Eighty percent of the more than 40 million people with epilepsy live in developing countries, where cultural factors frequently exacerbate the burden of disease on patients and their families. Even when assistance is sought, a treatment gap as high as 90 percent still affects some rural populations in low-income countries.

Many risk factors for epilepsy have been identified, including birth trauma, parasitic infections (most notably cysticercosis), bacterial and viral infections, head injuries, febrile seizures, and genetic factors. Local variation in risk factors at least partly explains the marked heterogeneity in the prevalence and incidence of the disease throughout the world.

Key preventive measures likely to significantly reduce the incidence of epilepsy include prenatal care, avoidance of labor and delivery complications, safety measures against head injuries, control of infectious and parasitic diseases, and genetic counseling for potential marriage partners who have the disease.

Phenobarbital is recommended for the treatment of partial and generalized tonic-clonic epilepsies in developing countries due to its efficacy for a wide range of seizure types, its low cost, and its superiority to both phenytoin and carbamazepine in recent community-level studies.

The lack of adequate drug production facilities and high prices for imported drugs restrict the availablity of anti-epileptic drugs in developing countries.