The primary purpose of this study was to evaluate the utilization pattern and seizure outcome of newer and older antiepileptic drugs in pediatric clinical practice in a tertiary care hospital setting. The study was a retrospective observational study carried out, among pediatric epilepsy patients who were diagnosed according to the classification of the International League Against Epilepsy and the information was gathered with the help of a validated data collection form. There was a relative male preponderance (56%) seen among epileptic patients. Of the total 210 patients analyzed, 110 (52.4%) were having partial seizure and 100 (47.6%) had generalized seizures. Out of 210 patients 134 (63.8%) were on monotherapy and 76 patients (36.2%) were on polytherapy. Mean daily doses of carbamazepine were 492.69±51.8 and 320.97±42.09 in polytherapy and monotherapy respectively. The number of patients on newer anticonvulsants was much smaller. The serum levels were monitored for commonly used antiepileptics like phenytoin, carbamazepine, phenobarbitone and Valproate in 43 (20.5%) patients. Among 210 patients, antiepileptic drugs were changed for 96 (45.71%) and the reasons for changing prescriptions were uncontrolled seizures (67.7%), recurrence (22.9%) and adverse effects (9.3%). A nationally based study and guidelines may bring a more rational approach for antiepileptic drug. Though most of the cases can be effectively managed with conventional antiepileptics, an increase in experience with the use of newer medications can offer an additional advantage to patients.

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