Epidemiology and Natural History

Epidemiological assessment of epilepsy faces significant methodological challenges, including inconsistent diagnostics, comorbidities, underreporting and selection bias. A considerable issue, often ignored, is that it is challenging to obtain population data on relatively common symptom complexes such as epilepsy. Incidence, reflecting new cases, peaks in young children and older adults and varies geographically, with higher rates in low- and middle-income countries. Prevalence, reflecting existing cases, shows lower-than-expected rates related to lifetime incidence, due to remission, spontaneous or antiseizure medication-induced remission, and premature mortality. Most people with uncomplicated epilepsy enter terminal remission and can come off medication. Risk factors and causes differ by age and region, with genetic and perinatal issues in children, traumatic brain injury and CNS infections in poorer areas and cerebrovascular disease in older adults. Comorbidities, including psychiatric, cognitive, and somatic disorders, are common and impact outcomes, highlighting the need for holistic management.