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We examined the relationship between race\/ethnicity and receipt of standard IS therapy (prednisolone, adrenocorticotropic hormone, vigabatrin), adjusting for demographic and clinical variables using logistic regression. Our primary outcome was <jats:italic>treatment course<\/jats:italic>, which considered therapy prescribed for the first and, when needed, the second IS treatment together.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 555 children, 324 (58%) were non\u2010Hispanic white, 55 (10%) non\u2010Hispanic Black, 24 (4%) non\u2010Hispanic Asian, 80 (14%) Hispanic, and 72 (13%) other\/unknown. Most (398, 72%) received a standard treatment course. Insurance type, geographic location, history of prematurity, prior seizures, developmental delay or regression, abnormal head circumference, hypsarrhythmia, and IS etiologies were associated with standard therapy. In adjusted models, non\u2010Hispanic Black children had lower odds of receiving a standard treatment course compared with non\u2010Hispanic white children (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.20\u20130.89; <jats:italic>p<\/jats:italic> =\u20090.02). Adjusted models also showed that children with public (vs. private) insurance had lower odds of receiving standard therapy for treatment 1 (OR, 0.42; CI, 0.21\u20130.84; <jats:italic>p<\/jats:italic> =\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Non\u2010Hispanic Black children were more often treated with non\u2010standard IS therapies than non\u2010Hispanic white children. Likewise, children with public (vs. private) insurance were less likely to receive standard therapies. Investigating drivers of inequities, and understanding the impact of racism on treatment decisions, are critical next steps to improve care for patients with IS. 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