In a native population of 4,436 in the Gbawein and Wroughbarh Clan region of Grand Bassa County, Liberia, West Africa, 123 cases of epilepsy were identified (prevalence 28 per 1,000). Among the 123 patients, 46 cases (37%) were classified as generalized seizures, 16 cases (13%) as simple partial seizures, and 61 cases (50%) as complex partial seizures. The male:female ratio was close to 1:1 (59/64). The mean age of onset (± standard error) in patients with generalized seizures was 12.87 ± 0.81 years, in patients with simple partial seizures (all of which had secondary generalization) 12.50 ± 1.73 years, and in patients with complex partial seizures 9.18 ± 0.48 years. Psychological changes and intellectual deficits, pyramidal and extrapyramidal signs, and burns were observed in approximately 30% of all epilepsy cases and appeared to be linked to the duration of the illness and the attack frequency. However, 32% of the 22 patients with complex partial seizures without secondary generalization exhibited extrapyramidal signs early in the course of their illness. An antecedent febrile illness could be identified in 47 patients (38% of all cases). This illness was characterized by fever, headache, and skin rash, in some cases accompanied by meningism and hematuria. Accidents (4 cases) or birth trauma (3 cases) were rarely encountered as precipitating factors. Anemia, enlarged spleen, or enlarged liver were found in a majority of both patients and nonepileptics of the same age.