Professor Emilio Perucca urges governments and non-governmental organisations in developing countries to ensure that effective treatment is available for all.

Of the 35 million people with epilepsy who live in developing countries, around 85% receive no treatment at all. As a result, they experience seizures and the psychological consequences of stigma and discrimination.

Regrettably, most of these people, many of whom are children, could return to a normal life by taking a single daily dose of a drug (phenobarbital) that costs less than $3 (£1.5; €2.2) each year.

The World Health Organisation recommends phenobarbital as the treatment of choice in resource restricted countries, but this policy has been questioned because of concerns about adverse behavioural effects, particularly in children.

Yet a study of children in Bangladesh also published in this week's BMJ, found no significant difference in behavioural problems between phenobarbital and another drug called carbamazepine. Despite some limitations, the study provides more evidence to support the use of phenobarbital in developing countries.

The burden of untreated epilepsy in terms of human suffering and social costs is enormous, says Professor Perucca.

An efficient epilepsy management programme will work only if fully integrated within a community healthcare delivery system, which should provide not only reliable supplies of drugs, with adequate facilities for storage and dispensing, but also educational programmes for health practitioners and the general population, he concludes.

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