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

Abstract

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.

Global macroeconomic burden of epilepsy and the role for neurosurgery: a modelling study based upon the 2016 Global Burden of Disease data

“…The greater VLW-to-GDP ratio observed among low-and middle-income countries is a function of the greater burden of epilepsy found in regions with lower economic productivity, which is multifactorial in aetiology. Firstly, most epidemiologic studies suggest that the prevalence of epilepsy is highest in resource poor settings, [2,17] and that focal onset epilepsy is disproportionately represented when compared with HICs. [28,29] This observation supports the suggestion that the greater morbidity and mortality burden of epilepsy in LICs and LMICs reflects increased exposure to potentially epileptogenic insults such as; birth trauma, central nervous system infections, head injury and micronutrient deficiencies.…”

“…[1] A recent estimate has suggested that this number is increasing by 4.6 million incident cases per year. [2] The vast majority of people with epilepsy reside in low-and middle-income countries, [1,3] where the associated morbidity and mortality are significantly greater. [1,4] Although most patients do not receive appropriate treatment, [5,6] 70% to 85% will achieve remission with appropriately selected antiepileptic medications alone.…”

Global neurosurgery: current and potential impact of neurosurgeons at the World Health Organization and the World Health Assembly. Executive summary of the World Federation of Neurosurgical Societies–World Health Organization Liaison Committee at the 71st World Health Assembly

“…6 They calculated an operative deficit of 5 million neurosurgical cases per annum, with traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy comprising the majority of the global neurosurgical disease burden. 4,5,[7][8][9][10]14,15,18 They further estimated that 23,300 additional neurosurgeons are needed to address the deficit, mostly in Africa and Southeast Asia.…”

Sodium valproate protects against neuronal ferroptosis in epilepsy via suppressing lysyl oxidase

“…Epilepsy is a chronic neurological disease characterized by spontaneous recurrent seizures [1] . It is considered to be the second most common disease after stroke [2] .…”