Upto 30% of children with epilepsy experience drug-resistant seizures. Traditional monitoring relies on clinical observation and EEG, but there is growing interest in serum biomarkers that reflect seizure activity or predict treatment response. Recent studies (within the last 5–10 years) have explored various blood-based indicators – including inflammatory cytokines, neurotrophic factors, metabolic signatures, and markers of neural injury – to correlate with seizure control in children. Identifying reliable biomarkers could improve prognostication (e.g. early identification of drug resistance) and enable more personalized management, much like HbA1c is used in diabetes to gauge disease control. Below, we summarize key findings on candidate serum biomarkers associated with seizure frequency, severity, and treatment response in pediatric epilepsy, noting each study’s strengths or limitations and the implications for clinical practice and future research.