporal spikes, and asking whether there is a loss of consciousness, the long answer is loss of consciousness. Because, in his imagination, loss of consciousness is inevitable when he has a seizure. However, if we asked the child, some children would answer, “I could hear my mom and dad talking, but I couldn’t speak”. This is certainly not a loss of consciousness. In addition to the time and frequency of seizures, the presence of aura, triggers, and post-seizure status, we should pay special attention to the form of the seizure and the state of consciousness during the seizure, which is an important basis for identifying generalized seizures or partial seizures. Partial seizures usually do not have loss of consciousness, while complex partial seizures do not have loss of consciousness, but there is impairment of consciousness. If a partial seizure generalizes to a generalized seizure, there is loss of consciousness. Tonic 2-clonic seizures, myoclonic, tonic, clonic, atonic and catatonic seizures are all generalized seizures, and these seizures are associated with loss of consciousness, and often involve a fall (catatonic seizures do not). It is worth noting that the International League Against Epilepsy (ILAE) Classification of Epileptic Seizures 1981 includes phytoneurotic seizures, which can also be the name of a type of epilepsy, e.g., headache epilepsy, abdominal pain epilepsy, etc. However, in pediatric patients, the diagnosis of this type of epilepsy can be made in the context of a generalized seizure. However, caution should be exercised when diagnosing these disorders in pediatric patients. There are many causes of pediatric headaches, and many systemic disorders can present with headaches. Among pediatric neurological disorders, migraine is the most common cause of headache. Abdominal pain is an even more common symptom in children, and is often “episodic”. A diagnosis of epilepsy cannot be made on the basis of a headache (or abdominal pain) accompanied by an “abnormal” electroencephalogram (EEG) (see Laboratory Tests for details). In the classification of epilepsies and epileptic syndromes published by the ILAE in 1989, headache epilepsy or abdominal pain epilepsy were not included as epileptic syndromes. It is the author’s understanding that the numerous vegetative seizures can be seen in temporal, frontal, parietal, occipital, or other epilepsy syndromes, and therefore are not listed as a separate epilepsy syndrome. The purpose of a detailed physical examination of a child with epilepsy is not to confirm the diagnosis of epilepsy, but to find the cause of epilepsy and determine its prognosis. In addition to a thorough physical examination, the following points should be noted: Head shape and size: Head size is one of the most important indicators of brain development. Head size is one of the most important indicators of brain development. The head circumference should be measured in every child with epilepsy. Intrauterine infections, severe perinatal ischemic-hypoxic encephalopathy, neonatal asphyxia, or intracranial infections can affect the development of the skull, and these disorders are often a common cause of secondary epilepsy. Facial appearance: Some congenital developmental disorders or hereditary diseases can cause seizures, and their appearance is also unique. Pay attention to whether the distance between the inner canthus is too large, whether the eyeballs are too small (small cornea), whether the length of the middle of the human body is too short, whether the position of the outer ear is too low, whether the jaw is too small, whether the arch of the jaw is too high and so on. Abnormalities of limbs and external genitalia: Some chromosomal abnormalities or endocrine disorders can cause secondary epilepsy. Some chromosomal or endocrine disorders may cause secondary epilepsy, which is often manifested by abnormalities of the limbs. Note the presence of polydactyly or syndactyly, and abnormalities of the external genitalia, such as testicular size in boys. Skin: Many of the neurocutaneous syndromes are comorbid with epilepsy and have obvious abnormalities of the skin that can be detected with a little attention. For example, in tuberous sclerosis, white depigmented patches of skin can be seen in infancy, and hemangiofibromas can appear on the face after the age of 5 to 6 years. In children with neurofibromatosis, coffee milk spots are common. Hemangiomatosis of the brain (Sturge2Weber disease), with red nevi on the face. Dyschromatosis with localized abnormal pigmentation of the skin. Ito pigmentosum, a condition in which large areas of pigmentation are seen in strips or patches on the skin of the limbs or trunk. Whether there is a special smell: in some abnormal amino acid metabolism disease in children, in addition to convulsive seizures, due to the abnormal metabolites in the body to increase the Chinese Journal of Neurology August 1996, Vol. 29, No. 4, No. 247, and by the urine, sweat, the affected children have a number of special smell, such as phenylketonuria (mouse urine smell); maple glucosuria (caramel flavor); hypermethioninemia (boiled cabbage water smell), and so on. Cerebral palsy is often associated with epilepsy. Children with cerebral palsy often show central movement disorders, abnormal posture, muscle tone and reflexes, and backward motor development. Electroencephalogram (EEG) is one of the most important objective indicators for the diagnosis of epilepsy. However, the diagnosis of epilepsy should not be based solely on the word “abnormal” written on the EEG report form. If the abnormality is general and non-specific, such as increased slow waves, mild asymmetry, poor regulation, etc., it cannot be used as the basis for diagnosing epilepsy. If there is an epileptiform pattern (spikes, sharp waves, spikes and slow waves, sharp and slow waves, multiple spikes and slow waves, paroxysmal high-amplitude slow waves protruding from the normal background, etc.), then the diagnosis is more significant. Rhythmic high-amplitude slow waves that occur during hyperventilation in children are not considered abnormal. In addition, in some epileptic syndromes unique to children, EEG has specific manifestations and is of diagnostic value. For example, in infantile epileptic encephalopathy with burst suppression (Ohtahara syndrome), the EEG shows alternating bursts and suppression during wakefulness and sleep. Infantile spasms (W est syndrome) show a high degree of dysrhythmia on EEG. Epilepsy that occurs in slow-wave sleep with persistent spike-slow waves, characterized by persistent diffuse spike-slow waves during slow-wave sleep. The characteristic EEG feature is a continuous diffuse spike during slow-wave sleep. The characteristic feature of absence seizures is symmetrically synchronized spikes at 3 times per second. Of course, some children with epilepsy have normal EEG during the interictal period, so epilepsy cannot be excluded just because the EEG is normal. How to improve the positive rate of EEG in epilepsy is a matter of great clinical concern. On the one hand, it can be solved by purchasing new advanced equipments, such as 24-hour EEG recorder, video and EEG synchronization monitoring, etc. However, more practical is to use the existing equipments. However, it is more practical to utilize the existing equipment to improve the positive rate. If we can do it according to the formal operation requirements, for example, the examination time is at least 20~30 minutes, and carefully do all kinds of triggering tests (hyperventilation, flash, sound), the positive rate will be improved. For pediatric patients, drug-induced test should be done as little as possible, and it is safer to do natural sleep or sleep deprivation induced test, which can significantly increase the positive rate of epilepsy. The author does not recommend drug sleep, sometimes in order to make the child cooperate with the examination, temporary chloral hydrate or use other sedatives, often fall asleep very deeply, so that some abnormal waveforms are masked by the high slow wave. If we can establish a system of evening EEG examination, the children will benefit greatly, and can improve the positive rate of EEG. Specifically, on the day of examination, the children wake up 2 hours earlier than usual, do not take a nap at noon, and go to the hospital for EEG examination at 7~8 p.m. Generally, they can fall asleep very quickly without sedatives, and it is easy to record the sleep EEG shape. Topography cannot recognize the waveforms (spikes and slow spikes) and phases (positive or negative) of the EEG. CT and MRI can detect structural abnormalities in the brain, which can help to find the cause of epilepsy, but the diagnosis of epilepsy cannot be confirmed or denied based on the presence or absence of abnormalities on CT or MRI.