Childhood “catastrophic” epilepsy syndromes are a group of epilepsy syndromes in children with severe and frequent seizures that are not well controlled by medication and can lead to developmental delay and intellectual disability. In the case of childhood epilepsy, the deciding factor for epilepsy treatment is not only seizure control, but also the development of brain function of the child with epilepsy. According to domestic and international data, when children with epilepsy are diagnosed with drug-refractory epilepsy, aggressive surgical treatment should be advocated. What is the basis for surgical treatment of drug-refractory epilepsy in children? First of all, frequent seizures can have a negative impact on the normal development of the child’s brain because the abnormal discharge of epilepsy can cause apoptosis or necrosis of normal nerve cells. The long-term use of antiepileptic drugs can also affect the maturation of the brain cortex in children. This shows that the younger the age of onset of epilepsy, the greater the degree of neurological impairment. Therefore, for those with refractory epilepsy who present at a younger age, if the epileptic focus is more limited, surgery should be performed as early as possible, and as the seizures disappear, the child’s brain maturation process will not be affected. Second, studies have shown that the greatest degree of recovery from impaired brain function occurs during childhood, so surgery should be performed as early as possible for children with refractory epilepsy. Third, there is another reason why children with refractory epilepsy should undergo aggressive surgical treatment: children with refractory epilepsy often require multiple antiepileptic drugs in sufficient doses, and because the excitatory and inhibitory mechanisms of the brain are not yet balanced in the immature brain during childhood, multiple high-dose antiepileptic drug treatments during neurodevelopment are more likely to cause cognitive dysfunction. In addition, the following conditions should be treated: 1) children with drug-refractory epilepsy and neurointelligence impairment; 2) children with limited epileptogenic foci that are not in functional areas and can be completely removed without neurological impairment; 3) children with benign, self-limiting epileptic syndromes and metabolic syndrome must be excluded. For children with diffuse abnormal discharges or multifocal epilepsy, the feasibility of surgery and prospective evaluation of surgical efficacy and risk must be fully discussed with the family. In the last decade, with the rapid progress in neurophysiology and neuroimaging, epilepsy surgery has also made important breakthroughs, especially for the precise localization of epileptic foci, which is an exciting development. Therefore, early diagnosis and treatment of refractory epilepsy in children is important to reduce the rate of intellectual disability in children.