MRgLITT was first used for treatment of epilepsy in a child in 2010. Since that initial case, the technique has been applied to many pediatric epileptogenic targets such as tuberous sclerosis, mesial temporal lobe epilepsy, focal cortical dysplasia, periventricular nodular heterotopia, insular epilepsy, cavernous malformation, and, most efficiently, hypothalamic hamartoma. The combination of instant thermal ablation and peri-operative steroids to combat edema has resulted in an 83% 1-year seizure freedom rate with 1.5% rate of memory impairment, making it a profound improvement on open surgery. The technique has also been applied in disconnection, such as in corpus callosotomy, both in de novo and in salvage cases. In the treatment of drop attacks, three to four lasers can be employed to achieve the disconnection minimally invasively, obviating the need for a craniotomy. Outside of hypothalamic hamartoma, there have been few large pathology-based series, and long-term cognitive data is not available. MRgLITT in pediatric epilepsy holds the promise of less morbidity and shorter hospital stays, steps that may narrow the treatment gap in pediatric epilepsy surgery from anxiety and morbidity avoidance.