Objective: To review systematically community-based primary care interventions for epilepsy in low and middle income countries to rationalize approaches and outcome parameters in relation to epilepsy care in these countries. Methods: A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL and Web of Science was undertaken to identify trials and implementation of provision of anti-seizure medications, adherence reinforcement and/or healthcare provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions and outcomes were extracted from eligible articles. Results: Twenty-four reports were identified, mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently though other conventional antiseizure medications have also been used but none of the newer. Tolerability rates in these studies are high but overall, attrition is considerable. Other approaches have included updating primary health care providers, reinforcing treatment adherence in clinics and raising community awareness. The coverage of existing treatment gap in the community, epilepsy-related mortality and comorbidity burden are fleetingly addressed in these programs. Conclusions: The cost-free provision, mostly of phenobarbital has resulted in short-term seizure freedom in roughly half of the people with epilepsy in LMICs. Future programs should include a range of antiseizure medications. These should cover apart from seizure control and treatment adherence, primary healthcare provider education, raising community awareness and referral protocols for specialist care. The programs should ensure sustainability and impact assessment at a community level.