Introduction:  Seizure control is the challenging job particularly in a resource-limited situation.  Multiple issues including correct diagnosis of the seizures and epilepsy syndrome, appropriate and effective antiepilepsy drug(AED) selection and compliance are important factors.

Objective:  To analyze the seizure pattern, cause of intractability and developing comorbidities, epilepsy classification and discuss on use of multiple AEDs with follow up report in twenty five children at our epilepsy clinic.

Methods:  We enrolled 25 children with poorly controlled seizures and recently developed severe comorbidities. All were on three or more AEDs, started within a short time after starting seizures.  Detail history including early milestone of development, seizure pattern with their evolution were recorded.  EEG and neuroimaging findings were correlated with clinical condition.  Significant change of the clinical condition after AED(s) were simplified will be discussed.

Result:  Age range was from 3 to15 years, primarily with partial or secondarily generalized seizures.  Electro-clinical correlation and simplification of AEDs helped in seizure control and improvement of the recent comorbidities.

Conclusion:  Electrophysiological information was useful in AED selection.  Inappropriate AED selection and polypharmacy were the reason for severe comorbidities and seizure recurrence particulalry in children with idiopathic epilepsy syndrome.