Acta Neurol Scand. 2020;00:1–11. | 1 wileyonlinelibrary.com/journal/ane 1 | INTRODUCTION Epilepsy affects over 50 million people worldwide 1 and accounts for nearly 0.5% of the world burden of disease. 2 In spite of the availabil- ity of effective and affordable anti-epileptic medications, majority of the people in the low and middle-income countries that constitute over 90% of all the people living with epilepsy (PWE) worldwide do not receive appropriate treatment. 3 A recent global burden of dis- ease (GBD) study showed a decrease in the disease burden from 1990 to 2016. 4 In spite of this finding, epilepsy remains an important cause of disability and mortality globally. 4 Almost two decades ago, having realized that the magnitude of epilepsy treatment gap in resource poor countries may be too intricate for an individual country or organization to handle, the International League Against Epilepsy (ILAE), International Bureau for Epilepsy, and World Health Organization (WHO), came together to bring epilepsy “out of the shadows” with the Global Campaign against Epilepsy (GCAE). 3,5,6 Received: 21 November 2019 | Revised: 16 February 2020 | Accepted: 20 March 2020 DOI: 10.1111/ane.13246 REVIEW ARTICLE Epilepsy treatment gap in Sub-Saharan Africa: Meta-analysis of community-based studies L. F. Owolabi 1 | S. D. Owolabi 2 | B. Adamu 3 | A.M. Jibo 4 | I. D. Alhaji 1 © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1 Departments of Medicine, Bayero University, Kano, Nigeria 2 Department of Psychiatry, Bayero University, Kano, Nigeria 3 Department of Medicine, University of Bisha, Bisha, Saudi Arabia 4 Department of Community Medicine, Bayero University, Kano, Nigeria Correspondence L. F. Owolabi, Departments of Medicine, Psychiatry , Bayero University, Kano, Nigeria. Email: drlukmanowolabi@yahoo.com Objective: To evaluate the prevalence, highlight the variation and determine the trend over time, of epilepsy treatment gap (ETG) in Sub-Saharan Africa (SSA). Methods: We systematically searched PubMed, MEDLINE, Embase, ISI databases, and African Journal Online (AJOL). We determined the pooled prevalence estimate of ETG and the degree of heterogeneity in the region. Further subgroup analysis by sub-region, settlement setting, and cutoff adopted for active epilepsy in the studies was carried out. Meta-regression technique was also used to determine the trend of the ETG magnitude over time. Results: Twenty-three studies from SSA met the inclusion criteria. We found a high level of discordance among the studies that were included. Collectively, the esti- mated ETG was 68.5% (95% CI: 59.5%-77.5%). On subgroup analysis, the prevalence of the ETG was 67% (95% CI: 52%, 83%) in the Western, 68% (95% CI: 56%, 80%) in the Eastern, and 63% (95% CI: 53%, 73%) in the Southern Africa sub-regions. On stratified analysis based on 1-year, 5-year, and 2-year cutoffs for definition of active epilepsy, the prevalence figures for the ETG were 71% (95% CI: 56%, 85%), 55% (95% CI: 33%, 77%), and 57% (95% CI: 43%, 71%), respectively. Meta-regression result sug- gested that the prevalence of the ETG decreases by approximately by 0.006 per year. Conclusion: The study showed a high prevalence of ETG, higher than the average for resource poor countries, and twice in rural compared with urban settlements in SSA. KEYWORDS epilepsy, magnitude, Sub-Saharan Africa, treatment gap, trend