In Sierra Leone, epilepsy starts at an early age with the mean age of onset being 12 years. Many of the cases are due to birth injuries, infections in childhood particularly cerebral malaria and meningitis, febrile convulsions and trauma. As a result of the Civil war in Sierra Leone which ended in 1992, we see many cases of head injuries resulting from gun shots, shrapnel damage and machete assaults. Road traffic accidents are also common, many associated with traumatic brain injuries. Middle aged and older patients presenting with epilepsy are relatively uncommon but strokes are perhaps the leading cause in this age group.
With poor investigative facilities, the majority of patients seen cannot be adequately investigated hence the cause of their epilepsy remain undiagnosed.