Background: Cardiovascular mortality and morbidity are more frequent in people with epilepsy than in the general population. The explanation for this may be the change in biochemical components due to the use of anti-epileptic drugs. We conducted a study to determine the prevalence and risk factors for Metabolic Syndrome (MetS) among Rwandan adults with epilepsy emphasizing the respective anti-epileptic drugs that the patients were receiving. Methods: This was a cross-sectional study conducted from December 2018 to December 2019 at Ndera Neuropsychiatric Hospital in Kigali, Rwanda. Consenting adult Rwandan patients with epilepsy, who had been on anti-epileptic drugs for at least two years, were recruited into the study. Participants had their anthropometric measurements taken and their fasting blood glucose plus lipids assayed. Using a data collection form, patients had their demographic and clinical characteristics recorded. Results: There were 1076 participants (male-to-female ratio, 1.4; age range, 42). Using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria, there were 329 individuals with MetS giving an overall prevalence rate of 30.6%. Significant risk factors for MetS included use of valproic acid (p=0.007), a sedentary lifestyle (p=0.025), waist circumference >102cm (p=0.001), high triglycerides (p=0.001), high blood pressure (p=0.001), and fasting blood glucose >6.1mmol (p=0.001). Conclusion: MetS is highly prevalent among Rwandan patients with epilepsy. Therefore, local physicians are advised to carefully select the type of anti-epileptic medication administered and to regularly request anthropometric as well as laboratory checkups for such patients to predict a diagnosis of MetS and the complications thereof.