BACKGROUND: Complementary and alternative therapies (CATs) are widely used among patients with epilepsy (PWE), yet their impact on adherence to antiepileptic drugs (AEDs) remains limited and unclear. This study aimed to (i) assess the usage, knowledge, attitudes and practices (KAP) related to CATs and (ii) evaluate their impact on AEDs adherence among PWE. METHODS: A cross-sectional study was conducted among 193 PWE, recruited conveniently from three hospitals on the East Coast of Peninsular Malaysia. Participants' data were collected through face-to-face administration of paper-based questionnaires, including a KAP-CATs and the Malaysia Medication Adherence Scale (MALMAS). The SPSS version 26.0 was used to perform descriptive statistics and non-parametric tests. RESULTS: Among the participants (mean age = 35.3 ± 12.6 years; female = 54.9%; Malay = 96.9%), 59.6% reported had used some types of CATs, with prayers (86.4%) and massage (78.8%) being the most common. Most participants demonstrated moderate knowledge (61.6%), neutral attitudes (78.6%) and a moderate engagement in CATs practices (47.6%). Common reasons for using CATs included greater availability (54.9%), belief in self-healing (45.6%) and the perception of a permanent cure (44.6%). Notably, only 28.5% of CATs users disclosed their use to a healthcare provider. The prevalence of non-adherence to AEDs was 22.8%, and no statistically significant association was found between usage, knowledge, attitude and practice regarding CATs and non-adherence to AEDs ( > 0.05). CONCLUSION: The findings highlight widespread use of CATs among PWE, often driven by cultural beliefs and perceived benefits. Thus, further research is warranted to explore integrative care models that ensure safe, coordinated epilepsy management.