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Yoseph LeonardoSamy, Abdallah MSarode, Gargi SachinSarode, Sachin CSathian, BrijeshSathyanarayan, AnudeepSatpathy, MaheswarSawhney, MonikaSelvaraj, SiddharthanSemreen, Mohammad HSendekie, Ashenafi KibretSenthilkumaran, SubramanianSethi, YashendraSeylani, AllenShahbandi, AtaollahShahid, SamiahShaikh, Masood AliShaikh, Summaiya ZareenShamim, Muhammad AaqibShams-Beyranvand, MehranShamsutdinova, AlfiyaSharifan, AminSharifi Rad, JavadSharma, AnupamSharma, VishalShayan, MaryamSheikh, Zubeda BegumShetty, MahabaleshShetty, Pavanchand HShetty, Premalatha KShittu, AminuShlobin, Nathan AShorofi, Seyed AfshinShrestha, SunilSiddig, Emmanuel EdwarSingh, GagandeepSingh, HarmanjitSingh, Jasvinder ASingh, ParamdeepSingh, PuneetpalSingh, SurjitSolanki, ShipraSoraneh, SoroushStanikzai, Muhammad HaroonSullman, Mark JMSunnerhagen, Katharina SSuresh, VinaySwain, Chandan KumarSzarpak, LukaszTabaee Damavandi, PayamTabarés-Seisdedos, RafaelTabche, CelineTaiba, JabeenTanwar, ManojTareke, MinaleTemsah, Mohamad-HaniTemsah, Reem Mohamad HaniTeramoto, MasayukiThangaraju, PugazhenthanThirunavukkarasu, SathishTicoalu, Jansje Henny VeraTiruye, Tenaw YimerTiwari, KrishnaTiwari, Vikas KumarTovani-Palone, Marcos RobertoTran, Thang HuuTran Minh Duc, NguyenTripathi, ManjariTromans, Samuel JosephTsai, Daniel Hsiang-TeTsatsakis, AristidisTsermpini, Evangelia EiriniTumurkhuu, MunkhtuyaUdoakang, Aniefiok JohnUllah, SaeedUmair, MuhammadUnnikrishnan, BhaskaranUrso, DanieleUsman, Jibrin SammaniVaithinathan, Asokan GovindarajVakilian, AlirezaVarma, Ravi PrasadVenketasubramanian, NarayanaswamyVillafañe, Jorge HugoVinayak, ManishVinueza Veloz, Andres FernandoWalde, Mandaras TarikuWang, ShuWang, YanzhongWaris, AbdulWickramasinghe, Nuwan DarshanaWinkler, Andrea SylviaYesuf, Subah AbderehimYiğit, ArzuYiğit, VahitYilma, Mekdes TigistuYismaw, Yazachew EngidaYon, Dong KeonYonemoto, NaohiroYu, ChuanhuaZandi, MiladZanghì, AuroraZeariya, Mohammed GMZhao, ZhongyiZhong, Claire ChenwenZielińska, MagdalenaZitoun, Osama AZyoud, Sa'ed HZyoud, Samer HRautalin, IlariNewton, Charles Richard JamesWiebe, SamuelMurray, Christopher JL2025-02-272025-02-272025The Lancet Public Health, ISSN: 2468-2667 (Print), Elsevier BV. doi: 10.1016/s2468-2667(24)00302-52468-2667http://hdl.handle.net/10292/18776Background: Epilepsy is one of the most common serious neurological disorders and affects individuals of all ages across the globe. The aim of this study is to provide estimates of the epilepsy burden on the global, regional, and national levels for 1990–2021. Methods: Using well established Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) methodology, we quantified the prevalence of active idiopathic (epilepsy of genetic or unknown origin) and secondary epilepsy (epilepsy due to an underlying abnormality of the brain structure or chemistry), as well as incidence, death, and disability-adjusted life-years (DALYs) by age, sex, and location (globally, 21 GBD regions and seven super-regions, World Bank country income levels, Socio-demographic Index [SDI], and 204 countries) and their trends from 1990 to 2021. Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy, largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). Findings: In 2021, there were 51·7 million (95% UI 44·9–58·9) people with epilepsy (idiopathic and secondary combined) globally, with an age-standardised prevalence of 658 per 100 000 (569–748). Idiopathic epilepsy had an age-standardised prevalence of 307 per 100 000 (235–389) globally, with 24·2 million (18·5–30·7) prevalent cases, and secondary epilepsy had a global age-standardised prevalence of 350 per 100 000 (322–380). In 2021, 0·7% of the population had active epilepsy (0·3% attributed to idiopathic epilepsy and 0·4% to secondary epilepsy), and the age-standardised global prevalence of epilepsy from idiopathic and secondary epilepsy combined increased from 1990 to 2021 by 10·8% (1·1–21·3), mainly due to corresponding changes in secondary epilepsy. However, age-standardised death and DALY rates of idiopathic epilepsy reduced from 1990 to 2021 (decline of 15·8% [8·8–22·8] and 14·5% [4·2–24·2], respectively). There were three-fold to four-fold geographical differences in the burden of active idiopathic epilepsy, with the bulk of the burden residing in low-income to middle-income countries: 82·1% (81·1–83·4) of incident, 80·4% prevalent (79·7–82·7), 84·7% (83·7–85·1) fatal epilepsy, and 87·9% (86·2–89·2) epilepsy DALYs. Interpretation: Although the global trends in idiopathic epilepsy deaths and DALY rates have improved in the preceding decades, in 2021 there were almost 52 million people with active epilepsy (24 million from idiopathic epilepsy and 28 million from secondary epilepsy), with the bulk of the burden (>80%) residing in low-income to middle-income countries. Better treatment and prevention of epilepsy are required, along with further research on risk factors of idiopathic epilepsy, good-quality long-term epilepsy surveillance studies, and exploration of the possible effect of stigma and cultural differences in seeking medical attention for epilepsy.© 2025 The Author(s). Published by Elsevier Ltd. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/https://creativecommons.org/licenses/by/4.0/4206 Public healthJournal ArticleOpenAccess10.1016/s2468-2667(24)00302-5