【Abstract】 Objective To study the effect of oxcarbazepine combined with vitamin B12 in the treatment of patients with high homocysteine in elderly epilepsy and the effects on Hcy and ICAM1 levels. Methods From June 2016 to July 2017, 153 high homocysteine patients with epilepsy in our hospital, according to the different drugs, were divided into control group and observation group. The control group was given oxcarbazepine. The treatment group in the control group based on the combined application of vitamin B12. The plasma ICAM1 and Hcy, the expression level changes, the cognitive function and the occurrence of adverse reactions were observed. Results After treatment, the total efficiency of observation group (8961%) was higher than that of the control group (7895%) (P＜005). The plasma Hcy and ICAM1 of observation group significantly decreased, compared with that of control group (P＜005). The cognitive function score of observation group significantly increased, compared with that of control group (P＜005). The side effect included dizziness, headache, diplopia, ataxia, nausea and blurred vision. The incidence of side effects of observation group was lower than that of the control. Conclusion Oxcarbazepine combined with vitamin B12 in treatment of elderly patients with hyperhomocysteinemia epilepsy can obviously enhance the curative effect, reduce serum Hcy and ICAM1 concentration, improve the cognitive function of patients and reduce the incidence of adverse reaction.