In the previous article, “What should I do if my epilepsy is not cured after spending all the money? In the article, the patient and his family thought that the surgery could cure epilepsy and never recur, so they spent all the money on the road to go home for the examination and intended to have the surgery. After the article came out, netizens were very concerned about this patient and asked me what happened afterwards. I didn’t know his condition at that time. It was only last month when his mother came to see me again that I learned about the recent situation. His mother said with remorse, “You are! Unlike some doctors who are just confused! You are the one who is really looking out for us, and I regret not listening to you at that time! Now, we are broke and can’t go home, so we have to stay and work to earn money to go home. When I came home after seeing you last time, I gave my son a hard time! I want him to take your medicine honestly from now on, and I won’t believe anything else anyone says!” Epilepsy is a chronic disease that requires long-term treatment and effective management, and good treatment results are based on a clear diagnosis and a reasonable treatment plan. If patients are intentionally or unintentionally misled, the end result can only be a lose-lose situation and nothing more. Epilepsy is, at once, simple and complex. The simple thing is that a typical seizure is recognized by anyone. The complexity is that even a typical seizure may not be epilepsy. In general, the possibility of epilepsy needs to be considered for seizures, transient, and stereotypic disorders. Recently, a 21-year-old boy had recurrent loss of consciousness and fall seizures for 1 year, and because the observers who witnessed the seizures many times did not report that the patient had convulsions, the doctors at the local hospital kept checking the heart with “syncope investigation”: long-range ECG monitoring, cardiac ultrasound, chest X-ray, etc., and did not check the EEG. He was diagnosed with “Q-T interval prolongation syndrome” based on a slight abnormality in the ECG, and was fitted with a pacemaker, but the seizures did not stop. I finally diagnosed him with epilepsy, which was effectively treated. Foreign literature reports that about 20 to 30% of epilepsy patients are misdiagnosed, mostly as cardiovascular disease, and other diseases such as cardiovascular disease are misdiagnosed as epilepsy and given long-term antiepileptic treatment. I have treated patients with “lupus erythematosus encephalopathy” misdiagnosed as “intractable epilepsy”, and surgery was ineffective, and the cause of the disease was finally found and diagnosed again only because the surgery failed. Therefore, for seizure disorders, if the treatment is not effective, it is necessary to review whether the diagnosis is true or not. In the end, it may be necessary to correct the diagnosis. Therefore, the first thing to do for a patient with “epilepsy” who is not doing well is to take a new history and re-evaluate the diagnosis, rather than making the diagnosis of “refractory epilepsy” in the first place in the interest of self-interest. If the diagnosis of epilepsy is clear, further information is needed about what type of seizures are present or whether multiple seizure types can be grouped into a syndrome. The treatment and prognosis for different syndromes are different. If a syndrome cannot indeed be diagnosed, at the very least, the type of seizure should be clarified, and the cause and use of medication varies between seizure types. Down the road, if the diagnosis and typing of epilepsy is fine and the outcome is poor, one must consider whether the medication selection is wrong or the dosage is inadequate. Some seizure types are sensitive to only one type of medication, while others are sensitive to most medications. It is common for the clinician to make the wrong choice of medication and to under-dose. Inexperienced clinicians only dare to use the regular dose but not to increase it, and when it is ineffective, they only know how to change the medication, and as a result, they have used many drugs, but in the end they are not satisfactory. Last week, an out-of-town patient came to see me after consulting me online. The patient had been taking sodium valproate, which did not work well; she switched to levetiracetam, but still had attacks. I think the diagnosis is clear, but the choice of medication is a bit inappropriate, and the dose is not enough, the patient is only on levetiracetam 1000 mg per day. I think it is possible to continue to increase the dosage. Yesterday, parents out of town brought a 10-year-old boy who had been seeing me through an acquaintance for 5 years with epilepsy that was not well controlled. The child has been treated at the local hospital for years with valproic acid 500 mg/day, but still has 1-2 seizures per month and the doctor has not adjusted the medication. In recent times the child had frequent seizures and the local doctor added topiramate 75 mg/day straight away! (Normal need to gradually increase the dose, if it takes more than 3 weeks to reach the same dose!) As a result, not only did the seizures not decrease, but the child became agitated and violent. Only then did the parents make up their mind to go out for medical treatment. This is also a problem of inappropriate use of medication. The treatment of epilepsy is an art: the judgment of the disease, the choice of medication, the communication with the patient, etc., but the most important thing is the kindness of the doctor! Kindness is the only way to be kind!