Global, regional, and national burden of epilepsy, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
journal contribution
posted on 2025-06-02, 15:16 authored by Valery L Feigin, Theo Vos, Balakrishnan Sukumaran Nair, Simon I Hay, Yohannes Habtegiorgis Abate, Abdallah HA 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, Abiola Victor Adepoju, Muhammad Sohail 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 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 Tahir Ansari, Saeid Anvari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Mosab Arafat, Aleksandr Y Aravkin, Brhane Berhe Aregawi, Abdulfatai Aremu, Maha Moh'd Wahbi Atout, Alok Atreya, Avinash Aujayeb, Setognal Birara Aychiluhm, Shahkaar Aziz, Ahmed Y Azzam, Ashish D Badiye, Ruhai Bai, Atif Amin Baig, Shankar M Bakkannavar, Soham Bandyopadhyay, Indrajit Banerjee, Mainak Bardhan, Suzanne Lyn Barker-Collo, Amadou Barrow, Zarrin Basharat, Azadeh Bashiri, Afisu Basiru, Mohammad-Mahdi Bastan, Sai Batchu, Babak Behnam, Diana Fernanda Bejarano Ramirez, Maryam Bemanalizadeh, Kebede A 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, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Rama Mohan Chandika, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Patrick R Ching, Hitesh Chopra, Dinh-Toi Chu, Hongyuan Chu, Samuele Cortese, Paolo Angelo Cortesi, Natalia Cruz-Martins, Omid Dadras, Xiaochen Dai, Emanuele D'Amico, Lalit Dandona, Rakhi Dandona, Samuel Demissie Darcho, Amira Hamed Darwish, Amol S Dhane, Vishal R Dhulipala, Michael J Diaz, Thanh Chi Do, Sushil Dohare, Ojas Prakashbhai Doshi, Haneil Larson Dsouza, Arkadiusz Marian Dziedzic, Alireza Ebrahimi, Negin Eissazade, Michael Ekholuenetale, Rabie Adel El Arab, Ibrahim Farahat El Bayoumy, Omar Abdelsadek Abdou El Meligy, Hala Rashad Elhabashy, Muhammed Elhadi, Chadi Eltaha, Adeniyi Francis Fagbamigbe, Ayesha Fahim, Jawad Fares, Mohsen Farjoud Kouhanjani, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Patrick Fazeli, Timur Fazylov, Ginenus Fekadu, Seyed-Mohammad Fereshtehnejad, Pietro Ferrara, Nuno Ferreira, Getahun Fetensa, Florian Fischer, Matteo Foschi, Muktar A Gadanya, Yaseen Galali, Balasankar Ganesan, Xiang Gao, Ravindra Kumar Garg, Miglas Welay Gebregergis, Fataneh Ghadirian, Seyyed-Hadi Ghamari, Jaleed Ahmed Gilani, Alem Abera Girmay, Giorgia Giussani, Elena V Gnedovskaya, Mahaveer Golechha, Mahdi Gouravani, Ayman Grada, Shi-Yang Guan, Sapna Gupta, Mohammad Haghani Dogahe, Arvin Haj-Mirzaian, Nadia M Hamdy, Netanja I Harlianto, Ahmed I Hasaballah, Hamidreza Hasani, Amr Hassan, Ikrama Ibrahim Hassan, Mahgol Sadat Hassan Zadeh Tabatabaei, Omar E Hegazi, Golnaz Heidari, Mehdi Hemmati, Kamal Hezam, Nguyen Quoc Hoan, Ramesh Holla, Mehdi Hosseinzadeh, Junjie Huang, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Adalia Ikiroma, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mohammad Tarique Imam, Mustapha Immurana, Arit Inok, Md Rabiul Islam, Chidozie Declan Iwu, Louis Jacob, Abdollah Jafarzadeh, Haitham Jahrami, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Reza Jalilzadeh Yengejeh, Roland Dominic G Jamora, Talha Jawaid, Sathish Kumar Jayapal, Zixiang Ji, Jost B Jonas, Nitin Joseph, Charity Ehimwenma Joshua, Zubair Kabir, Rizwan Kalani, Arun Kamireddy, Kehinde Kazeem Kanmodi, Neeti Kapoor, Faizan Zaffar Kashoo, Harkiran Kaur, Foad Kazemi, Himanshu Khajuria, Alireza Khalilian, Maseer Khan, Haitham Khatatbeh, Hamid Reza Khayat Kashani, Khalid A Kheirallah, Feriha Fatima Khidri, Moein Khormali, Atulya Aman Khosla, Jagdish Khubchandani, Yun Jin Kim, Yun Seo Kim, Ruth W Kimokoti, Hyun Yong Koh, Ali-Asghar Kolahi, Karel Kostev, Kewal Krishan, Vijay Krishnamoorthy, Jera Kruja, Mohammed Kuddus, Mukhtar Kulimbet, G Anil Kumar, Manasi Kumar, Satyajit Kundu, Ville Kytö, Chandrakant Lahariya, Dharmesh Kumar Lal, Judit Lám, Iván Landires, Francesco Lanfranchi, Nhi Huu Hanh Le, Seung Won Lee, Virendra S Ligade, Stephen S Lim, Christine Linehan, Xiaofeng Liu, Xuefeng Liu, José Francisco López-Gil, Giancarlo Lucchetti, Azeem Majeed, Kashish Malhotra, Ahmad Azam Malik, Vahid Mansouri, Hamid Reza Marateb, Miquel Martorell, Roy Rillera Marzo, Yasith Mathangasinghe, Rishi P Mediratta, Man Mohan Mehndiratta, Hadush Negash Meles, Endalkachew Belayneh Melese, George A Mensah, Atte Meretoja, Tomislav Mestrovic, Sachith Mettananda, Giuseppe Minervini, Reza Mirfakhraie, Moonis Mirza, Awoke Misganaw, Arup Kumar Misra, Abdalla Z Mohamed, Nouh Saad Mohamed, Abdollah Mohammadian-Hafshejani, Ibrahim Mohammadzadeh, Syam Mohan, Ali H Mokdad, Lorenzo Monasta, AmirAli Moodi Ghalibaf, Maryam Moradi, Rohith Motappa, Lorenzo Muccioli, Francesk Mulita, Yanjinlkham Munkhsaikhan, Efren Murillo-Zamora, Sathish Muthu, Amin Nabavi, Ganesh R Naik, Shumaila Nargus, Abdulqadir J Nashwan, Zuhair S Natto, Javaid Nauman, Muhammad Naveed, Biswa Prakash Nayak, Athare Nazri-Panjaki, Gaurav Nepal, Henok Biresaw Netsere, Hau Thi Hien Nguyen, Robina Khan Niazi, Ali Nikoobar, Majid Nozari, Chisom Adaobi Nri-Ezedi, Vincent Ebuka Nwatah, Ogochukwu Janet Nzoputam, Bogdan Oancea, Andrew T Olagunju, Oladotun Victor Olalusi, Ahmed Omar Bali, Michal Ordak, Verner N Orish, Esteban Ortiz-Prado, Nikita Otstavnov, Amel Ouyahia, Mayowa O Owolabi, Alicia Padron-Monedero, Jagadish Rao Padubidri, Sujogya Kumar Panda, Songhomitra Panda-Jonas, Deepshikha Pande Katare, Anamika Pandey, Leonidas D Panos, Ioannis Pantazopoulos, Paraskevi Papadopoulou, Utsav Parekh, Romil R Parikh, Nicholas Parsons, Roberto Passera, Shankargouda Patil, Shrikant Pawar, Hamidreza Pazoki Toroudi, Umberto Pensato, Prince Peprah, Mario FP Peres, Simone Perna, Hoang Nhat Pham, Zahra Zahid Piracha, Michael A Piradov, Dimitri Poddighe, Ramesh Poluru, Ahmad Pour-Rashidi, Jalandhar Pradhan, Manya Prasad, Dimas Ria Angga Pribadi, Jagadeesh Puvvula, Nameer Hashim Qasim, Venkatraman Radhakrishnan, Pankaja Raghav, Fakher Rahim, Mosiur Rahman, Amir Masoud Rahmani, Mohammad Rahmanian, Adarsh Raja, Ali Rajabpour Sanati, Pushp Lata Rajpoot, Mahmoud Mohammed Ramadan, Shakthi Kumaran Ramasamy, Nemanja Rancic, Sowmya J Rao, Mohammad-Mahdi Rashidi, Devarajan Rathish, Salman Rawaf, Murali Mohan Rama Krishna Reddy, Elrashdy M Moustafa Mohamed Redwan, Mohsen Rezaeian, Taeho Gregory Rhee, Muhammad Riaz, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Marina Romozzi, Moustaq Karim Khan Rony, Kevin T Root, Himanshu Sekhar Rout, Aly MA Saad, Cameron John Sabet, Basema Ahmad Saddik, Reihaneh Sadeghian, Mohammad Reza Saeb, Umar Saeed, Usman Saeed, Fatemeh Saheb Sharif-Askari, Narjes Saheb Sharif-Askari, Amirhossein Sahebkar, Zahra Saif, S Mohammad Sajadi, Afeez Abolarinwa Salami, Sohrab Salimi, Yoseph Leonardo Samodra, Abdallah M Samy, Gargi Sachin Sarode, Sachin C Sarode, Brijesh Sathian, Anudeep Sathyanarayan, Maheswar Satpathy, Monika Sawhney, Siddharthan Selvaraj, Mohammad H Semreen, Ashenafi Kibret Sendekie, Subramanian Senthilkumaran, Yashendra Sethi, Allen Seylani, Ataollah Shahbandi, Samiah Shahid, Masood Ali Shaikh, Summaiya Zareen Shaikh, Muhammad Aaqib Shamim, Mehran Shams-Beyranvand, Alfiya Shamsutdinova, Amin Sharifan, Javad Sharifi Rad, Anupam Sharma, Vishal Sharma, Maryam Shayan, Zubeda Begum Sheikh, Mahabalesh Shetty, Pavanchand H Shetty, Premalatha K Shetty, Aminu Shittu, Nathan A Shlobin, Seyed Afshin Shorofi, Sunil Shrestha, Emmanuel Edwar Siddig, Gagandeep Singh, Harmanjit Singh, Jasvinder A Singh, Paramdeep Singh, Puneetpal Singh, Surjit Singh, Shipra Solanki, Soroush Soraneh, Muhammad Haroon Stanikzai, Mark JM Sullman, Katharina S Sunnerhagen, Vinay Suresh, Chandan Kumar Swain, Lukasz Szarpak, Payam Tabaee Damavandi, Rafael Tabarés-Seisdedos, Celine Tabche, Jabeen Taiba, Manoj Tanwar, Minale Tareke, Mohamad-Hani Temsah, Reem Mohamad Hani Temsah, Masayuki Teramoto, Pugazhenthan Thangaraju, Sathish Thirunavukkarasu, Jansje Henny Vera Ticoalu, Tenaw Yimer Tiruye, Krishna Tiwari, Vikas Kumar Tiwari, Marcos Roberto Tovani-Palone, Thang Huu Tran, Nguyen Tran Minh Duc, Manjari Tripathi, Samuel TromansSamuel Tromans, Daniel Hsiang-Te Tsai, Aristidis Tsatsakis, Evangelia Eirini Tsermpini, Munkhtuya Tumurkhuu, Aniefiok John Udoakang, Saeed Ullah, Muhammad Umair, Bhaskaran Unnikrishnan, Daniele Urso, Jibrin Sammani Usman, Asokan Govindaraj Vaithinathan, Alireza Vakilian, Ravi Prasad Varma, Narayanaswamy Venketasubramanian, Jorge Hugo Villafañe, Manish Vinayak, Andres Fernando Vinueza Veloz, Mandaras Tariku Walde, Shu Wang, Yanzhong Wang, Abdul Waris, Nuwan Darshana Wickramasinghe, Andrea Sylvia Winkler, Subah Abderehim Yesuf, Arzu Yiğit, Vahit Yiğit, Mekdes Tigistu Yilma, Yazachew Engida Yismaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Milad Zandi, Aurora Zanghì, Mohammed GM Zeariya, Zhongyi Zhao, Claire Chenwen Zhong, Magdalena Zielińska, Osama A Zitoun, Sa'ed H Zyoud, Samer H ZyoudBackground: 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
