Developing countries (DCs) and developed countries have geographic, economic, and social differences. The prevalence and incidence of epilepsy are higher in DCs than in developed countries. However, within DCs, given the high incidence of epilepsy, the prevalence is relatively low, which may be due to high mortality for people with epilepsy (PWE). Neurocysticercosis is one of the main causes of symptomatic epilepsy in many DCs. Prognosis in DCs seems similar to that in developed countries. Because phenobarbital and phenytoin are available and inexpensive, they are the drugs most often used in DCs. The cost of newer antiepileptic drugs and the limited availability of resources for epilepsy care in DCs mean that care for PWE in DCs is marginalized and that many people receive no pharmacologic treatment. The most cost-effective way to decrease the treatment gap in DCs would be to deliver the epilepsy services through primary health care.