Objective: To explore the application value of video electroencephalogram (VEEG) and routine electroencephalogram (REEG) in the diagnosis and localization of epilepsy. Methods: A total of 103 patients with suspected epilepsy admitted to the epilepsy center of Wanbei Coal-electricity Group General Hospital from January 2020 to December 2020 were selected. and they were examined by REEG and VEEG. The detection rates of epileptic discharges, clinical symptoms and synchronous clinical seizures were compared between the two EEG methods. The temporal characteristics of epileptic discharges detected by VEEG and the location of epileptic lesions were analyzed. Results: The detection rates of epileptic discharge, clinical symptoms, and synchronous clinical attack in VEEG were 76.69% (79/103), 46.60% (48/103), and 53.16% (42/79), respectively, which were significantly higher than those in REEG [44.66% (46/103), 18.45% (19/103), and 19.57% (9/46), respectively (all P<0.05)]. Among the 79 patients with epileptic discharge detected by VEEG, the detection rate of VEEG in sleep phase was 65.82% (52/79), which was higher than that in awake phase 24.05% (19/79), and the difference was statistically significant (P<0.05). Among the 52 patients with epileptiform discharge during sleep, NREM I–II, III–IV, and REM accounted for 78.85% (41/52), 17.31% (9/52), and 3.85% (2/52), respectively. There was significant differences in the detection rates of epileptiform discharge in the above EEG phases (all P<0.05). There were 9 cases of epilepsy diagnosed by REEG and 42 cases by VEEG. The lesions were located in temporal lobe in 15 cases, frontal lobe in 11 cases, occipital lobe in 8 cases, central region in 5 cases, and cerebral cortex in 3 cases. Conclusion: Compared with REEG, VEEG can more fully understand the EEG activity information and clinical seizures, and provide the basis for the diagnosis and lesion location of epilepsy.