The use of video-electroencephalography for the evaluation of children is reserved for inpatients with intractable "seizures." Prolonged video-electroencephalographic monitoring is used to ascertain whether the events are epileptic in nature, or to evaluate the medically intractable patient with epilepsy for surgical management of seizures. The increasing interest in the evaluation of patients with intractable epilepsy and recent technologic advances have led to a greater sophistication and versatility in patient evaluation. This paper reviews currently available technologies and newer digital acquisition and playback systems, and discusses ways of optimizing the evaluation of patients with intractable seizures.