Global Prevalence of Epilepsy and Temporal Trends, 1980-2025: A Systematic Review and Meta-Analysis

The aims of this study were to synthesize population-based studies of epilepsy prevalence published between 1980 and 2025, estimate pooled global prevalence, characterize regional differences, quantify temporal trends, and examine the influence of study characteristics and development indicators (Human Development Index [HDI] and Socio-Demographic Index [SDI]).

We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for observational studies published from January 1, 1980, to December 31, 2025. Random-effects meta-analysis was used to pool prevalence estimates. Pre-specified subgroup analyses were conducted by geographical region, survey period, study design, data source, sample size, and HDI/SDI strata. Methodological subgroup analyses and sensitivity analyses were further performed to assess the robustness of the pooled estimates. Temporal patterns were assessed using regression-based β trend analysis across study survey years and estimated annual percentage change (EAPC) derived from the Global Burden of Disease (GBD) database.

We included 216 studies comprising 278,651,975 participants and 2,114,157 epilepsy cases. The pooled global prevalence was 7.57 per 1,000 population (95% confidence interval [CI], 6.78-8.45). Literature-based trend analysis suggested an increase in reported prevalence estimates from 1980 to 2025 (β = 0.206 per 1,000 population per year; p < 0.01). GBD-based analyses also showed an overall increase from 1990 to 2021 (EAPC = 0.102% per year), with significant increases during 1990-2009 but no significant change during 2010-2021. Prevalence differed significantly across geographical regions (p < 0.001), highest in Africa (10.67 per 1,000) and lowest in Asia (5.20 per 1,000). Prevalence was higher in low-HDI settings than in very high-HDI settings, but meta-regression did not support significant linear associations between prevalence and HDI or SDI (both p > 0.05). No significant sex difference was observed (p = 0.76). Sensitivity analyses supported the robustness of the main pooled estimate, and methodological subgroup analyses showed no major variation across prevalence definitions, case ascertainment methods, or diagnostic confirmation approaches.

Epilepsy prevalence remains high worldwide, with an overall increase in reported prevalence over the past 4 decades but a slower recent rise. Marked geographical disparities were observed, with higher reported prevalence in low-resource settings. Strengthening standardized epidemiological surveillance and improving access to diagnosis and treatment remain priorities, particularly in resource-limited regions.