Background: MRI plays a key role in the evaluation of pediatric patients with seizures and is considered important for the detection of epileptogenic lesions. However, MRS is not as widely used for the evaluation of children with seizures and is not included in the guidelines of the ILAE for the evaluation of infants and children with many types of epilepsy in 2009 Aim of the work: Evaluate the Diagnostic and prognostic role of Magnetic Resonance Spectroscopy in the evaluation of non-lesional epilepsy in pediatric patients Subjects& Methods: Our study was a prospective controlled study. It had been held up on pediatric epileptic patients who were regularly following in the pediatric neurology clinic over one year from July 2017 to July 2018. It included two groups: the case group that included 50 epileptic children with normal conventional MRI brain study and the control group that included 20 non epileptic children. Results: there was statistical significant differences between patients with intractable seizures and those with non-intractable seizures regarding NAA/Cr ratio in basal ganglia, white matter, Also there were statistical significant difference between patients with intractable seizures and those with non- intractable seizures regarding NAA/Cr+Cho ratio in basal ganglia. A ratio of NAA/Cr in basal ganglia with best cut off value ≤ 1.5 could differentiate epileptic children who will respond to treatment from those with intractable seizures with sensitivity of 100%and specificity of 62%. Also, a ratio of NAA/Cr in white matter with best cut off value ≤ 1.9 mg/dl could differentiate epileptic children who will respond to treatment from those with intractable seizures with sensitivity of 100% and specificity of 65%. Conclusion: MRS spectroscopy can be used as a prognostic tool to predict epileptic children who will develop intractable epilepsy