The World Health Organization (WHO) estimates that more than 50 million people worldwide live with epilepsy, making it one of the most common neurological conditions on the planet. Nearly 80% of those people live in low- and middle-income countries, where access to diagnosis and affordable medication remains severely limited. The WHO has made epilepsy a global health priority, setting targets through 2031 to close what it calls an “unacceptably high” treatment gap.
How the WHO Defines Epilepsy
Epilepsy is a brain disorder characterized by a lasting tendency to generate seizures. In practice, a diagnosis typically requires at least two unprovoked seizures occurring more than 24 hours apart. A person can also be diagnosed after a single unprovoked seizure if their risk of having another within the next ten years is at least 60%, or if they meet the criteria for a recognized epilepsy syndrome. The International League Against Epilepsy (ILAE), which works closely with the WHO, formalized this clinical definition to ensure consistent diagnosis across countries with very different healthcare systems.
The Global Treatment Gap
The most striking number in WHO reports on epilepsy is the treatment gap: the share of people who need anti-seizure medication but don’t receive it. In low-income countries, three out of four people with epilepsy go untreated. Across all developing countries, systematic reviews estimate the gap at roughly 56%, though some individual studies have placed it above 90% in the most under-resourced settings.
What makes this gap so frustrating is the cost of closing it. Basic anti-seizure medications can cost as little as US$5 per person per year and can be delivered through primary care systems, not specialized hospitals. About 70% of people with epilepsy could become seizure-free with access to these medicines. The barrier isn’t the science. It’s infrastructure, funding, and awareness.
Where Epilepsy Hits Hardest
Epilepsy exists everywhere, but it is not distributed evenly. Central Asia had the highest age-standardized prevalence in 2021, at roughly 773 cases per 100,000 people, according to the Global Burden of Disease Study. The broader region of central Europe, eastern Europe, and central Asia followed at about 667 per 100,000. These higher rates reflect a combination of factors: more exposure to preventable causes, less access to perinatal care, and greater prevalence of brain infections.
In tropical regions, central nervous system infections are a major driver. Neurocysticercosis, a parasitic brain infection spread through contaminated food and water, is one of the most common preventable causes of epilepsy in these areas. Birth-related brain injuries also play a larger role where obstetric care is limited. The WHO estimates that 25% of all epilepsy cases worldwide are potentially preventable through measures like better perinatal care, infection control, and head injury prevention.
Premature Death and Stigma
Untreated epilepsy carries real mortality risk. People with epilepsy face a significantly higher chance of dying prematurely compared to the general population, particularly in countries where treatment is scarce. Uncontrolled seizures can lead to drowning, falls, and sudden unexpected death. But the damage goes beyond physical health.
Across the world, people with epilepsy are targets of stigma, discrimination, and human rights violations. In many countries, they face barriers to education and employment and are effectively shut out of full participation in community life. Some nations still have discriminatory laws on the books that restrict marriage, driving, or employment for people with epilepsy, regardless of whether their seizures are controlled. The WHO has specifically called for countries to combat these discriminatory practices alongside improving medical access.
The WHO’s 2022-2031 Action Plan
In May 2022, WHO member states adopted the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders, covering the decade through 2031. The plan asks governments to take concrete steps: expanding access to affordable anti-seizure medications, training primary care workers to diagnose and manage epilepsy, and updating legislation that discriminates against people with the condition.
The word “intersectoral” matters here. The WHO frames epilepsy as a problem that can’t be solved by health ministries alone. Education systems need to accommodate children with epilepsy. Labor laws need to protect workers. Public health campaigns need to reduce the fear and misinformation that keep people from seeking care in the first place. The plan also emphasizes prevention, particularly reducing head injuries through traffic safety and falls prevention, improving birth care, and controlling parasitic infections in endemic regions.
What Causes Epilepsy
Epilepsy has many possible causes, and in a large number of cases no specific cause can be identified. Known causes include brain damage from oxygen loss or trauma during birth, head injuries later in life, brain infections like meningitis or encephalitis, stroke, and brain tumors. Genetic factors also play a role in many epilepsy syndromes, particularly those that begin in childhood.
The relative importance of each cause varies by region. In high-income countries, stroke and neurodegenerative conditions are leading causes among older adults, while genetic syndromes account for many childhood cases. In low- and middle-income countries, infections and birth injuries make up a larger share, which is precisely why the WHO emphasizes prevention in those settings. Reducing parasitic infections through sanitation and education, improving hospital care during delivery, and preventing traumatic brain injuries through safer roads and workplaces could eliminate a meaningful fraction of new cases each year.