What Does the Global Epilepsy Treatment Gap Actually Mean?

The epilepsy treatment gap is the difference between the number of people who need appropriate epilepsy care and the number who actually receive it. It is not one single global percentage, and it is not only a question of whether a person has been prescribed a medicine.

Why the number varies so much

Published estimates vary widely between countries and even between regions of the same country. Rural access, medicine availability, affordability, specialist distribution, transport, diagnostic capacity, stigma and health-system organisation can all affect the gap.

What international evidence shows

WHO reports that about three quarters of people with epilepsy in low-income countries do not receive the treatment they need, and the gap can reach about 90% in some settings. WHO also estimates that up to 70% of people with epilepsy could live seizure-free if they were properly diagnosed and treated.

A 2022 systematic review from the ILAE Epidemiology Commission found reported treatment gaps ranging from 5.6% in Norway to 100% in some study populations in Tibet, Togo and Uganda. The authors stressed that these figures cannot be compared naively because studies used different definitions, sampling methods and ways of identifying epilepsy.

The gap can begin before treatment

A person can be outside appropriate care long before the question of which antiseizure medicine to use. The pathway may break down because seizures are not recognised, diagnosis is delayed, there is no trained clinician nearby, EEG or MRI is unavailable where clinically needed, referral systems are weak, or stigma and cost discourage care-seeking.

This is why modern discussions increasingly distinguish different parts of the gap, including diagnostic gaps and therapeutic gaps, rather than treating all unmet need as one problem.

Medicine availability is still a major barrier

WHO identifies access to affordable, quality-assured neurological medicines as a major global challenge. In many low- and middle-income settings, essential antiseizure medicines may be unavailable in the public sector, intermittently stocked, unaffordable, or difficult to obtain consistently enough for long-term treatment.

For a condition that often requires continuous treatment over years, interrupted supply is not a minor inconvenience. It can lead to missed doses, breakthrough seizures, emergency care and loss of trust in the health system.

Workforce and service capacity matter too

WHO’s 2025 Global Status Report on Neurology shows major inequalities in neurological workforce, service delivery, financing, medicines and technologies. Low-income countries have far fewer neurologists per population than high-income countries, while rural and underserved communities are particularly likely to face long travel distances and limited specialist access.

Specialist shortages do not mean epilepsy care must wait for a neurologist in every case. WHO has long supported training non-specialist and primary-care workers to diagnose and treat common epilepsy presentations using structured guidance, with referral pathways for complex cases.

Primary care can reduce the gap

Most epilepsy care does not require highly specialised technology. WHO programmes using primary-care and non-specialist models have shown that diagnosis, treatment and follow-up can be expanded in lower-resource settings when health workers are trained, essential medicines are available and referral pathways are in place.

The advanced-treatment gap is different again

Even where basic antiseizure treatment is available, access to epilepsy-protocol MRI, long-term video-EEG, presurgical assessment, epilepsy surgery and neuromodulation can remain highly concentrated. Someone with drug-resistant focal epilepsy may therefore have access to medication but still face a major gap in tertiary care.

Why one percentage can be misleading

A national treatment-gap figure can hide important differences between rural and urban areas, adults and children, richer and poorer households, public and private care, or basic and advanced treatment. It can also hide whether the main barrier is diagnosis, affordability, medicine supply, specialist referral, stigma or something else.

For that reason, treatment-gap statistics are most useful when they are interpreted alongside the health-system context that produced them.

Why this matters

Epilepsy is one of the clearest examples of a neurological condition for which large numbers of people could do substantially better with timely diagnosis and consistent access to established treatment. Closing the gap therefore requires more than discovering new medicines: it also requires trained staff, reliable supply chains, affordable care, functioning referral systems, public understanding and health policies that include epilepsy.

Sources

Evidence checked: September 2026.