Global, regional, and national burden of epilepsy, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Masayuki Teramoto, Theo Vos, Balakrishnan Nair, Simon I Hay, Yohannes Abate, Abdallah H A Abd Al Magied, Samar Abd ElHafeez, Atef Abdelkader, Mohammad‐Amin Abdollahifar, Auwal Abdullahi, Richard Gyan Aboagye, Lucas Guimarães Abreu, Samir Abu‐Rumeileh, Hasan Abualruz, Salahdein Aburuz, Ahmed Abu‐Zaid, Isaac Yeboah Addo, Rufus Adesoji Adedoyin, Victor Abiola Adepoju, Muhammad U. Afzal, Saira Afzal, Aqeel Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Amir Mahmoud Ahmadzade, Ayman Ahmed, Haroon Ahmed, Mehrunnisha Sharif Ahmed, Muktar Beshir Ahmed, Salah Al Awaidy, Omar Al Omari, Yazan A. Al‐Ajlouni, Mohammed ALBashtawy, Bassam Al‐Fatly, Abdelazeem M. Algammal, Abid Ali, Mohammed Usman Ali, Syed Shujait Ali, Waad Ali, Sheikh Mohammad Alif, Joseph Uy Almazan, Najim Z. Alshahrani, Awais Altaf, Mohammad Al‐Wardat, Yaser Mohammed Al‐Worafi, Hany Aly, Karem H. Alzoubi, Sohrab Amiri, Robert Ancuceanu, Dhanalakshmi Angappan, Mohammed T Ansari, Saeid Anvari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Mosab Arafat, Aleksandr Y. Aravkin, Brhane Berhe Aregawi, Abdulfatai Aremu, Maha Atout, Alok Atreya, Avinash Aujayeb, Setognal Birara Aychiluhm, Shahkaar Aziz, Ahmed Y. Azzam, Ashish Badiye, Ruhai Bai, Atif Amin Baig, Shankar M Bakkannavar, Soham Bandyopadhyay, Indrajit Banerjee, Mainak Bardhan, Suzanne Barker‐Collo, Amadou Barrow, Zarrin Basharat, Azadeh Bashiri, Afisu Basiru, Mohammad‐Mahdi Bastan, Sai Batchu, Babak Behnam, Diana Fernanda Bejarano Ramírez, Maryam Bemanalizadeh, Kebede Beyene, Devidas S. Bhagat, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Ajay Nagesh Bhat, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Mohiuddin Ahmed Bhuiyan, Soumitra S. Bhuyan, Cem Bilgin, Francesca Bisulli, Archith Boloor, Sri Harsha Boppana, Souad Bouaoud, Yasser Bustanji, Mehtap Çakmak Barsbay, Félix Carvalho, João Maurício Castaldelli-Maia
Abstract
BACKGROUND: Epilepsy is one of the most common serious neurological disorders and affects individuals of all ages across the globe. The aim of this study is to provide estimates of the epilepsy burden on the global, regional, and national levels for 1990-2021. METHODS: Using well established Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) methodology, we quantified the prevalence of active idiopathic (epilepsy of genetic or unknown origin) and secondary epilepsy (epilepsy due to an underlying abnormality of the brain structure or chemistry), as well as incidence, death, and disability-adjusted life-years (DALYs) by age, sex, and location (globally, 21 GBD regions and seven super-regions, World Bank country income levels, Socio-demographic Index [SDI], and 204 countries) and their trends from 1990 to 2021. Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy, largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). FINDINGS: In 2021, there were 51·7 million (95% UI 44·9-58·9) people with epilepsy (idiopathic and secondary combined) globally, with an age-standardised prevalence of 658 per 100 000 (569-748). Idiopathic epilepsy had an age-standardised prevalence of 307 per 100 000 (235-389) globally, with 24·2 million (18·5-30·7) prevalent cases, and secondary epilepsy had a global age-standardised prevalence of 350 per 100 000 (322-380). In 2021, 0·7% of the population had active epilepsy (0·3% attributed to idiopathic epilepsy and 0·4% to secondary epilepsy), and the age-standardised global prevalence of epilepsy from idiopathic and secondary epilepsy combined increased from 1990 to 2021 by 10·8% (1·1-21·3), mainly due to corresponding changes in secondary epilepsy. However, age-standardised death and DALY rates of idiopathic epilepsy reduced from 1990 to 2021 (decline of 15·8% [8·8-22·8] and 14·5% [4·2-24·2], respectively). There were three-fold to four-fold geographical differences in the burden of active idiopathic epilepsy, with the bulk of the burden residing in low-income to middle-income countries: 82·1% (81·1-83·4) of incident, 80·4% prevalent (79·7-82·7), 84·7% (83·7-85·1) fatal epilepsy, and 87·9% (86·2-89·2) epilepsy DALYs. INTERPRETATION: Although the global trends in idiopathic epilepsy deaths and DALY rates have improved in the preceding decades, in 2021 there were almost 52 million people with active epilepsy (24 million from idiopathic epilepsy and 28 million from secondary epilepsy), with the bulk of the burden (>80%) residing in low-income to middle-income countries. Better treatment and prevention of epilepsy are required, along with further research on risk factors of idiopathic epilepsy, good-quality long-term epilepsy surveillance studies, and exploration of the possible effect of stigma and cultural differences in seeking medical attention for epilepsy. FUNDING: Bill and Melinda Gates Foundation.