Concepts behind epilepsy among Egyptian patients. Is it a disease or a possession?

•Epilepsy is a disorder known since ancient civilizations.•Epilepsy in Egypt dates to the great pharaohs and is mentioned in different papyri.•Traditional healers are a corner stone for treating epilepsy in sub-Saharan Africa.•Seeking traditional healing for epilepsy is not uncommon among Egyptians.•Awareness of epilepsy as a medical disorder is still questionable. Many epileptic patients visit traditional healers secondary to unaffordability, inaccessibility of medical service and being refractory. This may lead to delay in seeking medical advice and may influence prognosis. Studying concepts behind epilepsy among Egyptian epilepsy sufferers including beliefs behind epilepsy and whether there is difference in these beliefs as regards gender, education and urban to rural socioeconomic status. A semi structured questionnaire designed according to the guidelines of the 9th edition of research methods in psychology and applied to 393 cases presenting to epilepsy clinics at three hospitals representing rural delta, capital, and upper rural Egypt between November 2019 and April 2020. Inclusion criteria included a fulfillment of the international league against epilepsy operational definition and availability of an electroencephalogram supporting the diagnosis of epilepsy. 30 % of patients visited traditional healers within the course of their illness with males accounting for 55.9 %, and relatives’ impact was more obvious in this decision (83.9 % visited traditional healers secondary to a relative influence). 43.2 % of traditional healers’ visitors had a basic education. Low education level was significantly correlated with visiting traditional healers (rho=-0.126, p = 0.012). 43 patients (36.4 %) received traditional therapy and only 3 patients (2.5 %) out of them improved. More males (55.9 %) than females (29.5 %) were found to seek non-medical help with no significant difference (p = 0.852). Additionally, it was noticed that males who lived in rural areas visited traditional healers significantly more than those who lived in urban (72.2 % vs 27.3 %, p = 0.011) while in females, it seems that residency did not affect traditional healers seeking behavior (50 % urban vs 50 % rural). Rural residents were seeking non-medical advice more than urban (28.3 % vs 22 %, p < 0.001) as well as receiving traditional treatments (19.7 % vs 11 %, p = 0.017). Seeking traditional healers in epilepsy sufferers is not uncommon in Egypt. Education, gender, and residency may affec