BACKGROUND: Epilepsy can be a large economic burden in countries where appropriate treatment is not taken due to religious and psychosocial beliefs. The objective of this study was to explore the perceptions and experiences of patients with epilepsy attending their treatment at Tikur Anbessa Specialized Hospital about their illness and treatment. METHODS: A qualitative exploratory design with an in-depth interview was followed.  Fourteen purposively selected patients were used until saturation of key emerging themes was achieved. RESULTS: The finding showed that study participants expressed perceptions towards their illness including about its cause, timeline, severity and psychosocial consequences which at times may be considered different from the biomedical version. They also expressed concerns about their treatment, reported about social and psychological issues and in certain cases dissatisfaction with their healthcare providers. Such issues may have led to delays in treatment-seeking and non-adherence to recommended treatment regimens and as well use of traditional medicine and spiritual healing. On the other hand, reasons that were reported to positively influence their treatment experiences include necessity perceptions about their medications, family support and use of spiritual healing alongside their biomedical treatment. CONCLUSION: The healthcare provision should improve to cater to these groups of patients including instituting chronic care management and appropriate health education provision.KEYWORDS: Patient perceptions, Kleinman’s model, Necessity-Concerns framework, Epilepsy, Qualitative research, Ethiopia