**1.3 Epidemiology and burden of epilepsy**

Although epilepsy occurs in a ubiquitous manner, its burden is unevenly spread in different regions of the world depending on the local distribution of risk factors, access to treatment, and population demography. A recent meta-analysis found an overall lifetime prevalence of epilepsy of 7.60 per 1000 population (95% CI 6.17– 9.38); this was higher in low and middle income countries (LMICs) (8.75 per 1000; 95% CI 7.23–10.59) than in high income countries (5.18 per 1000; 95% CI 3.75–7.15) [12]. A similar pattern was observed regarding epilepsy incidence: it was higher in LMICs compared to high-income countries, 139.0 per 100,000 person years (95% CI 69.4–278.2) vs. 48.9 per 100,000 person years (95% CI 39.0–61.1) [12].

These numbers clearly demonstrate that epilepsy poses a greater problem among populations living in LMICs compared to those in industrialized countries [2]. Indeed, nearly 80% of the global burden of epilepsy occurs in the people living in LMICs [1]. In sub-Saharan Africa specifically, a median epilepsy prevalence of 14.2 per 1000 (IQR 8·0–33·2) was documented, with over 90% of cases being younger than 20 years [13]. Annual epilepsy incidence was also high, reaching 81.7 per 100,000. Mortality was greatest in the 18–24 years age group, suggesting a relatively low life expectancy among persons with epilepsy (PWE) in Africa [13]. Suggested explanations for this pattern include the epilepsy risk factors that are often reported in resource-poor settings such as perinatal brain insults, traumatic head injury and infections of the central nervous system [13]. A variable genetic predisposition to manifest seizures in different populations may also explain the regional disparities observed in the occurrence of epilepsy worldwide, as people of different ethnic origins within a given population were found to have different incidence rates for epilepsy [14].

According to the 2016 Global Burden of Disease Collaborators, epilepsy accounted for >13 million Disability Adjusted Life Years (DALYs – a measure of the number of years of healthy life lost to epilepsy within a given population), and was responsible for 0.5% of the total disease burden in 2016 [15]. Again, important geographical differences were noted with epilepsy ranking among the top five neurological diseases in low-income regions. That study also found significant reductions in mortality and DALY among PWE between 1990 and 2016, reflecting some improvement in epilepsy healthcare and treatment.
