Complementary and alternative medicine (CAM) usage were reported in Europe, the United States of America and monoethnic Asian countries such as Korea and Taiwan. However, limited literature is available on the variability of CAM usage patterns among people with epilepsy (PWE) in a multi-racial country in particular Malaysia. This cross-sectional study assessed the prevalence, types, predictors and impact of CAM use among adult PWE and their adherence to anti-epileptic drugs (AEDs) treatment.140 patients were recruited, with a median age of 37.5 (IQR,28.0-51.5) years, majority female, had secondary or lower education level, earn <USD1077 and seizure frequency of <1 per month. One quarter (25.7%) used CAM for seizure control, of which 94.4% adhered to AEDs treatment while on CAM. Common CAM used were prayers, traditional herbal remedies, massage, and acupuncture. Only 33.3% have discussed CAM usage with their physician. The main reason for CAM usage was patients’ willingness to try other alternatives for seizure control. Although most patients had not used CAM, 20.2% were receptive to using CAM as concomitant treatment. Buddhists were more open to CAM while Muslims uses CAM selectively and avoid amulets, acupuncture, chiropractic, Ayurveda, yoga, and reiki. Logistic regression analysis showed Buddhist’s religion (OR,11.01), Muslims (OR,4.04), ≥1 seizure per month (OR,3.85) and monthly income of ≥USD1077 (OR,2.92) as the predictors for CMA usage. CAM use is common in Malaysia, especially among Buddhists and Muslims, with higher socio-economic status, and uncontrolled seizures. CAM is mostly used to complement but not in replacement of AEDs.