OBJECTIVES: To assess the rate and clinical outcomes of using antiepileptic drugs (AEDs) at doses above the recommended range (DARR) in pediatric outpatients with structural-metabolic epilepsy. METHODS: Patients were followed-up retrospectively for one year since the first visit. Inclusion criteria were age >2 years; a diagnosis of structural-metabolic epilepsy; AEDs treatment; and three or more visits during the first year from the referral time. Exclusion criteria were epilepsy surgery within the first year from the referral time; and patients not satisfied inclusion criteria. During the period from January to June 2010, the required data were extracted from medical records. Assessment of AEDs doses was based on the recommended drug doses that were mentioned in “Pediatric Protocols for Malaysian Hospitals”.  RESULTS: Of 120 followed-up patients, only 13 (10.83%) of them exposed to AEDs at DARR. In term of visits, 32 (5.68%) visits out of 563 demonstrated DARR. There was no association between the uses of AEDs at DARR with age, gender, race, child development, and seizure type. However, the uses of AEDs at DARR were significantly higher in polytherapy than monotherapy visits (Chi-square, p<0.001). Visits included DARR led to higher seizure frequency than visits without DARR (Mann-Whitney, P=0.001). Ultimately, only patients who weren’t exposed to AEDs at DARR showed a significant improvement in their seizure control at the last follow-up visit compared with the baseline (Wilcoxon, P=0.001).  CONCLUSIONS: The low frequency of DARR indicates the knowledgeability and awareness of the in charged pediatric neurologist about consequences of exceeding average effective doses. In term of better seizure control, uses of AEDs at DARR shows no benefit over using these agents at recommended doses.