<p>We present the case of a 20-year-old male who died of sudden unexpected death in epilepsy in a small rural community in northern Uganda. The neuropathologic substrate for the seizure disorder was the combination of two neurological diseases that are prevalent in East Africa. There was evidence of both neurocysticercosis and nodding syndrome. Neurocysticercosis is an infection of the brain by the pork tapeworm which causes epilepsy by creating localized lesions in the brain. Nodding syndrome is a poorly understood disorder with cortical tau pathology which likely represents an epileptogenic lesion. Nodding syndrome has been epidemiologically associated with another parasitic disease, onchocerciasis. In contrast to Africa, most cases of epilepsy in temperate climates are not parasitic. In Africa and Asia, acquired forms of parasitic epilepsy may be the substrate of sudden unexpected death in epilepsy. Prevention of many fatalities due to epilepsy in tropical countries can probably be achieved by eradication of parasites.</p>