Introduction: Many of patients with seizure disorder remain uncontrolled on a single anti-epileptic drug (AED). For these patients, polytherapy is standard practice. The potential advantages of rational polytherapy are to achieve better seizure control with fewer side effects, as well as control of multiple seizure types that respond to different drugs.

Aims of the study: To determine the reasons for poor response in children with seizure on polytherapy AED.

Methods: This was a prospective observational study carried out (6 months from May 2016 to Oct 2016) on children attending Neurology OPD. We included all the children with seizure disorder on polytherapy.

Results: Out of 57 cases, 33 cases (57.9%) had poor response on polytherapy. Out of 24 cases who had well control, only 5 cases (20.8%) required 3 or more AEDs.11 out of 17 (64.7%) cases of partial seizures responded well on polytherapy as compared to 13 out of 40 (32.5%) cases of generalized epilepsy.2/3^rd of the cases with generalized seizures requiring polytherapy had poor control as compared to 1/3^rd with the cases of partial seizures.76.9% of Idiopathic seizures and 83.3% of Syndromic epilepsy cases had poor response even on polytherapy AEDs.

Conclusion: In our study we found that there is fair chance of seizure control with two drugs regimen however the chance of seizure freedom declined with successive drug regimens. Also Partial seizures are better controlled compared to generalized seizures and symptomatic epilepsy have better seizure freedom then idiopathic epilepsy.