Epilepsy is a major public health concern in low and middle-income countries (LMICs) and comorbiditiesaggravate the burden associated with the disease. The epidemiology of these comorbidities hasnot been well described, although, identifying the main comorbidities of epilepsy, and their relativeimportance, is crucial for improving the quality of care. Comorbidities were defined as disorderscoexisting with or preceding epilepsy, or else compounded or directly attributed to epilepsy or to itstreatment. A meta-analysis of the proportion of main comorbidities by subcontinent as well as overallwas also conducted. Out of the 2,300 papers identified, 109 from 39 countries were included in thissystematic review. Four groups of comorbidities were identified: parasitic and infectious diseases(44% of comorbid conditions), somatic comorbidities (37%), psychosocial (11%), as well as psychiatriccomorbidities (8%). Heterogeneity was statistically significant for most variables then random effectmodels were used. The most frequently studied comorbidities were: neurocysticercosis (comorbidproportion: 23%, 95% CI: 18–29), head trauma (comorbid proportion: 9%, 95% CI: 5–15) malnutrition(comorbid proportion: 16%, 95% CI: 28–40), stroke (comorbid proportion: 1.3%, 95% CI: 0.2–7.0),and discrimination for education (comorbid proportion: 34%, 95% CI: 28–40). Many comorbidities ofepilepsy were identified in LMICs, most of them being infectious.