Intractable epilepsies pose a therapeutic challenge. Precise localization of the epileptic focus is imperative before planning for surgical intervention. Functional imaging is an important component of comprehensive evaluation for intractable epileptic children. Since PET is unavailable, hence the need to evaluate the available imaging modality (SPECT). We investigated 39 children with intractable epilepsy by performing thorough clinical examination, EEG, MRI, interictal SPECT to all cases and ictal SPECT to 13 cases. The localizing value of interictal and ictal SPECT for epileptic foci was correlated with clinical semiology, EEG and MRI. Ictal SPECT was localizing in 9 of 13 cases (69.2%). Interictal SPECT was localizing in 43.6%, MRI in 46.2%, EEG in 30.8%. Our data demonstrated that ictal SPECT was more sensitive in the localization of epileptogenic foci in children with intractable epilepsy than EEG, interictal SPECT and MRI.