Objective To understand the prevalence rate, and treatment gap of epilepsy in Yueyang of Hunan Province.Methods A door-to-door epidemiological survey on epilepsy was conducted by random cluster sampling among the urban and rural populations of Yueyang, Hunan Province, China. The screening questionnaire for epilepsy used in this study was adapted from the WHO and ICBERG standard screening questionnaire. The persons diagnosed or suspected as epilepsy during screening were followed up by neurologists.Results A total of 32059 persons were investigated. One hundred and forty-three persons were diagnosed with epilepsy, with a prevalence rate of 4.5‰. Prevalence rate of epilepsy was higher in males than in females and it was higher in rural areas than in urban areas. Two peak prevalences of epilepsy were found in 20-(8.4%) and 60-year-old groups(5.4%). Secondary generalized tonic-clonic seizure prevailed over other seizure types in frequency(63.4%). 93.4% of the patients with active epilepsy did not receive standard and regular antiepileptic treatments.Conclusions The prevalence rate of epilepsy in rural areas is higher than in urbans in Yueyang of Hunan Province. The large amount of patients with treatment gaps indicates an urgent need for a rational intervention strategy.