OBJECTIVES: Complete adherence to anticonvulsant therapy is essential for seizure control and improved quality of life in epileptic patients. This study described adherence to anticonvulsant therapy in a resource-limited setting to generate evidence-based data for intervention studies. METHODS: The study was a prospective cross-sectional assessment of epileptic patients using standardized structured questionnaire in English Language to evaluate their adherence to treatment. Epileptic patients who have been on anticonvulsant therapy for more than 12 months who understand English and gave their informed consent to participate in the study were randomly selected and recruited for the study. Data were summarized using descriptive statistics. Study lasted from January to October 2016. RESULTS: The average age of 102 patients who participated in the study was 31.69±11.53. 10 (9.8%) of the patients were on once daily medications, 89 (87.3%) on twice daily while 3 (2.9%) were on thrice daily. Whereas 83 (81.4%) were on monotherapy, 16 (15.7%) were on dual therapy, and 3 (2.9%) on polytherapy. Adherence was high in 9 (8.8%) of the patients while 63.3 (91.2%) were non-adherent. The level of seizure control was good in 19 (18.6%), fair in 46 (45.1%) and poor in 37 (36.4). The factors affecting adherence from the study were side effect of drugs 34 (33.3%), lack of knowledge about the illness 34 (33.3), cost of medication 17 (16.7%) and forgetfulness 17 (16.7%). Physicians admitted they assessed patients’ adherence through assessment of patients’ condition 68%, pill count 17%, and patients’ interview 100%. All the physicians admitted to emphasize adherence to therapy before and after prescribing. CONCLUSIONS: Patients adherence to anticonvulsant therapy in the facility was poor. Non-adherence was associated with preventable factors bordering on the patients and health care providers.