Global, regional, and national burden of epilepsy, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Abstract

Epilepsy is one of the most common serious brain conditions of increasing burden that affects individuals of all ages across the globe,1,2 increases risk of premature death up to three times compared with the general population, and is characterised by recurrent, unprovoked seizures due to abnormal excessive or synchronous neuronal activity in the brain.3 The disease imposes a substantial economic, psychosocial, physical, and mental burden for health systems, societies, and affected individuals and their families.4–6 In 2022, epilepsy was identified by the 75th World Health Assembly and WHO as one of the top priorities in prevention and control of non-communicable diseases, and a special intersectoral global action plan on epilepsy and other neurological disorders for 2022–31 was adopted.6 To enable evidence-based actions and awareness campaigns, and to strengthen public and private efforts to improve quality of and access to care and reduce the effect of the disease, accurate and regularly updated data on epilepsy incidence, prevalence, death, and disability by age, sex, and location are of crucial importance.2 From public health perspectives, it is important to provide burden estimates for idiopathic (genetic) epilepsy separately from and combined with secondary epilepsy (epilepsy syndrome due to an underlying abnormality of the brain structure or chemistry)7 for identifying prognosis and opportunities for prevention efforts, which are clearly different between the two types of epileptic seizures. As in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) report on epilepsy published in 2019,8 causes of secondary epilepsy included, among others, stroke, neurodegenerative disorders, infections and inflammatory disorders, brain tumours, traumatic brain injuries, and congenital abnormalities. In this GBD study, these conditions were not considered risks, but rather quantified as sequelae of the underlying causes of secondary epilepsy. Therefore, the causes of secondary epilepsy are more amendable to prevention, but their treatment usually is less successful because they do not address the often severe comorbid disabilities from motor or intellectual impairments. This information might also be used for projections of the burden of epilepsy, which is also important for health-care planning and resource allocation.9 As emphasised by WHO, an understanding of the development of epilepsy after a brain insult or parasitic infection is crucial to the development of secondary prevention strategies.2