Epilepsy is a common neurological disorder in childhood. In a majority, the cause of epilepsy remains a mystery in spite of extensive investigations. The aim of drug treatment is to effectively stop the seizures with minimum of side effects, causing no impairment of long term learning abilities of the child. Up to 30% of children with epilepsy may continue to have seizures in spite of adequate drug therapy. In this review, an overview of the recent advances that affect the diagnosis, prognosis and therapy of childhood epilepsy including the dilemmas of everyday practice is presented.