Systematic Review and Meta‐analysis of Incidence Studies of Epilepsy and Unprovoked Seizures

Abstract

Summary:Purpose: To evaluate the methodology of incidence studies of epilepsy and unprovoked seizures and to assess the value of their findings by summarizing their results.Methods: A Medline literature search from January 1966 to December 1999 was conducted. In each selected study, key methodologic items such as case definition and study design were evaluated. Furthermore, a quantitative meta-analysis of the incidence data was performed.Results: Forty incidence studies met the inclusion criteria. There was considerable heterogeneity in study methodology, and the methodologic quality score was generally low. The median incidence rate of epilepsy and unprovoked seizures was 47.4 and 56 per 100,000, respectively. The age-specific incidence of epilepsy was high in those aged 60 years or older, but was highest in childhood. Males had a slightly higher incidence of epilepsy (median, 50.7/100,000) than did females (median, 46.2/100,000), and partial seizures seemed to occur more often than generalized seizures. Developing countries had a higher incidence rate of epilepsy (median, 68.7/100,000) than did industrialized countries (median, 43.4/100,000). Similar results were found for unprovoked seizures. The incidence of epilepsy over time appears to decrease in children, whereas it increases in the elderly.Conclusions: The age-specific incidence of epilepsy showed a bimodal distribution with the highest peak in childhood. No definitive conclusions could be reached for the incidence of unprovoked seizures and other specific incidence rates of epilepsy. More incidence studies with an adequate study methodology are needed to explore geographic variations and time trends of the incidence of epilepsy and unprovoked seizures. Key Words: Incidence-Epilepsy-Unprovoked seizuresReview-Epidemiology.Incidence studies provide important information regarding the natural history of epilepsy and its risk factors. During the last three decades, several incidence studies of epilepsy have been performed. These studies indicate that the incidence of epilepsy varies considerably with age and that epilepsy is slightly more common in males. Moreover, recent studies suggest a secular trend in the age-specific incidence, with a decline in children and an increase in elderly people (1,2).However, the available data are difficult to interpret and compare because of methodologic differences (3,4). So far, only one systematic study on the epidemiology of epilepsy has been done (5). In this study (5), the results of incidence and prevalence studies of epilepsy have been described without conducting a meta-analysis of the incidence data. We performed a systematic review and a quantitative meta-analysis of incidence studies of epilepsy and unprovoked seizures (USs) to study the effect of methodologic quality on the incidence reported, on the magnitude of possible geographic differences in incidence, on the epidemiology of different types of seizures, and the possible changes of incidence over time. METHODS Study selectionWe identified previously publi...

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