Background: Folic acid deficiency occurs in some epileptic patients on long term treatment with enzyme inducing antiepileptic drug (AED) particularly phenytoin and this may lead to the development of atherosclerosis due to the lipid profile alteration. Objective: The present study was planned to investigate folic acid level and lipid profile among patients with epilepsy on antiepileptic drug treatment. Materials and Methods: A 25-week, prospective study was conducted in 250 bedded private hospital, Salem, Tamil Nadu, India. In this study, an attempt was made to compare the folic acid level, lipid profile and atherosclerotic risk including Framingham risk score between the normal healthy volunteers (Control), patients with newly diagnosed cases of epilepsy (Supercontrol) and patients with more than one year of antiepileptic drug treatment (Cases). Results: Folic acid level (in ng/dl) was found to be lower in cases (7.26 ± 2.98) than control (12.69 ± 5.64) and super control (9.35 ± 2.73) - the difference was statistically significant (p<0.05). Normal total cholesterol (TC) level (162.0 ± 23.22 mg/dl) and normal very low density lipoprotein (VLDL) level (40.5 ± 12.89 mg/dl) was observed in cases. But decrease in high density lipoprotein (HDL) level (36.5 ± 12.45 mg/dl), elevated triglycerides (TGs) level (202.5 ± 64.44 mg/dl) was noted in cases and the difference was found to be significant (p<0.05) as compared to control and su-percontrol. TC/HDL ratio, LDL/HDL ratio and TG/HDL ratio were increased in cases when compared with control and supercontrol. Framingham risk score reveals slightly higher risk in cases as compared to control and supercontrol. Conclusion: The result of this study reinforces the results of previous reports in terms of folic acid deficiency with AED treatment and the correlation between folic acid deficiency and cardiovascular risk needs to be established.