Global, regional, and national burden of epilepsy, 1990-2021: a Global Burden of Disease study

Epilepsy is a common neurological disorder characterised by spontaneous seizures without an identifiable cause, leading to high morbidity and a significant public health burden. Understanding trends in its incidence, prevalence, mortality, and disability-adjusted life years (DALYs) is essential for developing effective prevention and treatment strategies. We aim to describe global trends in epilepsy over the past 32 years and explore the impact of sociodemographic index (SDI) levels on disease burden using the Global Burden of Disease 2021 data.

We analysed the global burden of epilepsy (1990-2019) using age-standardised rates (ASRs) and their 95% uncertainty intervals (UI). We assessed temporal trends with estimated annual percentage change and joinpoint regression. We used decomposition analysis to quantify the effects of population growth, ageing, and epidemiological shifts. Using the Pearson correlation, we examined the relationship between SDI and DALY rates. Additionally, we evaluated global disparities using the slope index of inequality and the concentration index. We used multidimensional health inequality analysis to identify the population with the highest disease burden. Lastly, we used frontier analysis to identify DALY gaps across 204 countries, and the Bayesian age-period-cohort model to predict future burden.

The global burden of epilepsy decreased from 1990 (ASR = 208.1; 95% UI = 163.2, 260.3) to 2021 (ASR = 177.8; 95% UI = 137.7, 225.9). However, there was a gradual increase in incidence from 1990 (ASR = 38.1; 95% UI = 27.9, 49.5) to 2021 (ASR = 42.8; 95% UI = 31.2, 53.7) and prevalence from 1990 (ASR = 287.5; 95% UI = 215.7, 363.0) to 2021 (ASR = 307.4; 95% UI = 234.7, 389.0). The ASR of DALYs was negatively correlated with SDI (R² = 0.619; P < 0.001). Furthermore, a multidimensional analysis of health inequalities identified specific groups with a high disease burden. Frontier analysis identified countries and regions that require targeted interventions to address the burden. We projected that the ASDR will continue to decline, with rates dropping to 159.56 (95% UI = 102.26, 216.86) for males and to 109.32 (95% UI = 70.47, 148.17) for females by 2050.

We provide valuable insights into global trends and the burden of epilepsy, emphasising the need for targeted prevention and healthcare strategies across socioeconomic levels.