Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom; Epilepsy Society, Chalfont St Peter, United Kingdom.
Epilepsia. 2014 Jul;55(7):958-62. doi: 10.1111/epi.12605. Epub 2014 Jun 25.
The reported incidence (rate of new cases in a population) of epilepsy is consistently lower in high-income than in lower-income economies, whereas opinions vary regarding comparative prevalence rates (proportion of the population with epilepsy). For any condition that does not influence mortality, lifetime prevalence should approximate to the cumulative incidence. We suspected that epilepsy prevalence might be uniform throughout the world, whereas incidence is higher in resource-poor countries. To test whether our suspicion was reasonable, we conducted a Medline search to estimate the prevalence of active and lifetime epilepsy in different economic areas throughout the world. We found that the range of estimated prevalence of epilepsy may be broadly similar throughout the world, but comparison is limited by lack of door-to-door studies in high-income economies and by variations in the definitions of active epilepsy. We contend that any inconsistencies between incidence and prevalence are due largely to the excess premature death rate in people with epilepsy in lower-income economies. Much of the variability in epidemiologic indices arises from differences in study methodology, definitions, and risk factors. The epidemiology of epilepsy, and particularly its mortality, needs thorough investigation using uniform definitions that do not include antiepileptic drug use; causes of death should be identified and actions, including treatment and education, should be taken to avoid preventable deaths.
据报道，高收入经济体中癫痫的发病率（人群中新病例的发生率）始终低于低收入经济体，而关于患病率（癫痫患者在人群中的比例）的比较则存在不同意见。对于任何不影响死亡率的疾病，终身患病率应接近累计发病率。我们怀疑癫痫的患病率在全球范围内可能是一致的，而发病率在资源匮乏的国家更高。为了检验我们的怀疑是否合理，我们进行了 Medline 搜索，以估算全球不同经济地区的活动性癫痫和终身癫痫的患病率。我们发现，癫痫患病率的估计范围在全球范围内可能大致相似，但由于高收入经济体缺乏上门研究，以及活动性癫痫的定义存在差异，因此比较受到限制。我们认为，发病率和患病率之间的任何差异主要归因于低收入经济体中癫痫患者的过早死亡率过高。流行病学指标的大部分变异性源于研究方法、定义和危险因素的差异。需要使用不包括抗癫痫药物使用的统一定义，对癫痫的流行病学，特别是其死亡率进行彻底调查；应确定死因，并采取包括治疗和教育在内的行动，以避免可预防的死亡。
