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International Journal of Clinical and Experimental Neurology, 2014, Vol. 2, No.

2, 29-39
Available online at
© Science and Education Publishing

The Prevalence, Incidence and Etiology of Epilepsy

Shakirullah*, Niaz Ali, Aslam khan, Muhammad Nabi

Basic Medical Science, Khyber Medical University Peshawar Phase IV, Hayatabad, Peshawar, Pakistan
*Corresponding author:

Received December 14, 2014; Revised December 24, 2014; Accepted December 28, 2014
Abstract Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most
parts of the world. This disease is linked to different provocative causes and affects almost all generation, ethnicity
and age population. Therefore, the aim of this article is to systemically review the literature about the prevalence,
incidence and etiology of epilepsy to find possible approaches to control epilepsy. The worldwide prevalence of
epilepsy is variable and varied among countries. High prevalence is found in adolescent and early age group
population. In North America, Central and South America high prevalence is found in male except in New York,
Bolivia, Honduras and Argentina where prevalence is high in female. In Asian countries such as China, India,
Turkey and Saudi Arabia the prevalence is high in Male except in Pakistan here prevalence is high in female
similarly to European countries where also prevalence is high in female. The prevalence of epilepsy in male and
female is variable in African countries. Generalized seizure is high in America, Asia, Europe, and Africa than the
other types of epilepsies. Very limited data is available about the incidence of epilepsy especially from low and
lower middle income countries. The incidence rate of epilepsy is higher in the developing countries than the
industrialized countries. Similarly, the incidence is also higher in male than female. Head injury, birth trauma,
cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) and genetic factors
are the main causes of epilepsy.
Keywords: prevalence, incidence, epilepsy and causes of epilepsy
Cite This Article: Shakirullah, Niaz Ali, Aslam khan, and Muhammad Nabi, “The Prevalence, Incidence and
Etiology of Epilepsy.” International Journal of Clinical and Experimental Neurology, vol. 2, no. 2 (2014): 29-39.
doi: 10.12691/ijcen-2-2-3.

motor system, personal health and objectives are commonly

concern with epilepsy. While, the seizure is usually of
1. Significance Statement brief duration and may produce post seizure impairment.
Similarly, convulsion is violent attack manifested by
Epilepsy is a neuronal disease which affects almost all strong contraction of the involuntary muscles [2]. Literally
groups of the society. It is still is not properly out of “Epilepsy” is a Greek derived word “epilambanein”,
shadow and need more work at scientific background to meaning “to be seized” or "to be overwhelmed by
know about the exact prevalence, incidence and etiology surprise". The word Epilepsy is used both in verbal and in
of epilepsy. The prevalence and incidence of epilepsy is written context from more than 4000 years and many
varying among the countries with heterogeneous figures. misconceptions are found which are mainly linked to the
The overall prevalence of epilepsy is 10 per 1000 persons. culture of a particular era or part of the world. There are a
lot of arcane theories found about the causes and
manifestation of epilepsy in the world.
2. Introduction The forced cry, the loss of consciousness, the fall, the
twitching and the foaming at the mouth, is linked to
Epilepsy is a chronic neuronal disorder or group of “possession by the spirit”. People with epilepsy are being
disorders, which is characterized by the recurrent (two or looked upon as “being chosen” or as “being possessed”
more) epileptic seizures that usually recur unpredictably in depending on the belief of that moment or place. Some
the absence of provoking factors. An epileptic seizure is a people has believe that epilepsy is communicable disease
clinical presentation which is linked to an abnormal and and hesitate to help or touch that person who has fallen in
excessive discharge from a set of neurons in a specific a seizure, even when this happens in hazardous places,
locus of the brain. This clinical manifestation consists of like in the water or near an open fire. The stigma
sudden and transitory abnormal phenomena which may associated with epilepsy also has a great effect on the
include alterations in consciousness, motor, sensory, education of children and young people and mostly lead to
autonomic or psychic behaviors [1]. Epilepsy is different isolation from the society [3].
from seizure which is characterized by an excessive, It has been stated that the history of epilepsy spans over
abnormal discharge of neurotransmitters from cortical 4000 years of ignorance, superstition and stigmatization
neurons. Loss of consciousness, disturbance in sensory [4]. Epilepsy affects approximately 70 million people of
International Journal of Clinical and Experimental Neurology 30

all ages throughout the world. Epilepsy is responsible for “epidemiology of epilepsy”, “prevalence by gender, age,
1% contribution to the global burden of diseases while this race, ethnicity, and socioeconomic status” shown in Table 1.
contribution is 80% in the developing countries [5]. To In order to specify our search by adopting a particular
explore epilepsy as a Global Campaign against epilepsy method such as by writing “title: or Auth: and then
was launched in 1997 “to improve acceptability, treatment, followed by the key words in Google and in Google
services and prevention of epilepsy effectively throughout scholar. Similarly, in order to specify the search in
the world [6,7]. We categorically review the literature on PubMed database by writing the key words followed by [ti]
prevalence, incidence, and etiology of epilepsy by using or [Auth] respectively.
PubMed, Google, Google scholar, and respective journals
of epilepsy. The main purpose of this project to collect, 3.2. Articles ReviewCriteria and Analysis
compile and disseminate the relevant information about
the prevalence, incidence and etiology of epilepsy. A total of 1000 articles were reviewed from 1980 to
2014. Articles were assessed on the basis of authors name
and relevant topic. The results were evaluated on the basis
3. Methodology of prevalence, incidence, demography, classification, etiology
of epilepsy. A total of 135 articles were included for this
study because these articles contain relevant information.
3.1. Protocol of the Searching The excluded articles are either contain no relevant information
We searched the following tabulated databases, journals or may contain only abstract. The overall literature search
and sites by using the key word “prevalence of epilepsy”, process is pictured in the following Figure 1.
“Incidence of epilepsy”, “etiology of epilepsy”,

Table 1. Searching Engines, Databases and Journals

S.NO Searching Engine Databases Journals
1 Google
2 Google scholar
3 Epilepsia
4 The official journal of the American academy of Neurology
5 PubMed
6 PakmediNet
7 Journals of respective medical colleges and universities
8 J NeurolNeurosurg Psychiatry
9 Irnian journal of child neurology
10 Lancet Neurol
11 New journal of England
12 BMC
13 Elsevier
14 WHO bulletin about epilepsy

3.3. Statistics
The data is presented in the form of bar graphs, Percent
prevalence or prevalence per 1000 and incidence per

4. Results
4.1. Prevalence
Prevalence is the proportion of people with a disease in
the population in a period of time. The purpose of
prevalence study of a disease is very vital because it
enables us to find the number of people suffering from
that particular disease and helps us to make a plan to
prevent or treat this disease in time and also to reduce the
burden of this disease on the society. Prevalence is
expressed per 1000 people in the population.

4.2. Incidence
Incidence is the number of new cases in a population at
Figure 1. Literature Search Picture
a given time. Incidence is the number of new cases per
year divided by the average susceptible population under
31 International Journal of Clinical and Experimental Neurology

study during a specified time period and is expressed as observed in married population of Pakistan. Generalized
new cases per 100,000 persons per year. Incidence studies seizure is the most common type of seizure which is
provide a better understanding of the etiology and natural observed in 77% patients of Pakistan. The primary
history of epilepsy. Due to exertion and expenses the incidence generalized seizure is 59%, secondary generalized
studies are conducted less often than prevalence studies. seizures is 18%, partial seizures is 9%, myoclonic, tonic-
clonic seizures is 5.8% [12]. There are two peak age
4.3. Prevalence and Incidence of Epilepsy in groups which are commonly affected by epilepsy, one
Pakistan group is children and other group is adults younger than
30 years of age. In case of gender the prevalence in male
According to Mac et al the prevalence of epilepsy in is 9.2 while in female is 10.9 of Pakistan. The results are
Pakistan is 10 per 1000 which is become cleared from depicted in Figure 2, Figure 3 and Figure 4 [8,13]. There
several other studies as well [8,9,10,11]. According to are no comprehensive studies available in regard of
Aziz et al the ratio in term of percent the epilepsy in urban incidence of epilepsy in Pakistan.
area is 64.7% and in rural is 35.5% while 60% ratio is

Figure 2. Distribution of Epilepsy on the Basis of Location in Pakistan in Term of Percent

Figure 3. Distribution of Types of Epilepsies in Term of Percent in Pakistan

International Journal of Clinical and Experimental Neurology 32

Figure 4. Prevalence on the Basis of Gender in Pakistan

4.4. Prevalence and Incidence of Epilepsy in compared to the prevalence of epilepsy in Pakistan and
India some other countries however, the prevalence is slightly
high in Indian rural area as compared to Pakistani rural
A meta-analysis study reveal that the prevalence of areas [13-20].
epilepsy is 5 per 1000 in India which is quite low as

Figure 5. Prevalence of Epilepsy on the Basis of Location and Gender in India

The figures of other epidemiological studies in India on epilepsy available at PubMed, Embase, Chinese Biological
epilepsy are comparable to the developed countries, with a Medical Literature (CBM), Chinese National Knowledge
prevalence rate of 5 per 1000 and incidence rate of 50 per Infrastructure (CNKI), and Chinese Wanfang and
100,000 [15,16,20]. Heterogeneity is found across the Chongqing VIP databases. The ratio is 3.83% and 3.45%
studies from India however, the prevalence is 5.33 after in male and female respectively which is comparably low
correction. Similarly, the prevalence in urban/semi-urban as compared to the prevalence ratio between men and
area is 5.11 while, in rural area is 5.47 of India. The women of Pakistan and Indian epileptic patients. The ratio
prevalence of epilepsy in men is 5.88 (rural men, 5.39; of epilepsy is 2.34% and 3.17% in urban and rural areas of
urban men, 6.52) while, the prevalence in female is 5.51 China. There is no significant difference observed in the
(rural women, 4.83; urban women. 6.54) of India which is prevalence of epilepsy on the basis of location between
shown in Figure 5 [14,20]. china and Indian epileptic patients while, the foresaid
situation is different from Pakistani epileptic population
4.5. Prevalence and Incidence of Epilepsy in [13,20,22].
China Studies reports a high prevalence in male as compared
to female, in rural areas in contrast to urban areas and in
The overall prevalence in china is 3.6 per 1000 [21] peak age group is ranged from 10-20 years. The prevalence
according to epidemiological studies on the prevalence of
33 International Journal of Clinical and Experimental Neurology

studies conducted shows a high proportion of patients common in age group of 16-31 years. The prevalence of
have a generalized seizure as compared to other types of epilepsy is slightly high in Bangladesh as compared to
epilepsies in China. The epilepsy incidence rates reported other countries [24,25]. The results of a prospective study
from China is low which is ranging from 28.8 per 100 000 which was conducted in Bangabandhu Sheikh Mujib
per year to 35.0 per 100 000 per year [23]. Medical University from January 2008 to June 2010 are
summarized in Figure 6 and Figure 7. There are
4.6. Prevalence and Incidence of Epilepsy in comparable results in regard to types of epilepsies, age
Bangladesh groups and gender mean that prevalence of generalized
tonic clonic is high, age group is ranging from 10-30 years
Although there are no national statistics available about and males are more affected than females [26]. However,
the prevalence of epilepsy, but it is estimated that there are there are no articles available about the incidence of
at least 1.5–2.0 million people suffering from epilepsy in epilepsy in Bangladesh.
Bangladesh, i.e. about 10-12 per 1000 people and mostly

Figure 6. Epilepsy on the Basis of Age in Bangladesh in Percent

Figure 7. Types of Epilepsy in Bangladesh in Percent

The prevalence of epilepsy in Iran is 7.87/1000

4.7. Prevalence and Incidence of Epilepsy in individuals which is lower than the prevalence of epilepsy
Iran in Pakistan but on contrary to India the prevalence is high.
International Journal of Clinical and Experimental Neurology 34

There is no marked difference in the ratio of epilepsy on The generalized epilepsy had a higher frequency than the
the basis of gender in Iran however; this picture is other types of epilepsies [27]. The data are summarized
different from the study report from Pakistan and India. about the types of epilepsy from cohort study in Figure 8.

Figure 8. Depicts the Percent Distribution of Types of Epilepsy in Iranian Population

Other important aspects of the studies are that the The age adjusted prevalence is 5.0 in North America,
common cause of epilepsy is perinatal problems such as 7.1 in Mississippi of North America [31,32,33]. In Central
asphyxia, sepsis and neonatal hypoglycemia. A positive and South America the age adjusted prevalence is ranging
association of epilepsy with family history is observed. from 3.7 per 1000 in Argentina[34] to 22.2 per 1000 in
The prevalence of epilepsy in regard of age and sex in Ecuador [35]. There is lowest age adjusted prevalence in
southern Iran is not too much different from rest of the South America which is 3.7 [34]. The prevalence is high
world [28]. There is no study available to figure out the in lower-income families, older, and male children
incidence of epilepsy in Iran. [36].The point prevalence of epilepsy in Canada is
5.2/1000 according to data from two national health
4.9. Prevalence and Incidence in Egypt surveys [37,38]. The age adjusted incidence rate is ranged
from 16 to 51 per 100,000 people in North America [39].
A community based study was conducted by Eman M
in Egypt. According to this study the crude lifetime
prevalence rate (CPR) of epilepsy is 12.67/1000 while, the
4.12. Prevalence and Incidence of Epilepsy in
prevalence rate is 9.3/1000 and the incidence rate is Europe
1.5/1000. Generalized seizures is more common (CPR The prevalence rate is 6.2 per 1000 population
6.75/1000) than partial seizures (CPR 2.5/1000) in this according to Lorna Booth and Gavin Thompson study on
study. The prevalence of partial seizures leading to epilepsy statistics in 2010 but this rate was 7.1 in 1994
secondary generalize seizure is 0.84/1000 while simple and 7.6 in 1999 [40,41,42]. There is approximately 60%
partial and complex partial seizures had CPR of 1.4/1000 of patients have tonic clonic seizures, 20% complex
and 0.34/1000 respectively. Epilepsy is slightly high in partial, 12% mixed tonic clonic and partial seizure, 3%
male than female with no prominent difference (CPR of simple partial and less than 5% absence seizures,
14.4 and 10.9 per 1000). The CPR is higher in rural, myoclonic seizures and other types of seizures. The
illiterate group than urban and literate populations (17.7/1000, overall prevalence of epilepsy in United Kingdom is 9.7
9.56/1000 and 12.02/1000, 9.94/1000, respectively). The per 1,000 [40,43,44,45,46,47]. The incidence rate of
highest prevalence rate is recorded in the early and late epilepsy in England is 47 per 100,000 [48].
childhood group (69.78/100,000 and 43.78/100,000) [29]. An epidemiological study of active epilepsy in people
The determination of incidence rate is still to be studied in over 14 years of age is being performed in other eight
Egypt. European states. The prevalence is relatively consistent
within the Europe 2.2-3.4 per 1000). The crude prevalence
4.10. Prevalence and Incidence in Middle rate is 7.0 per 1000 (8.8 in rural and 4.5 in 1000 in urban
East Region of Arab Countries areas) in Europe, with a mean age at onset of 12.9 years
[3]. The prevalence is 10 per 1000 according to data of
The prevalence is 6.5/1,000 in Saudi Arabia and high in Irish self-report which was collected through the Central
male population as compare to female which is confirmed Statistics Office (CSO) through their Quarterly National
by three different studies. The prevalence is probably 2 Household Survey (QNHS).The overall prevalence rate of
times higher in children, in young adults compared to treated epilepsy is ranged from 8.3 per 1,000 people in
other groups and with a lower rate in middle-age people 2002 to 9.0 per 1,000 in 2005. The prevalence among
[30]. The incidence study about the epilepsy is not females ranged from 7.7 to 8.6 per 1,000 in 2002 to 2005,
available up to now. while the rates for males is ranged from 8.9 to 9.5 per
1,000 in the same period (2002-2005) [49]. The crude
4.11. Prevalence and Incidence in America
35 International Journal of Clinical and Experimental Neurology

prevalence rate of epilepsy increased from the western to ways pattern is also present in both men and women
the eastern regions of Russian Federation in those times population. There are only two studies conducted about
which are 2.2 in Moscow to 4.2 per 1000 in Irkutsk. Late- the incidence of epilepsy in Africa. In Tanzania the crude
onset epilepsy is more common in the European region incidence is 73 per 100,000 and age-adjusted incidence is
than in the Asian region of Russia [50]. Age adjusted 51 per 100,000 [55]. In Ethiopia the crude incidence of
incidence of epilepsy in European studies ranged from 26 epilepsy is 64 per 100,000 while age-adjusted incidence of
per 100,000 person years in Norway (110) to 47 per epilepsy is 43 per 100,000 [39].
100,000 person years in England [51].
4.14. Prevalence and Incidence in Australia
4.13. Prevalence and Incidence in African There is no such study available to know about the
Countries prevalence of epilepsy but a cross sectional survey in
Data collection is one of a big health problem to address Tasmania and a study conducted 30 years ago suggests
a disease in African countries [52]. The prevalence was that it is prevalent in between 6 and 7.5 per 1000 people.
evaluated through a questionnaire by University of Maree et al suggest that over 8,800 Australians develop
Limoges, in tropical countries [53]. The prevalence is the epilepsy every year [56,57].
varying in range of 2.2 to 58 per 1000 in the African
region is ranging from 2.2 to 58 per 1000 with an average 4.15. Overall Prevalence of Epilepsy
prevalence of 15.83 [52,54]. Low prevalence rate is The worldwide prevalence of epilepsy is inconsistent
observed in Sudan which is 0.9 per 1,000[30].The and diversified among countries but, it is estimated that
prevalence of active epilepsy is at peak in two age groups the overall prevalence is 10/1,000 people [58]. The
which are 20 to 29 (11.5 per 1000) and 40 to 49 (8.2 per prevalence of epilepsy of some countries is summarized in
1000). The lowest prevalence is 3.1 per 1000 is observed Figure 9.
in age group of 60 or more than 60 and the above two



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Countries Specific Prevalence

Figure 9. Prevalence of Epilepsy in Different Countries of the World

In Europe, age-adjusted prevalence is low, 2.7 per 1000 in the Nakhchivan area, Azerbaijan is 5.9 per 1000
to 3.3 per 1000, respectively [59,60] while there is a population (S. Magalov, personal communication, 2004).
prevalence of 7.0/1000 in European region of Turkey [61]. The crude and age-adjusted prevalence rate of active
The majority of studies in regard to epilepsy are epilepsy in an adult population in Estonia is 5.3 per 1000
conducted in Asia which is a significant health problem in [65].
Asia. The age-adjusted prevalence of epilepsy is 10.2 per
1000 in Asian Turkey [62] which is higher than in 4.16. Age Specific Prevalence
European Turkey [13]. The difference may be due to some
biological variability between the Asia and the West Generally it is found from most of the studies that there
population, and the smaller physique among Asians [63]. is increased prevalence in adolescent and early childhood
Mac et al systematically review the literature on age [65,66,67,68]. The prevalence is constant in adult age
epidemiology, etiology, and management of epilepsy in 23 but increases after the age of 50 in developed countries
Asian countries while prevalence data are available for [67,69]. The prevalence of epilepsy remains stable in third
only 11 countries [11]. and fourth decades but then drops after the fifth decade of
In 1997, Jallon reviewed studies from Asia, mostly life in developing countries [65,66,67,68]. The epilepsy in
done in the 1980s, and showed a prevalence varying from adolescent and childhood are commonly idiopathic
1·5 per 1000 in Japan to 9·99 per 1000 in Pakistan [12,64]. (primary) in nature while, in the rest of the groups are
Data on prevalence of epilepsy are available from commonly secondary epilepsy.
Azerbaijan, Estonia, Lithuania and the Russian Federation,
but the differences in methodology and study populations 4.17. Prevalence by Gender
make the comparisons quite difficult. The prevalence rate
International Journal of Clinical and Experimental Neurology 36

The prevalence is higher in male than female in North, data available about the incidence of epilepsy [3]. A meta-
Central and South America except in New York, Bolivia, analysis of incidence studies reports that developing
Honduras and Argentina where the female ratio is high. countries have a higher incidence rate of epilepsy as
The Placencia et al., 1992 study shows a high prevalence compared to developed countries which are figured in
in male but after Basch et al., 1997 study then this ratio median as 68.7/100,00 and 43.4/100,000 [86]. Age-
become change and the prevalence become high in female adjusted incidence of epilepsy is ranging from 16 per
[35,66,70,71,72,73]. In Europe the prevalence is high in 100,000 people per years to 51 per 100,000 person-years
female in Italy but according to Rocca et al in 2001 the in North America [87,88]. There is a diversified figure
male ratio become high while in Turkey the prevalence is about the incidence of epilepsy in Europe. Age adjusted
high in male [34,59,60]. In Asian countries such as China, incidence of epilepsy is 26 per 100,000 person years in
India, Turkey and Saudi Arabia the prevalence is high in Norway while 47 per 100,000 person years in England of
Male while according to Aziz et al the prevalence is high Europe [89]. One age adjusted incidence study is available
in female in Pakistan [13,15,20,51,61,74,75]. The from Asia which is conducted in India and age adjusted
prevalence of epilepsy in male and female in the countries incidence is 35 per 100,000 people in year [90]. In
of sub-continent of Africa is variable. In Nigeria and in Tanzania, crude incidence is 73 per 100,000 and age-
Uganda the prevalence is high in female [76,77,78,79]. On adjusted incidence is 51 per 100,000 of Africa [55]. In
contrary the prevalence in male is high as compared to Ethiopia, crude incidence of epilepsy is 64 per 100,000
female in Ethiopia, Tunisia, Kenya and Zambia [39,69,80,81]. while age-adjusted incidence of epilepsy is 43 per 100,000
According to Rwiza et al in 1995 in Tanzania the [39]. Statistic about the incidence of epilepsy in China and
prevalence is high in female while according to Dent et al India are similar to those in the America and Europe but
in 2005 the prevalence become high in male as compared lower than those from Africa and Latin America [11]. The
to female [55,82]. However, absolute difference in gender- whole picture about the incidence of epilepsy in
specific prevalence is minimal. The most extreme example developing countries is different from those in developed
of a male excess is reported in a study conducted in India, countries. However, overall age- adjusted incidence of
in which prevalence of males (5.1 per 1000) is epilepsy is 24 to 53 per 100,000 [11]. The difference in
significantly higher than females (2.2 per 100) [83]. The incidence may be attributed to economic status of the
biological differences, climatic differences is a partly countries because this is an expensive study to carry out.
reason for the higher prevalence. Psychosocial, cultural, The second main cause of difference is cousin marriages
economic, political and organizational factors are also which are common in certain societies and particular in
important in manipulating epilepsy causation, management India and Muslim population. The treatment gap is also
and outcome in the region [63]. In some population, the the main cause of difference in incidence in epilepsy. The
symptoms and diagnosis of epilepsy in women is treatment gap is defined as the proportion of people with
concealed from public because the exposure of epilepsy active epilepsy who is not appropriately treated at a given
may become a hurdle in their marriage. To explore the point of time.
exact cause of difference in epilepsy between genders an
extensive further scientific study is needed. 4.21. Age Specific Incidence
The incidence of epilepsy is high in first year of life,
4.18. Prevalence by Race and Ethnicity early childhood and after adolescent in developed countries
Few studies are available about the prevalence of [19,48,91,92] while, in developing countries the incidence
epilepsy on the basis of race and ethnicity. Haerer et al is higher in only childhood group [39,55,66,88,93,94]. We
assessed the prevalence of epilepsy on the basis of race presume that genetic (Family history), environmental
and ethnicity and found age adjusted prevalence is high in factors (Aspasia, infections during and after birth), and
African-Americans (8.2 per 1000) as compared to health system (ignorance and no proper care system)
Caucasians (5.4 per 1000) [31]. Wright et al examined mainly affect the incidence of epilepsy because early
racial differences between South Asians and non-South children and adolescent age group is more prone to these
Asians, and found prevalence of active epilepsy to be factors.
lower in South Asians in comparison to Non South Asians
[84]. The difference may be due to some endemic 4.22. Incidence by Gender
problems such as neurocysticercosis or malaria, the status
of medical infrastructure, Preventive Health related Many studies report a higher incidence in males than
programs or availability of local health care system[85]. female in both developed and developing countries [58].
The difference in incidence may be due some sex
hormones which has some association with epilepsy. It is
4.19. Prevalence of the Basis of Seizure Types proved scientifically that two female sex hormones
Seizure types are dependent on accurate of history, (estrogen and progestogens) affect the threshold of seizure
availability and sophistication of diagnostic tests used, and to some extent which is lead to differences in gender
age at which the patient. However, prevalence of [3,66].
generalized seizure is high in America, Asia, Europe, and
Africa as compared to other types of seizures [58]. 4.23. Incidence by Race and Ethnicity
No statistically significant differences in incidence are
4.20. Incidence of Epilepsy found among non-Hispanic whites, African-Americans,
Incidence studies provide a better understanding of the Hispanics, and Asians [86].
etiology and natural history of epilepsy. There is a limited
37 International Journal of Clinical and Experimental Neurology

4.24. Incidence by Seizure Type proper history, advanced technology and neurologist but,
still misclassification might be expected. We need further
Eight incidence studies are available to give study to know accurately about the prevalence and
information on seizure types. The incident studies incidence of epilepsy and the study must be include
performed in developing countries, particularly in Africa, people from different ages, races, socioeconomic
reported a greater proportion of individuals to have background to explore the role factors clearly a such age,
epilepsy characterized by generalized onset seizures than gender, race and socioeconomic status on epilepsy. It is
epilepsy characterized by partial seizures [3,85]. important to conduct prevalence study in those region
from which still no data available about the prevalence of
4.25. Etiology of Epilepsy epilepsy. To know about the etiology of epilepsy it is
From the available literature, causes seem to be important to carry out more detailed studies about the
dominated are head injury, birth trauma, asphyxia, incidence of epilepsy. The proper consideration of culture
cerebrovascular disease, and intracranial infections of society, health care policies and access to health care
(neurocysticercosis or meningoencephalitis) [64]. Genetic system is important to interpret the findings from all
factors have a strong association with idiosyncratic studies.
epilepsy [94].

4.26. Head Injury Acknowledgement

Head injury is the main cause of epilepsy and account I am very thankful to my supervisor Dr.Niaz Ali for
for 5% epilepsy and 20% of symptomatic epilepsy [95]. their kind supervision during my writing. I am also
thankful to Dr.Esther van de Vosse and Dr.Aslam khan for
4.27. CNS Infections major review before the submission of this article. I would
like to pay thanks to Muhammad Nabi my Laboratory
The Commission on Tropical Disease of the fellow.
International League Against Epilepsy listed several
diseases as causes of epilepsy, including malaria,
tuberculosis, schistosomiasis, acquired immunodeficiency References
syndrome, and cysticercosis [74,96]. An association
between neurocysticercosis and epilepsy is found in [1] Eucare., European white paper on epilepsy-call to action.
various studies in Africa and Latin America the results on Epilepsia, 2003. 44(6): p. 4-8.
the relation between neurocysticercosis and epilepsy in [2] Leon Shargel, et al., Comprehensive pharmacy Review for
Asia is varied significantly [97]. Neurocysticercosis is NAPLEX 8th Edition. Wolters Kluwer/ Lippincott Williams &
Wilikin, 2000: p. pp743.
probably an important cause of seizures and epilepsy in [3] Saraceno., B., EPILEPSY IN THE WHO EUROPEAN REGION.
regions with a high prevalence of Taeniasolium infection 2005.
in human beings [98,99,100]. [4] R., K., Bringing epilepsy out of the shadows. BMJ, 1997. 315: p.
[5] Giuliano Avanzini and L. Prilipko., Epilepsy Care in the World
4.28. Genetic Factors WHO 2005. Epilepsy Atlas, 2005.
Some studies show that there is no association of [6] Ngugi AK, et al., Estimation of the burden of active and
genetic factors with epilepsy [101-106]. However, family life‐time epilepsy: A meta‐analytic approach. Epilepsia., 2010.
51(5): p. 883-890.
history and largely genetic factors is linked to epilepsy in [7] Organization., W.H., Epilepsy: aetiology, epidemiology and
many studies [107,108]. The most common human genetic prognosis. WHO Fact Sheet., 2009. No. 999.
epilepsies display a complex pattern of inheritance and the [8] Khatri I, et al., Epidemiology of epilepsy in Pakistan: review of
associations with genes are largely unknown. Pathogenic literature. Epidemiology., 2003.
alterations or mutation in genes and structural [9] Khan N, et al., Audit of 100 cases of epilepsy in a tertiary care
hospital. Gomal Journal of Medical Sciences., 2010. 9(1).
abnormalities in chromosomes (deletions, insertions) are
[10] Malik MA, et al., Childhood epilepsy. Journal of College
responsible for a variety of epilepsies [95]. Physicians Surgeon Pakistan., 2011. 21(2): p. 74-8.
[11] Mac TL, et al., Epidemiology, aetiology, and clinical management
of epilepsy in Asia: a systematic review. The Lancet Neurology.,
5. Conclusion 2007. 6(6): p. 533-43.
[12] Aziz H, Akhtar SW, and H. KZ., Epilepsy in Pakistan: Stigma and
Psychosocial Problems. A Population‐Based Epidemiologic
It is clear from the study that overall prevalence of
Study. Epilepsia., 1997. 38(10): p. 1069-73.
epilepsy in the world is about 10 per 1000 people. There [13] Aziz H, et al., Comparative Epidemiology of Epilepsy in Pakistan
are differences in prevalence by gender which is slightly and Turkey: Population‐Based Studies Using Identical Protocols.
high in male than female although, the differences is non- Epilepsia., 1997. 38(6): p. 716-22.
significant and generalized type of epilepsy is the common [14] Sridharan, R. and B. Murthy, Prevalence and pattern of epilepsy in
one among the other types of epilepsies. However, the India. Epilepsia, 1999. 40(5): p. 631-636.
[15] Radhakrishnan, K., et al., Prevalence, knowledge, attitude, and
number of affected patients in the world is still large and practice of epilepsy in Kerala, South India. Epilepsia, 2000. 41(8):
much remains poorly documented. There is still a limited p. 1027-1035.
data available about the prevalence of epilepsy to find [16] Khadilkar, S., Neurology: the scenario in India. J Assoc
exact figure. There is lack of consistency in incidence Physicians India, 2012. 60: p. 42-4.
studies although, statistically non-significantly higher [17] Das, K., et al., Evaluation of socio-economic factors causing
discontinuation of epilepsy treatment resulting in seizure
incidence is observed for males as compared to females. recurrence: a study in an urban epilepsy clinic in India. Seizure,
Classification of seizure types is largely dependent on the 2007. 16(7): p. 601-607.
International Journal of Clinical and Experimental Neurology 38

[18] Leonardi, M. and T.B. Ustun, The global burden of epilepsy. [43] 43. Blume, W.T., et al., Glossary of descriptive terminology for
Epilepsia, 2002. 43(s6): p. 21-25. ictal semiology: report of the ILAE task force on classification and
[19] Mani, K., et al., The Yelandur study: a community-based approach terminology. Epilepsia, 2001. 42(9): p. 1212-1218.
to epilepsy in rural South India—epidemiological aspects. Seizure, [44] Brown, S., et al., Epilepsy needs revisited: a revised epilepsy
1998. 7(4): p. 281-288. needs document for the UK. Seizure, 1998. 7(6): p. 435-446.
[20] PS, R., et al., Quality of life among people with epilepsy: A cross- [45] Shorvon, S.D., Handbook of epilepsy treatment. 2005: John Wiley
sectional study from rural southern India. Natl Med J India, 2012. & Sons.
25: p. 261-4. [46] Sander, J.W., The use of antiepileptic drugs—principles and
[21] Huang, M., et al., [The prevalence of epilepsy in rural Jinshan in practice. Epilepsia, 2004. 45(s6): p. 28-34.
Shanghai]. Zhonghua liu xing bing xue za zhi= Zhonghua [47] WHO, Fact sheet 999, epilepsy.
liuxingbingxue zazhi, 2002. 23(5): p. 345-346. [48] Forsgren, L., et al., Incidence and Clinical Characterization of
[22] Gu, L., et al., Prevalence of epilepsy in the People's Republic of Unprovoked Seizures in Adults: A Prospective Population‐Based
China: A systematic review. Epilepsy research, 2013. 105(1): p. Study. Epilepsia, 1996. 37(3): p. 224-229.
195-205. [49] Linehan, C., The Prevalence of Epilepsy in Ireland: Brainwave
[23] Wang, W., et al., [Epidemiological survey on epilepsy among The Irish Epilepsy Association Summary Report 2009. 2012.
rural populations in five provinces in China]. Zhonghua yi xue za [50] Gekht, A., et al., An epidemiological study of epilepsy in Moscow.
zhi, 2002. 82(7): p. 449-452. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova/Ministerstvo
[24] de Boer, H.M., et al., ILAE/IBE/WHO Global Campaign Against zdravookhraneniia i meditsinskoĭ promyshlennosti Rossiĭskoĭ
Epilepsy: a partnership that works. Current opinion in neurology, Federatsii, Vserossiĭskoe obshchestvo nevrologov [i]
2013. 26(2): p. 219-225. Vserossiĭskoe obshchestvo psikhiatrov, 1999. 99(10): p. 51.
[25] Mannan, M., Epilepsy in Bangladesh. Neurol Asia, 2004. 9(1): p. [51] MacDonald, B., et al., The incidence and lifetime prevalence of
18. neurological disorders in a prospective community-based study in
[26] abu nasar rizvi, et al., Epileptic Patients Attending in a Tertiary the UK. Brain, 2000. 123(4): p. 665-676.
Care Hospital:A 4 (four) Years Study. Bangladesh Journal of [52] M. Belhocine, H.M. de Boer, and C. Mandlhate., The global
Neuroscience 2011. 27(1): p. 18-21. campaign against epilepsy: out of the shadows. WHO, 2004.
[27] Ebrahimi, H., M. Shafa, and S. Hakimzadeh Asl, Prevalence of [53] Diagana, M., et al., Dépistage de l’épilepsie en zones tropicales:
active epilepsy in Kerman, Iran: a house based survey. Acta validation d’un questionnaire en Mauritanie. Bull Soc Pathol Exot,
Neurol Taiwan, 2012. 21(3): p. 115-24. 2000. 93: p. 276-8.
[28] Inaloo, S. and P. Katibeh, An epidemiologic study of 389 children [54] M., D.-C., Epilepsie en Afrique subsaharienne. Thèse,
with epilepsy in southern Iran. IJCN, 2011. 5(4): p. 15-20. Universitéde Limoges, France, 2002.
[29] Khedr, E.M., et al., A community based epidemiological study of [55] Rwiza, H., et al., Prevalence and Incidence of Epilepsy in Ulanga,
epilepsy in Assiut Governorate/Egypt. Epilepsy research, 2013. a Rural Tanzanian District: A Community‐Based Study.
103(2): p. 294-302. Epilepsia, 1992. 33(6): p. 1051-1056.
[30] Benamer, H.T. and D.G. Grosset, A systematic review of the [56] Hackett, M.L., et al., Sydney epilepsy incidence study to measure
epidemiology of epilepsy in Arab countries. Epilepsia, 2009. illness consequences: the SESIMIC observational epilepsy study
50(10): p. 2301-2304. protocol. BMC neurology, 2011. 11(1): p. 3.
[31] Theodore, W.H., et al., Epilepsy in North America: a report [57] D’Souza, W.J., et al., The Tasmanian Epilepsy Register–a
prepared under the auspices of the global campaign against community-based cohort. Neuroepidemiology, 2008. 29(3-4): p.
epilepsy, the International Bureau for Epilepsy, the International 255-263.
League Against Epilepsy, and the World Health Organization.
[58] Noronha, A.L., et al., Prevalence and pattern of epilepsy treatment
Epilepsia, 2006. 47(10): p. 1700-1722.
in different socioeconomic classes in Brazil. Epilepsia, 2007.
[32] Kelvin, E.A., et al., Prevalence of self-reported epilepsy in a 48(5): p. 880-885.
multiracial and multiethnic community in New York City.
[59] Reggio, A., et al., Prevalence of epilepsy. A door-to-door survey
Epilepsy research, 2007. 77(2): p. 141-150.
in the Sicilian community of Riposto. The Italian Journal of
[33] Haerer, A.F., D.W. Anderson, and B.S. Schoenberg, Prevalence Neurological Sciences, 1996. 17(2): p. 147-151.
and clinical features of epilepsy in a biracial United States
[60] Rocca, W., et al., Door-to-door prevalence survey of epilepsy in
population. Epilepsia, 1986. 27(1): p. 66-75.
three Sicilian municipalities. Neuroepidemiology, 2001. 20(4): p.
[34] Melcon, M.O., S. Kochen, and R.H. Vergara, Prevalence and 237-241.
clinical features of epilepsy in Argentina. Neuroepidemiology,
[61] Onal, A.E., et al., Epilepsy prevalence in a rural area in Istanbul.
2006. 28(1): p. 8-15.
Seizure, 2002. 11(6): p. 397-401.
[35] Cruz, M.E., et al., Pilot study to detect neurologic disease in
[62] Karaaĝaç, N., et al., Prevalence of epilepsy in Silivri, a rural area
Ecuador among a population with a high prevalence of endemic
of Turkey. Epilepsia, 1999. 40(5): p. 637-642.
goiter. Neuroepidemiology, 1985. 4(2): p. 108-116.
[63] Chong-Tin, T., Differences in epilepsy and seizures between Asia
[36] Russ, S.A., K. Larson, and N. Halfon, A national profile of
and the West. Neurology Asia, 2007. 12: p. 59-60.
childhood epilepsy and seizure disorder. Pediatrics, 2012. 129(2):
p. 256-264. [64] Jallon, P., Epilepsy in developing countries. Epilepsia, 1997.
38(10): p. 1143-1151.
[37] Frieden, T.R., Epilepsy in adults and access to care--United States,
2010. Center for disease control and prevention MMWR. [65] Õun, A., S. Haldre, and M. Mägi, Prevalence of adult epilepsy in
Estonia. Epilepsy research, 2003. 52(3): p. 233-242.
Morbidity and mortality weekly report, 2012. 61(45): p. 909.
[38] Tellez-Zenteno, J.F., et al., National and Regional Prevalence of
[66] Lavados, J., et al., A descriptive study of epilepsy in the district of
El Salvador, Chile, 1984–1988. Acta neurologica scandinavica,
Self‐reported Epilepsy in Canada. Epilepsia, 2004. 45(12): p.
1992. 85(4): p. 249-256.
[67] Basch, E., et al., Prevalence of epilepsy in a migrant population
[39] Tekle-Haimanot, R., et al., Clinical and electroencephalographic near Quito, Ecuador. Neuroepidemiology, 1997. 16(2): p. 94-98.
characteristics of epilepsy in rural Ethiopia: a community-based
study. Epilepsy research, 1990. 7(3): p. 230-239.
[68] Olafsson, E. and W.A. Hauser, Prevalence of Epilepsy in Rural
Iceland: A Population‐Based Study. Epilepsia, 1999. 40(11): p.
[40] Purcell, B., et al., Epilepsy prevalence and prescribing patterns in
England and Wales. Health Statistics Quarterly, 2002.
15(Autumn): p. 23-30. [69] Birbeck, G.L. and E. Kalichi, Epilepsy prevalence in rural Zambia:
a door-to-door survey. Tropical Medicine & International Health,
[41] Forsgren, L., et al., The epidemiology of epilepsy in Europe–a
systematic review. European Journal of Neurology, 2005. 12(4): p. 2004. 9(1): p. 92-95.
245-253. [70] Forsgren, L., Prevalence of epilepsy in adults in northern Sweden.
Epilepsia, 1992. 33(3): p. 450-458.
[42] Berg, A.T., et al., Revised terminology and concepts for
organization of seizures and epilepsies: report of the ILAE [71] Placencia, M., et al., Epileptic seizures in an Andean region of
Commission on Classification and Terminology, 2005–2009. Ecuador: incidence and prevalence and regional variation. Brain,
Epilepsia, 2010. 51(4): p. 676-685. 1992. 115(3): p. 771-782.
[72] Nicoletti, A., et al., Prevalence of epilepsy in rural Bolivia A door-
to-door survey. Neurology, 1999. 53(9): p. 2064-2064.
39 International Journal of Clinical and Experimental Neurology

[73] Medina, M.T., et al., Prevalence, incidence, and etiology of [90] Graaf, A.d., Epidemiological aspects of epilepsy in northern
epilepsies in rural Honduras: the Salama Study. Epilepsia, 2005. Norway. Epilepsia, 1974. 15(3): p. 291-299.
46(1): p. 124-131. [91] Stephen, L.J. and M.J. Brodie, Epilepsy in elderly people. The
[74] Li, S.c., et al., Epidemiology of epilepsy in urban areas of the Lancet, 2000. 355(9213): p. 1441-1446.
People's Republic of China. Epilepsia, 1985. 26(5): p. 391-394. [92] Granieri, E., et al., A descriptive study of epilepsy in the district of
[75] Koul, R., S. Razdan, and A. Motta, Prevalence and pattern of Copparo, Italy, 1964–1978. Epilepsia, 1983. 24(4): p. 502-514.
epilepsy (Lath/Mirgi/Laran) in rural Kashmir, India. Epilepsia, [93] Olafsson, E., et al., Incidence of unprovoked seizures and epilepsy
1988. 29(2): p. 116-122. in Iceland and assessment of the epilepsy syndrome classification:
[76] Al Rajeh, S., et al., The prevalence of epilepsy and other seizure a prospective study. The Lancet Neurology, 2005. 4(10): p. 627-
disorders in an Arab population: a community-based study. 634.
Seizure, 2001. 10(6): p. 410-414. [94] Klein, P., L.M. van Passel-Clark, and J.C. Pezzullo, Onset of
[77] Osuntokun, B.O., et al., Research protocol for measuring the epilepsy at the time of menarche. Neurology, 2003. 60(3): p. 495-
prevalence of neurologic disorders in developing countries. 497.
Neuroepidemiology, 1982. 1(3): p. 143-153. [95] Kaneko, S., et al., Genetics of epilepsy: current status and
[78] Osuntokun, B., et al., Prevalence of the Epilepsies in Nigerian perspectives. Neuroscience research, 2002. 44(1): p. 11-30.
Africans: A Community‐Based Study. Epilepsia, 1987. 28(3): p. [96] Epilepsy, C.o.T.D.o.t.I.L.A., Relationship between epilepsy and
272-279. tropical diseases. Epilepsia, 1994. 35: p. 89–93.
[79] Longe, A. and B. Osuntokun, Prevalence of neurological disorders [97] Garcia, H.H. and O.H. Del Brutto, Neurocysticercosis: updated
in Udo, a rural community in southern Nigeria. Tropical and concepts about an old disease. The Lancet Neurology, 2005. 4(10):
geographical medicine, 1989. 41(1): p. 36-40. p. 653-661.
[80] Kaiser, C., et al., Rating D, Leichsenring M, 1996. The prevalence [98] Murthy, J., et al., Acute symptomatic seizures associated with
of epilepsy follows the distribution of onchocerciasis in a west neurocysticercosis: A community-based prevalence study and
Ugandan focus. Bull World Health Organ. 74: p. 361-367. comprehensive rural epilepsy study in South India. Neurol Asia,
[81] Attia-Romdhane, N., A. Mrabet, and M.B. Hamida, Prevalence of 2004. 9(Suppl 1): p. 86.
epilepsy in Kelibia, Tunisia. Epilepsia, 1993. 34(6): p. 1028-1032. [99] Tran, D.-S., et al., Prevalence of epilepsy in a rural district of
[82] Snow, R., et al., The prevalence of epilepsy among a rural Kenyan central Lao PDR. Neuroepidemiology, 2006. 26(4): p. 199-206.
population. Its association with premature mortality. Tropical and [100] Kuruvilla, A., et al., Neurocysticercosis: a clinical and radiological
geographical medicine, 1993. 46(3): p. 175-179. appraisal from Kerala State, South India. Singapore medical
[83] Dent, W., et al., Prevalence of Active Epilepsy in a Rural Area in journal, 2001. 42(7): p. 297-303.
South Tanzania: A Door‐to‐Door Survey. Epilepsia, 2005. [101] Jain, S., et al., Twin birth and epilepsy: an expanded India study.
46(12): p. 1963-1969. Neurol J Southeast Asia, 1999. 4: p. 19-23.
[84] Bharucha, N.E., et al., Prevalence of epilepsy in the Parsi [102] Sharma, K., Genetic epidemiology of epilepsy: a twin study.
community of Bombay. Epilepsia, 1988. 29(2): p. 111-115. Neurology India, 2005. 53(1): p. 93.
[85] Wright, J., et al., A population-based study of the prevalence, [103] Lu, J., et al., The gene encoding GABBR1 is not associated with
clinical characteristics and effect of ethnicity in epilepsy. Seizure, childhood absence epilepsy in the Chinese Han population.
2000. 9(5): p. 309-313. Neuroscience letters, 2003. 343(3): p. 151-154.
[86] Banerjee, P.N., D. Filippi, and W. Allen Hauser, The descriptive [104] Ren, L., et al., Lack of GABABR1 gene variation (G1465A) in a
epidemiology of epilepsy—a review. Epilepsy research, 2009. Chinese population with temporal lobe epilepsy. Seizure, 2005.
85(1): p. 31-45. 14(8): p. 611-613.
[87] Kotsopoulos, I.A., et al., Systematic Review and Meta‐analysis [105] Chen, Y., et al., [Association of child absence epilepsy with T-
of Incidence Studies of Epilepsy and Unprovoked Seizures. STAR gene]. Zhonghua yi xue za zhi, 2003. 83(13): p. 1134-1137.
Epilepsia, 2002. 43(11): p. 1402-1409. [106] Chen, Y., et al., T-type calcium channel gene alpha (1G) is not
[88] Benn, E.K., et al., Estimating the incidence of first unprovoked associated with childhood absence epilepsy in the Chinese Han
seizure and newly diagnosed epilepsy in the low‐income urban population. Neuroscience letters, 2003. 341(1): p. 29-32.
community of Northern Manhattan, New York City. Epilepsia, [107] Nair, R.R. and S.V. Thomas, Genetic liability to epilepsy in
2008. 49(8): p. 1431-1439. Kerala State, India. Epilepsy research, 2004. 62(2): p. 163-170.
[89] Hauser, W.A., J.F. Annegers, and L.T. Kurland, Incidence of [108] Ramasundrum, V. and C.T. Tan, Consanguinity and risk of
epilepsy and unprovoked seizures in Rochester, Minnesota: 1935– epilepsy. Neurol Asia, 2004. 9(Suppl 1): p. 10-11.
1984. Epilepsia, 1993. 34(3): p. 453-458.