Abstracts

Rationale: Epilepsy is a disease of recurrent unprovoked seizures. Although epilepsy affects children and adults, it often arises during childhood and is prevalent in up to 1% of children and adolescents. Children with epilepsy are also at increased risk for learning, cognitive, and behavior problems that can cause significant secondary disease burden if underlying seizures are not treated. In the United States, about 10% of those with epilepsy are children. Previous studies show that the incidence of epilepsy is almost threefold higher in lower and middle income countries compared to higher income countries. We were interested in examining trends in pediatric epilepsy deaths globally as this relates to socioeconomic, regional, and healthcare system markers.

Methods: Using the Global Burden of Disease (GBD) database, we extracted deaths per 100000 people attributable to epilepsy for patients less than 20 years old for every country in the world for the years 1990 through 2021. We also abstracted gross domestic product (GDP) per capita, Healthcare Access and Quality Index (HAQI), United Nations geoscheme region (UNGR), and neurologists and neurosurgeons per capita.

Results: From 1990 to 2021, most countries saw a decrease in deaths due to pediatric epilepsy, with an average decrease of 23%. 37/204 (18%) countries showed an increase in deaths. From 1990 to 2021, the lowest GDP quartile countries had an average decrease in deaths of 14%, while the upper three quartiles had average decreases in deaths greater than 20%. Countries in the highest HAQI quartile had an average decrease in deaths of 24%, compared to a 7% average decrease in the countries in the lowest HAQI quartile (Figure 1). Data sorted by UNGR showed an increase in pediatric epilepsy deaths in Melanesia, Micronesia, Polynesia, and Oceania, with Polynesia showing the greatest increase at 63%. The only other UNGR with an increase in deaths attributable to pediatric epilepsy was Southern Africa (+4%). Melanesia, Polynesia, and Oceania are among the UNGR with the lowest neurologists and neurosurgeons per capita (Figure 2).

Conclusions: Although countries in all GDP and HAQI quartiles saw a decrease in deaths attributable to pediatric epilepsy from 1990 to 2021, wealthier countries, with more-developed healthcare systems, saw a greater improvement, resulting in increased inequality. This may be related to the fact that these wealthier countries are more likely to have comprehensive epilepsy treatment that includes specialist neurologist and neurosurgeon care for treatment resistant cases, which can occur in up to one third of pediatric epilepsy patients. Differences related to socioeconomic, regional, and healthcare system markers may also be related to demographic factors such as age effects, reporting bias, or increased prevalence of comorbid pathologies such as meningoencephalitis and traumatic brain injury that may be epileptogenic and disproportionately affect a pediatric population.

Funding: N/A