Epilepsy in India I: Epidemiology and public health

What is it about?

Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden. This paper (first of the two part series) provides an in-depth understanding of the epidemiological aspects of epilepsy in India for developing effective public health prevention and control programs. The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year) data from recent studies in India on general population are comparable to the rates of high-income countries (HICs) despite marked variations in population characteristics and study methodologies. There is a differential distribution of epilepsy among various sociodemographic and economic groups with higher rates reported for the male gender, rural population, and low socioeconomic status. A changing pattern in the age-specific occurrence of epilepsy with preponderance towards the older age group is noticed due to sociodemographic and epidemiological transition. Neuroinfections, neurocysticercosis (NCC), and neurotrauma along with birth injuries have emerged as major risk factors for secondary epilepsy. Despite its varied etiology (unknown and known), majority of the epilepsy are manageable in nature.

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Why is it important?

The present review on the distribution and determinants of epilepsy from an epidemiological and population perspective emphasizes the need for life-course approach in prevention and management and also the need for focused and targeted programs. The increasing burden of epilepsy in India in coming years due to sociodemographic and epidemiological transition warrants public health community to give priority for this eminently preventable and manageable condition in healthcare delivery. However, a proper understanding of the epidemiology of epilepsy is required to discern and delineate factors that are of relevance (that can be modified) in prevention, management, and rehabilitation. Future studies need to move to nationally representative populations using well-defined methodologies for developing a strong public health response for prevention and control of epilepsy in India.