Introduction: Many studies have suggested that the plasma homocysteine level is increased 
as a side effect with prolonged use of some antiepileptic drugs, which is associated with 
increase Carotid intima media thickness; hence it increases the risk of atherosclerosis in 
young age. Objectives: To assess serum level of homocysteine in epileptic children on long 
standing antiepileptic drugs and its association with increased incidence of cardiovascular 
disease. Patients and methods: This study will include 85 children between 2-15 years (20 
on one old generation antiepileptic drug, 20 on one new generation antiepileptic drug, 20 on 
polytherapy of antiepileptic drugs on antiepileptic drugs for at least 1 year and 25 apparently 
healthy children will be taken as a control group). All of them subject to careful history taken, 
clinical examination and anthropometric measures, laboratory investigation included (serum
homocysteine) and radiological assessment included (carotid intima media thickness and
carotid stiffness). Results: Our study revealed statically significant increase serum level of 
homocysteine, carotid intima media thickness and carotid stiffness in children on
monotherapy of old generation antiepileptic drugs and poly therapy than that in children on
monotherapy of new generation antiepileptic drugs and control. Conclusion: The old 
generation antiepileptic drugs and polytherapy antiepileptic drugs modalities increase the 
serum level of homocysteine in children. The new generation antiepileptic drugs have 
minimal effect on their serum level. Children who use the old generation antiepileptic drugs
and polytherapy antiepileptic drugs have increasing in carotid intima media thickness and 
carotid stiffness than those who use the new generation antiepileptic drugs.