Objectives: to investigate the clinical, neuroimaging, and electroencephalographic characteristics of pediatric medically intractable epilepsy in order to predict and overcome this intractability. Methods: We conducted a prospective case-control study with 50 participants, divided into a study group of 25 patients with refractory epilepsy and a control group of 25 epileptic children with good control of seizures. All participants underwent a comprehensive assessment, including medical history, physical examination, neuroimaging, neurophysiological evaluation, and metabolic workup. Results: The study revealed that total number of patients was 50 (25 case 12 male & 13 female and 25 control 11 male & 14 female). Children with refractory epilepsy had abnormal neuroimaging. Additionally, the interictal EEG monitoring showed more frequent epileptiform discharges in the refractory group. Conclusions: It is important to evaluate pediatric patients with medically intractable epilepsy. Abnormal development, neuroimaging and frequent epileptiform discharges on EEG may indicate a higher likelihood of refractory epilepsy for further research with large number.