Background/Objectives: In Tibetan-inhabited plateau regions of western China, remoteness, uneven access to care, and preventable causes complicate epilepsy care. We assessed whether regional evidence supports an independent effect of chronic altitude exposure on epilepsy risk and identified healthcare priorities. Methods: We conducted a targeted narrative review of English-language journal articles published through 12 June 2026 (PubMed/MEDLINE, Web of Science Core Collection, citation tracking). Altitude-related evidence was evaluated against four prespecified, review-defined features; core sources underwent structured qualitative appraisal. Results: Three community surveys with differing case definitions and ascertainment reported prevalence estimates of 2.5–23.5 per 1000; the most recent (Daofu County, 2025) reported 4.4 per 1000 (95% confidence interval 3.7–5.1). No population-based incidence study of long-term residents was identified among the retrieved publications, and no identified resident-population study reported all four features. Regional studies documented parasitic, traumatic, and vascular etiologies, historical treatment gaps of 97–100%, and uneven diagnostic and workforce capacity. Among 127 Daofu participants assessed in detail, 33.1% were classified as receiving nonstandard treatment and 14.2% as untreated; 35.4% and 52.0% screened positive for depressive and anxiety symptoms. Conclusions: Current evidence neither establishes nor excludes an independent effect of chronic altitude exposure. It supports prospective evaluation of prevention, treatment continuity, diagnostic and referral services, workforce development, integrated mental health care, and surveillance.
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