McHugh John C, Delanty Norman
Department of Neurology, Beaumont Hospital, Dublin 9, Ireland.
Int Rev Neurobiol. 2008;83:11-26. doi: 10.1016/S0074-7742(08)00002-0.
Epilepsy is a common disease. The cumulative lifetime risks for epilepsy and for any unprovoked seizure are 3.1% and 4.1%, respectively, in industrialized countries. Estimate of annual incidence of epilepsy are as high as 43 cases per 100,000 of the population in so-called developed countries, and are almost double this figure in the developing world. Within this there is a growing appreciation of gender differences in the epidemiology of epilepsy and of specific epilepsy syndromes. In 1993, the International League Against Epilepsy (ILAE) proposed simplified classification guidelines to facilitate epidemiologic work in epilepsy, and to allow meaningful comparison between studies undertaken at different times and in different parts of the world. Since then, a number of national studies have been completed, adding to the existing data of already well-established databases such as the Rochester Epidemiology Project. There is broad agreement between studies that females have a marginally lower incidence of epilepsy and unprovoked seizures than males. This difference is usually attributed to male's greater exposure to risk factors for lesional epilepsy and acute symptomatic seizures. On the other hand, idiopathic generalized epilepsies (IGEs), which may represent some 15-20% of all epilepsies, are more common among females. Also, the behavior of some common epilepsy syndromes such as mesial temporal sclerosis may differ between genders with isolated auras more common among females and secondary seizure spread more likely in males. Trends toward gender differences are also seen in other important aspects of epilepsy. These include the incidence of status epilepticus (more common in men), incidence of sudden unexpected death in epilepsy (SUDEP), prognosis, and mortality.
癫痫是一种常见疾病。在工业化国家，癫痫和任何无诱因发作的终生累积风险分别为3.1%和4.1%。在所谓的发达国家，癫痫的年发病率估计高达每10万人中有43例，而在发展中世界这一数字几乎是前者的两倍。在此背景下，人们越来越认识到癫痫流行病学以及特定癫痫综合征中的性别差异。1993年，国际抗癫痫联盟（ILAE）提出了简化的分类指南，以促进癫痫的流行病学研究工作，并允许对在不同时间和世界不同地区进行的研究进行有意义的比较。从那时起，已经完成了一些国家研究，为罗切斯特流行病学项目等已建立完善的数据库的现有数据增添了内容。各项研究之间普遍达成共识，即女性癫痫和无诱因发作的发病率略低于男性。这种差异通常归因于男性更多地暴露于病灶性癫痫和急性症状性发作的风险因素。另一方面，特发性全身性癫痫（IGE）约占所有癫痫的15% - 20%，在女性中更为常见。此外，一些常见癫痫综合征（如内侧颞叶硬化）的表现可能因性别而异，孤立性先兆在女性中更常见，继发性发作扩散在男性中更可能发生。在癫痫的其他重要方面也可见到性别差异趋势。这些包括癫痫持续状态的发病率（男性更常见）、癫痫猝死（SUDEP）的发病率、预后和死亡率。
