Epilepsy is one of the serious neurological conditions, and 30 to 40% of people with epilepsy have seizures that are not controlled by primary medication. It is estimated that 10–20 % children with epilepsy, usually have negative effect on the education, social life. Absence of response to 2 anti-epileptic drugs tolerated at reasonable doses is considered refractory for all working purpose. Advances in imaging and electrophysiology have revolutionized the management of children with refractory epilepsy. Several newer antiepileptic drugs with novel mechanism of action and Ketogenic diet along with advanced epileptic surgery and nerve stimulation has changed the lives of the patients along with better outcome.