To determine the safety, tolerability, and efficacy of rufinamide in treating refractory epilepsy in a largely pediatric population. A retrospective chart review was conducted of all patients prescribed rufinamide from December 2008 to July 2010 in the Pediatric Epilepsy Program at Massachusetts General Hospital for Children. Eighty-eight patients on rufinamide with sufficient data for analysis were included in the study. Eight (9.1%) patients had >90% seizure reduction, 40 (45.5%) patients had 50–90% seizure reduction, 19 (21.6%) patients had <50% seizure reduction, and 21 (23.9%) patients had no change in seizure frequency. Generally mild side effects were reported by 28 (31.8%) patients, with the two most common side effects being decreased appetite in seven (8.0%) patients, and somnolence in six (6.8%) patients. Rufinamide appears to be an effective, safe, and well-tolerated antiepileptic drug in the treatment of broad-spectrum intractable epilepsy, expanding outside its specific Food and Drug Administration approved usage in treatment of Lennox-Gastaut syndrome.