An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy

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OBJECTIVE

Epilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.

METHODS

The authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.

RESULTS

This systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.

CONCLUSIONS

Understanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.

ABBREVIATIONS AEDs = antiepileptic drugs; AFR = African Region; AMR-L = Region of the Americas (Latin America); AMR-US/Can = Region of the Americas (United States/Canada); DALYs = disability-adjusted life years; DRE = drug-resistant epilepsy; EMR = Eastern Mediterranean Region; EUR = European Region; HICs = high-income countries; ICD = International Classification of Diseases; ILAE = International League Against Epilepsy; LMICs = low- and middle-income countries; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SEAR = South-East Asian Region; STE = surgically treatable epilepsy; WPR = Western Pacific Region.

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Article Information

Correspondence Kerry A. Vaughan: Hospital of the University of Pennsylvania, Philadelphia, PA. kerry.vaughan@uphs.upenn.edu.

INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.3.JNS171722.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    PRISMA flowchart. Article selection for systematic review of the literature.

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    World map of the prevalence and incidence of active epilepsy by WHO region and the annual volume of new STE cases by WHO region. © OpenStreetMap contributors (http://www.openstreetmap.org/copyright). Published with permission. Figure is available in color online only.

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