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

2, 29-39
Available online at http://pubs.sciepub.com/ijcen/2/2/3
© Science and Education Publishing
DOI:10.12691/ijcen-2-2-3

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: shakir_pharmacist@yahoo.com

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

1. Significance Statement
Epilepsy is a neuronal disease which affects almost all
groups of the society. It is still is not properly out of
shadow and need more work at scientific background to
know about the exact prevalence, incidence and etiology
of epilepsy. The prevalence and incidence of epilepsy is
varying among the countries with heterogeneous figures.
The overall prevalence of epilepsy is 10 per 1000 persons.
2. Introduction
Epilepsy is a chronic neuronal disorder or group of
disorders, which is characterized by the recurrent (two or
more) epileptic seizures that usually recur unpredictably in
the absence of provoking factors. An epileptic seizure is a
clinical presentation which is linked to an abnormal and
excessive discharge from a set of neurons in a specific
locus of the brain. This clinical manifestation consists of
sudden and transitory abnormal phenomena which may
include alterations in consciousness, motor, sensory,
autonomic or psychic behaviors [1]. Epilepsy is different
from seizure which is characterized by an excessive,
abnormal discharge of neurotransmitters from cortical
neurons. Loss of consciousness, disturbance in sensory
concern with epilepsy. While, the seizure is usually of
brief duration and may produce post seizure impairment.
Similarly, convulsion is violent attack manifested by
strong contraction of the involuntary muscles [2]. Literally
“Epilepsy” is a Greek derived word “epilambanein”,
meaning “to be seized” or "to be overwhelmed by
surprise". The word Epilepsy is used both in verbal and in
written context from more than 4000 years and many
misconceptions are found which are mainly linked to the
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.
The forced cry, the loss of consciousness, the fall, the
twitching and the foaming at the mouth, is linked to
“possession by the spirit”. People with epilepsy are being
looked upon as “being chosen” or as “being possessed”
depending on the belief of that moment or place. Some
people has believe that epilepsy is communicable disease
and hesitate to help or touch that person who has fallen in
a seizure, even when this happens in hazardous places,
like in the water or near an open fire. The stigma
associated with epilepsy also has a great effect on the
education of children and young people and mostly lead to
isolation from the society [3].
It has been stated that the history of epilepsy spans over
4000 years of ignorance, superstition and stigmatization
[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
1% contribution to the global burden of diseases while this
contribution is 80% in the developing countries [5]. To
explore epilepsy as a Global Campaign against epilepsy
was launched in 1997 “to improve acceptability, treatment,
services and prevention of epilepsy effectively throughout
the world [6,7]. We categorically review the literature on
prevalence, incidence, and etiology of epilepsy by using
PubMed, Google, Google scholar, and respective journals
of epilepsy. The main purpose of this project to collect,
compile and disseminate the relevant information about
the prevalence, incidence and etiology of epilepsy.
3. Methodology
3.1. Protocol of the Searching
We searched the following tabulated databases, journals
and sites by using the key word “prevalence of epilepsy”,
“Incidence of epilepsy”, “etiology of epilepsy”,
“epidemiology of epilepsy”, “prevalence by gender, age,
race, ethnicity, and socioeconomic status” shown in Table 1.
In order to specify our search by adopting a particular
method such as by writing “title: or Auth: and then
followed by the key words in Google and in Google
scholar. Similarly, in order to specify the search in
PubMed database by writing the key words followed by [ti]
or [Auth] respectively.
3.2. Articles ReviewCriteria and Analysis
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
of prevalence, incidence, demography, classification, etiology
of epilepsy. A total of 135 articles were included for this
study because these articles contain relevant information.
The excluded articles are either contain no relevant information
or may contain only abstract. The overall literature search
process is pictured in the following Figure 1.

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
100,000.

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

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

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

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

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

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
There is no marked difference in the ratio of epilepsy on
the basis of gender in Iran however; this picture is
different from the study report from Pakistan and India.
Figure 8. Depicts the Percent Distribution of Types of Epilepsy in Iranian Population
Other important aspects of the studies are that the
common cause of epilepsy is perinatal problems such as
asphyxia, sepsis and neonatal hypoglycemia. A positive
association of epilepsy with family history is observed.
The prevalence of epilepsy in regard of age and sex in
southern Iran is not too much different from rest of the
world [28]. There is no study available to figure out the
incidence of epilepsy in Iran.
4.9. Prevalence and Incidence in Egypt
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
prevalence rate is 9.3/1000 and the incidence rate is
1.5/1000. Generalized seizures is more common (CPR
6.75/1000) than partial seizures (CPR 2.5/1000) in this
study. The prevalence of partial seizures leading to
secondary generalize seizure is 0.84/1000 while simple
partial and complex partial seizures had CPR of 1.4/1000
and 0.34/1000 respectively. Epilepsy is slightly high in
male than female with no prominent difference (CPR of
14.4 and 10.9 per 1000). The CPR is higher in rural,
illiterate group than urban and literate populations (17.7/1000,
9.56/1000 and 12.02/1000, 9.94/1000, respectively). The
highest prevalence rate is recorded in the early and late
childhood group (69.78/100,000 and 43.78/100,000) [29].
The determination of incidence rate is still to be studied in
Egypt.
4.10. Prevalence and Incidence in Middle
East Region of Arab Countries
The prevalence is 6.5/1,000 in Saudi Arabia and high in
male population as compare to female which is confirmed
by three different studies. The prevalence is probably 2
times higher in children, in young adults compared to
other groups and with a lower rate in middle-age people
[30]. The incidence study about the epilepsy is not
available up to now.
4.11. Prevalence and Incidence in America
34
The generalized epilepsy had a higher frequency than the
other types of epilepsies [27]. The data are summarized
about the types of epilepsy from cohort study in Figure 8.
The age adjusted prevalence is 5.0 in North America,
7.1 in Mississippi of North America [31,32,33]. In Central
and South America the age adjusted prevalence is ranging
from 3.7 per 1000 in Argentina[34] to 22.2 per 1000 in
Ecuador [35]. There is lowest age adjusted prevalence in
South America which is 3.7 [34]. The prevalence is high
in lower-income families, older, and male children
[36].The point prevalence of epilepsy in Canada is
5.2/1000 according to data from two national health
surveys [37,38]. The age adjusted incidence rate is ranged
from 16 to 51 per 100,000 people in North America [39].
4.12. Prevalence and Incidence of Epilepsy in
Europe
The prevalence rate is 6.2 per 1000 population
according to Lorna Booth and Gavin Thompson study on
epilepsy statistics in 2010 but this rate was 7.1 in 1994
and 7.6 in 1999 [40,41,42]. There is approximately 60%
of patients have tonic clonic seizures, 20% complex
partial, 12% mixed tonic clonic and partial seizure, 3%
simple partial and less than 5% absence seizures,
myoclonic seizures and other types of seizures. The
overall prevalence of epilepsy in United Kingdom is 9.7
per 1,000 [40,43,44,45,46,47]. The incidence rate of
epilepsy in England is 47 per 100,000 [48].
An epidemiological study of active epilepsy in people
over 14 years of age is being performed in other eight
European states. The prevalence is relatively consistent
within the Europe 2.2-3.4 per 1000). The crude prevalence
rate is 7.0 per 1000 (8.8 in rural and 4.5 in 1000 in urban
areas) in Europe, with a mean age at onset of 12.9 years
[3]. The prevalence is 10 per 1000 according to data of
Irish self-report which was collected through the Central
Statistics Office (CSO) through their Quarterly National
Household Survey (QNHS).The overall prevalence rate of
treated epilepsy is ranged from 8.3 per 1,000 people in
2002 to 9.0 per 1,000 in 2005. The prevalence among
females ranged from 7.7 to 8.6 per 1,000 in 2002 to 2005,
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
35 International Journal of Clinical and Experimental Neurology

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

15
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ad

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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
to 3.3 per 1000, respectively [59,60] while there is a
prevalence of 7.0/1000 in European region of Turkey [61].
The majority of studies in regard to epilepsy are
conducted in Asia which is a significant health problem in
Asia. The age-adjusted prevalence of epilepsy is 10.2 per
1000 in Asian Turkey [62] which is higher than in
European Turkey [13]. The difference may be due to some
biological variability between the Asia and the West
population, and the smaller physique among Asians [63].
Mac et al systematically review the literature on
epidemiology, etiology, and management of epilepsy in 23
Asian countries while prevalence data are available for
only 11 countries [11].
In 1997, Jallon reviewed studies from Asia, mostly
done in the 1980s, and showed a prevalence varying from
1·5 per 1000 in Japan to 9·99 per 1000 in Pakistan [12,64].
Data on prevalence of epilepsy are available from
Azerbaijan, Estonia, Lithuania and the Russian Federation,
but the differences in methodology and study populations
make the comparisons quite difficult. The prevalence rate
in the Nakhchivan area, Azerbaijan is 5.9 per 1000
population (S. Magalov, personal communication, 2004).
The crude and age-adjusted prevalence rate of active
epilepsy in an adult population in Estonia is 5.3 per 1000
[65].
4.16. Age Specific Prevalence
Generally it is found from most of the studies that there
is increased prevalence in adolescent and early childhood
age [65,66,67,68]. The prevalence is constant in adult age
but increases after the age of 50 in developed countries
[67,69]. The prevalence of epilepsy remains stable in third
and fourth decades but then drops after the fifth decade of
life in developing countries [65,66,67,68]. The epilepsy in
adolescent and childhood are commonly idiopathic
(primary) in nature while, in the rest of the groups are
commonly secondary epilepsy.
4.17. Prevalence by Gender
 International Journal of Clinical and Experimental Neurology
The prevalence is higher in male than female in North,
Central and South America except in New York, Bolivia,
Honduras and Argentina where the female ratio is high.
The Placencia et al., 1992 study shows a high prevalence
in male but after Basch et al., 1997 study then this ratio
become change and the prevalence become high in female
[35,66,70,71,72,73]. In Europe the prevalence is high in
female in Italy but according to Rocca et al in 2001 the
male ratio become high while in Turkey the prevalence is
high in male [34,59,60]. In Asian countries such as China,
India, Turkey and Saudi Arabia the prevalence is high in
Male while according to Aziz et al the prevalence is high
in female in Pakistan [13,15,20,51,61,74,75]. The
prevalence of epilepsy in male and female in the countries
of sub-continent of Africa is variable. In Nigeria and in
Uganda the prevalence is high in female [76,77,78,79]. On
contrary the prevalence in male is high as compared to
female in Ethiopia, Tunisia, Kenya and Zambia [39,69,80,81].
According to Rwiza et al in 1995 in Tanzania the
prevalence is high in female while according to Dent et al
in 2005 the prevalence become high in male as compared
to female [55,82]. However, absolute difference in gender-
specific prevalence is minimal. The most extreme example
of a male excess is reported in a study conducted in India,
in which prevalence of males (5.1 per 1000) is
significantly higher than females (2.2 per 100) [83]. The
biological differences, climatic differences is a partly
reason for the higher prevalence. Psychosocial, cultural,
economic, political and organizational factors are also
important in manipulating epilepsy causation, management
and outcome in the region [63]. In some population, the
symptoms and diagnosis of epilepsy in women is
concealed from public because the exposure of epilepsy
may become a hurdle in their marriage. To explore the
exact cause of difference in epilepsy between genders an
extensive further scientific study is needed.
4.18. Prevalence by Race and Ethnicity
Few studies are available about the prevalence of
epilepsy on the basis of race and ethnicity. Haerer et al
assessed the prevalence of epilepsy on the basis of race
and ethnicity and found age adjusted prevalence is high in
African-Americans (8.2 per 1000) as compared to
Caucasians (5.4 per 1000) [31]. Wright et al examined
racial differences between South Asians and non-South
Asians, and found prevalence of active epilepsy to be
lower in South Asians in comparison to Non South Asians
[84]. The difference may be due to some endemic
problems such as neurocysticercosis or malaria, the status
of medical infrastructure, Preventive Health related
programs or availability of local health care system[85].
4.19. Prevalence of the Basis of Seizure Types
Seizure types are dependent on accurate of history,
availability and sophistication of diagnostic tests used, and
age at which the patient. However, prevalence of
generalized seizure is high in America, Asia, Europe, and
Africa as compared to other types of seizures [58].
4.20. Incidence of Epilepsy
Incidence studies provide a better understanding of the
etiology and natural history of epilepsy. There is a limited
36
data available about the incidence of epilepsy [3]. A meta-
analysis of incidence studies reports that developing
countries have a higher incidence rate of epilepsy as
compared to developed countries which are figured in
median as 68.7/100,00 and 43.4/100,000 [86]. Age-
adjusted incidence of epilepsy is ranging from 16 per
100,000 people per years to 51 per 100,000 person-years
in North America [87,88]. There is a diversified figure
about the incidence of epilepsy in Europe. Age adjusted
incidence of epilepsy is 26 per 100,000 person years in
Norway while 47 per 100,000 person years in England of
Europe [89]. One age adjusted incidence study is available
from Asia which is conducted in India and age adjusted
incidence is 35 per 100,000 people in year [90]. In
Tanzania, crude incidence is 73 per 100,000 and age-
adjusted incidence is 51 per 100,000 of Africa [55]. In
Ethiopia, crude incidence of epilepsy is 64 per 100,000
while age-adjusted incidence of epilepsy is 43 per 100,000
[39]. Statistic about the incidence of epilepsy in China and
India are similar to those in the America and Europe but
lower than those from Africa and Latin America [11]. The
whole picture about the incidence of epilepsy in
developing countries is different from those in developed
countries. However, overall age- adjusted incidence of
epilepsy is 24 to 53 per 100,000 [11]. The difference in
incidence may be attributed to economic status of the
countries because this is an expensive study to carry out.
The second main cause of difference is cousin marriages
which are common in certain societies and particular in
India and Muslim population. The treatment gap is also
the main cause of difference in incidence in epilepsy. The
treatment gap is defined as the proportion of people with
active epilepsy who is not appropriately treated at a given
point of time.
4.21. Age Specific Incidence
The incidence of epilepsy is high in first year of life,
early childhood and after adolescent in developed countries
[19,48,91,92] while, in developing countries the incidence
is higher in only childhood group [39,55,66,88,93,94]. We
presume that genetic (Family history), environmental
factors (Aspasia, infections during and after birth), and
health system (ignorance and no proper care system)
mainly affect the incidence of epilepsy because early
children and adolescent age group is more prone to these
factors.
4.22. Incidence by Gender
Many studies report a higher incidence in males than
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
proved scientifically that two female sex hormones
(estrogen and progestogens) affect the threshold of seizure
to some extent which is lead to differences in gender
[3,66].
4.23. Incidence by Race and Ethnicity
No statistically significant differences in incidence are
found among non-Hispanic whites, African-Americans,
Hispanics, and Asians [86].
37 International Journal of Clinical and Experimental Neurology
4.24. Incidence by Seizure Type
Eight incidence studies are available to give
information on seizure types. The incident studies
performed in developing countries, particularly in Africa,
reported a greater proportion of individuals to have
epilepsy characterized by generalized onset seizures than
epilepsy characterized by partial seizures [3,85].
4.25. Etiology of Epilepsy
From the available literature, causes seem to be
dominated are head injury, birth trauma, asphyxia,
cerebrovascular disease, and intracranial infections
(neurocysticercosis or meningoencephalitis) [64]. Genetic
factors have a strong association with idiosyncratic
epilepsy [94].
4.26. Head Injury
Head injury is the main cause of epilepsy and account
for 5% epilepsy and 20% of symptomatic epilepsy [95].
4.27. CNS Infections
The Commission on Tropical Disease of the
International League Against Epilepsy listed several
diseases as causes of epilepsy, including malaria,
tuberculosis, schistosomiasis, acquired immunodeficiency
syndrome, and cysticercosis [74,96]. An association
between neurocysticercosis and epilepsy is found in
various studies in Africa and Latin America the results on
the relation between neurocysticercosis and epilepsy in
Asia is varied significantly [97]. Neurocysticercosis is
probably an important cause of seizures and epilepsy in
regions with a high prevalence of Taeniasolium infection
in human beings [98,99,100].
4.28. Genetic Factors
Some studies show that there is no association of
genetic factors with epilepsy [101-106]. However, family
history and largely genetic factors is linked to epilepsy in
many studies [107,108]. The most common human genetic
epilepsies display a complex pattern of inheritance and the
associations with genes are largely unknown. Pathogenic
alterations or mutation in genes and structural
abnormalities in chromosomes (deletions, insertions) are
responsible for a variety of epilepsies [95].
5. Conclusion
It is clear from the study that overall prevalence of
epilepsy in the world is about 10 per 1000 people. There
are differences in prevalence by gender which is slightly
high in male than female although, the differences is non-
significant and generalized type of epilepsy is the common
one among the other types of epilepsies. However, the
number of affected patients in the world is still large and
much remains poorly documented. There is still a limited
data available about the prevalence of epilepsy to find
exact figure. There is lack of consistency in incidence
studies although, statistically non-significantly higher
incidence is observed for males as compared to females.
Classification of seizure types is largely dependent on the
proper history, advanced technology and neurologist but,
still misclassification might be expected. We need further
study to know accurately about the prevalence and
incidence of epilepsy and the study must be include
people from different ages, races, socioeconomic
background to explore the role factors clearly a such age,
gender, race and socioeconomic status on epilepsy. It is
important to conduct prevalence study in those region
from which still no data available about the prevalence of
epilepsy. To know about the etiology of epilepsy it is
important to carry out more detailed studies about the
incidence of epilepsy. The proper consideration of culture
of society, health care policies and access to health care
system is important to interpret the findings from all
studies.
Acknowledgement
I am very thankful to my supervisor Dr.Niaz Ali for
their kind supervision during my writing. I am also
thankful to Dr.Esther van de Vosse and Dr.Aslam khan for
major review before the submission of this article. I would
like to pay thanks to Muhammad Nabi my Laboratory
fellow.
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