This study investigates the long-term neuropsychological trajectories in children with drug-resistant epilepsy before and after epilepsy surgery. The researchers analyzed data from 500 children who underwent epilepsy surgery at Great Ormond Street Hospital between 1990 and 2018. They found that children showed declines in all domains of neuropsychological functioning before surgery, with an average loss of one to four points per year. However, children who became seizure-free through surgery demonstrated significant improvements in neuropsychological functioning over the long term. Specifically, these children showed continued improvements in neuropsychological performance, particularly in working memory, processing speed, and numeracy. Additionally, children who discontinued antiseizure medication at the one-year follow-up showed greater gains in these areas compared to those still receiving or weaning off medication. The study suggests that epilepsy surgery, by providing seizure freedom and the opportunity to discontinue medication, can not only halt but potentially reverse the decline in neuropsychological functioning observed in children with drug-resistant epilepsy. Early referral and evaluation for epilepsy surgery are recommended to maximize the potential for cognitive recovery.This study investigates the long-term neuropsychological trajectories in children with drug-resistant epilepsy before and after epilepsy surgery. The researchers analyzed data from 500 children who underwent epilepsy surgery at Great Ormond Street Hospital between 1990 and 2018. They found that children showed declines in all domains of neuropsychological functioning before surgery, with an average loss of one to four points per year. However, children who became seizure-free through surgery demonstrated significant improvements in neuropsychological functioning over the long term. Specifically, these children showed continued improvements in neuropsychological performance, particularly in working memory, processing speed, and numeracy. Additionally, children who discontinued antiseizure medication at the one-year follow-up showed greater gains in these areas compared to those still receiving or weaning off medication. The study suggests that epilepsy surgery, by providing seizure freedom and the opportunity to discontinue medication, can not only halt but potentially reverse the decline in neuropsychological functioning observed in children with drug-resistant epilepsy. Early referral and evaluation for epilepsy surgery are recommended to maximize the potential for cognitive recovery.