Of the 35 million people with epilepsy who live in developing countries, around 85% receive no treatment at all.1 2 As a consequence, they experience morbidity related to seizures and the psychosocial consequences of stigma and discrimination. Regrettably, most of these people—many of whom are children—could have their seizures completely controlled and they could return to a normal life by taking a single daily dose of a drug that costs less than $3 (£1.50; €2.20) each year.3 In this week's BMJ, a randomised controlled trial in Bangladesh by Banu and colleagues compares the effects of carbamazepine and phenobarbital on seizure control and behavioural side effects in 108 children with epilepsy.4

The World Health Organization recommends phenobarbital as the treatment of choice for partial and tonic clonic seizures in resource restricted countries,5 but this policy has been questioned because phenobarbital is thought to be less well tolerated than other antiepileptic drugs.6 Concerns apply particularly to children, who are especially vulnerable to this drug's adverse cognitive and behavioural effects.7 Differences in tolerability between phenobarbital and other anticonvulsants …