Epilepsy is a common disease of the pediatric nervous system, due to the characteristics of the disease itself, the treatment cycle is long, there are about 30% of drug-refractory epilepsy, it is difficult to rely on drugs alone to achieve complete control, and even some of these patients have always been difficult to control seizures with the help of other means, in view of which, many parents of children are afraid of epilepsy. So why is it that some people have epilepsy and others have a rough time with it? This may be related to the cause of epilepsy, which often has a different prognosis. As a pediatric epileptologist, I often tell parents or students that the etiologic diagnosis of epilepsy should always be emphasized in the diagnosis and treatment of epilepsy. If we can find out the etiology of a certain disease, we can get a general idea of the difficulty of the child’s medication, whether cognition may be impaired, the prognosis, the possibility of stopping the medication, etc., as well as the possibility of a better treatment or a solution in addition to antiepileptic medication. .. Epilepsy can be categorized into idiopathic, symptomatic, and cryptogenic epilepsy depending on the cause. Idiopathic tends to specialize in its genetic susceptibility, such as partial ion channelopathies, neurotransmitter receptor gene mutations, etc., which can have a drug cure rate of about 80%, and most have a good prognosis. Symptomatic epilepsy refers to epilepsy caused by certain diseases, either congenital or acquired, resulting in brain damage and structural inheritance of the brain. Compared with idiopathic and cryptogenic epilepsy, it is more difficult to be treated by drugs, and some of them need to be treated by surgical means and neuromodulation therapy to control seizures, with a relatively poor prognosis. Cryptogenic epilepsy refers to epilepsy in which no clear cause of epilepsy can be found with current screening methods, and the drug cure rate can reach about 70%, and the prognosis is often good. The current mainstream view of the cause of epilepsy is subdivided into several parts, structural, genetic, infection, metabolism, immunity, other, in some aspects of each other may have overlapping parts of the different causes of epilepsy prognosis is different, for the causes that can be lifted, often relatively good prognosis. 1, structural etiology, any cause of structural abnormality of the brain, can be the causative factor of epilepsy, the more common limited cerebral cortical dysplasia (FCD), gray matter heterotopia, hippocampal sclerosis, megacystic gyrus malformations, multiple cerebellar gyrus malformations, penetrating malformations, neurofibromatosis, cerebral facial angiomatosis, cerebral leukoencephalopathy, tuberous sclerosis, encephalitis after brain injury, traumatic brain injury, brain tumors, etc., some of which are congenital and others are due to acquired factors, a significant proportion of which may be medically refractory epilepsy, and a proportion of which can be resolved with surgical means for seizures, such as FCD, hippocampal sclerosis, gray matter ectasia, and brain tumors, with some having a favorable postoperative outcome. For this etiology, it is often necessary to improve the cranial MRI scanning, if possible, thin layer epilepsy sequence scanning, PETCT, etc., to understand the structural abnormality of the brain, and to seek a new direction for treatment. 2, hereditary etiology, the literature now reports that about 40% of epilepsy is genetically related, and some even report that the positive rate of genetic factors can reach 60%, of course, may be related to the selection of cases. However, it is true that in epilepsy diagnosis and treatment, the possibility of genetic factors contributing to the development of the disease should not be ignored, and for some specific diseases, it can be of definite help in treatment. In my case I will give two examples, one of the children is about one year old, the disease during the year repeatedly adjusted the application of antiepileptic drugs has always been difficult to control seizures, to us, re-review of the medical history, found that the child’s early cerebrospinal fluid examination of the glucose level is reduced, so we suspected that glucose transporter 1 deficiency syndrome may be, and then verified by the genetic testing, and immediately adjusted the direction of the treatment, to the child’s ketogenic The child was put on a ketogenic diet, and the seizures soon stopped, and the antiepileptic drugs were gradually withdrawn, with no further seizures. Another child was diagnosed with epilepsy in my place, early antiepileptic drugs combined with vitamin B6 treatment went well, after stopping B6 and then reoccurring, plus after that it got better again, consider pyridoxine-dependent epilepsy, after genetic monitoring to confirm, high dose B6 application after seizure termination, stopping the antiepileptic drugs, and there was no recurrence of seizures. The point of citing these two cases is that genetic examination of epilepsy may be helpful for the etiologic clarification, treatment, and prognosis of the disease. If conditions permit, the relevant examination should be improved, especially if the treatment is not smooth. 3, infectious factors, this is easy to understand, encephalitis, meningitis, brain abscess, sepsis, severe pneumonia, toxic dysentery and other infectious diseases, directly or indirectly lead to brain damage, the degree of brain damage is different, whether the damage can be recovered, are factors that affect the prognosis. 4, immune factors, at present, immune factors are also one of the causes of epilepsy, such as autoimmune encephalitis, paraneoplastic syndrome, MOG encephalitis, FIRES, immune demyelinating disease, etc., can be epileptic as the main clinical manifestations, when there is a suspected presence of immune factors, the relevant examination should be improved, and some of them have a poor prognosis. 5, metabolic factors, this refers to genetic metabolic diseases, common phenylketonuria, glutaric aciduria, methylmalonic acidemia, Niemann-Pick disease, Gaucher’s disease, mitochondrial disease, adrenoleukodystrophy, mucopolysaccharidosis, glycogen storage disease, etc., most of them overlap with genetic factors, which can be confirmed by metabolic screening or genetic testing. 6.Others, at present, the above etiology can not be clear, for possible cryptogenic epilepsy. In conclusion, in the treatment of epilepsy always, we always have to think about the etiologic diagnosis of epilepsy and should give the etiologic diagnosis as much as possible, because it is crucial for the treatment and prognosis judgment, especially for drug-refractory epilepsy. One last word to all parents of children, let’s be fearful and hopeful and work together to cure the disease and give your child back a blue sky! A word of encouragement.