A mixed methods study was conducted in the outpatient neurology clinic of a large public hospital in Conakry, Guinea, between 2024–2025. Standardized survey-based interviews were administered to PwE in their preferred language by trained study staff. PwE ≥18 years with ≥2 unprovoked lifetime seizures were included. PwE who had a seizure in the preceding 24 hours were excluded. 

Of 101 PwE interviewed (mean age 30.4 ± 12.0 (SD) years; 57% men; mean duration of epilepsy: 16.3 ± 12.2 years), n=64 reported that community members attributed their epilepsy to supernatural causes such as “devils” or “spirits,” but only 15/64 personally endorsed a supernatural etiology. Conversely, n=24 personally believed in a biological cause, but only 5/24 reported congruent views from the community. PwE with 7–11 years of formal education (n=23) were the most likely to report community endorsement of a supernatural cause (19/23). Prognostic attitudes were largely positive; however, belief in the possibility of cure was highest among those who personally endorsed a supernatural etiology (12/15), exceeding that of participants without such beliefs. Likewise, a greater proportion of those whose community attributed their epilepsy to supernatural causes believed in a cure (46/64), relative to peers whose communities held non-supernatural explanations.

Among PwE in Guinea, differences between personal and community beliefs regarding the etiology of epilepsy were evident and corresponded with differences in prognostic attitudes. Further research will help better characterize the sociocultural factors underlying these findings.