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Background: The majority of people afflicted with epilepsy live in developing countries. Poor adherence to prescribed medication is considered the main cause of unsuccessful drug treatment for epilepsy. Our study aims to evaluate the factors influencing medication adherence in epilepsy patients at a public hospital in Mumbai, India., Method: This cross-sectional study was carried out on a cohort of 313 epilepsy patients regularly attending an out-patient clinic at a tertiary-care hospital. A semi-structured questionnaire was used to assess demographic information, the level of medication adherence, and various factors that could influence adherence. Brief Illness Perception Questionnaire and WHO QoL-BREF Scale were also administered to the study population., Results: Patients on anti-epilepsy medication reported an overall good quality of life and a good level of adherence. 90.1% of study participants reported being adherent with their treatment regimen. The main factors found to impact medication adherence were the duration of non-availability of medications in the public sector, and the monthly cost of the medications in the private sector. Other therapy-related, health system-related, socioeconomic, and psychosocial variables were not found to be significant determinants of medication nonadherence in our setting., Conclusion: Ensuring that anti-epilepsy drugs remain available in the public sector, and/or making them more affordable in the private sector are the main interventions likely to improve medication adherence in clinical settings such as ours., (© Journal of the Association of Physicians of India 2011.)