In Lao PDR research conducted over the last 7 years has highlighted the diffi cult challenges that the 52,000 patients living with epilepsy (PWE) have to face. Mortality and morbidity is high among untreated patients. The treatment gap is 90% or more. The highly traditional and poor knowledge of the disease and its treatment, low trust in modern treatment, restricted access to anti-epileptic drugs (phenobarbital is the fi rst line drug), and ignorance of requirement for long term treatment explain the high treatment gap. Stigma, misconceptions, and fear of the disease are common. Knowledge of medical staffs regarding epilepsy diagnosis and treatment is poor. The neurology investigational facilities are basic and mainly concentrated in the capital city. Using lessons from program of neighboring countries, the authors have been developing a step-by-step treatment intervention project since 2009. The intervention was adapted to the local constraints and a limited budget, which demanded regular feedbacks, analysis and reorientation of the activities.