Pragmatic strategies for improving prevention, diagnosis, and treatment of epilepsy in low- and middle-income countries.

Epilepsy poses a major public health challenge in low- and middle-income countries (LMICs), where prevention, diagnosis, and treatment must be tailored to local resources, infrastructure, and cultural contexts. Despite their diversity, LMICs commonly experience a pronounced urban-rural disparity in epilepsy care, with rural communities facing limited healthcare infrastructure, a shortage of specialists, and pervasive stigma. Prevention efforts should focus on modifiable risk factors. Neurocysticercosis, a leading preventable cause of epilepsy in endemic regions, can be addressed through improved sanitation, access to clean water, and timely treatment supported by low-cost diagnostics. Enhancing perinatal care, injury prevention, and stroke management is also essential to reduce epilepsy incidence. Stigma continues to hinder care. Targeted education campaigns aimed at schools, community leaders, and the general public are vital to improving awareness and reducing discrimination. Bridging diagnostic gaps requires accessible, cost-effective tools such as portable EEGs, smartphone-based seizure recordings, and mobile diagnostic applications. Integration of these technologies into community health systems, and their use by trained primary care providers and community health workers, enables earlier detection and ongoing monitoring, particularly in underserved areas. Treatment strategies should prioritize "easy-to-use," well-tolerated medications such as levetiracetam. Improving the affordability of antiseizure medications involves promoting generic alternatives, revising patent laws, regulating drug prices, setting price ceilings for essential medicines, and enabling bulk procurement. National health insurance schemes are crucial to ensure access for low-income populations. Expanding access through home-based care by community health workers, mobile outreach clinics, telemedicine, and collaboration with traditional healers can further improve treatment adherence and outcomes. Finally, training primary care physicians in epilepsy care is essential, as they are often the first point of contact for patients in rural and resource-limited settings.