Noncompliance in patients with epilepsy is a serious hindrance to successful treatment. It can result in increased healthcare costs and put both the patients and others around them at unnecessary risk. Noncompliance should be considered whenever a patient has (1) an unexpected increase in number or severity of seizures, (2) serum levels of anticonvulsant medications below the expected range, or (3) a change in medical reimbursement systems. Effective intervention strategies are based on assessment of life-style issues and possible barriers to compliance. Communication with the patient about medication regimens and the value of treatment is extremely important, and a real partnership between physician and patient is needed to set and achieve goals.