Francesco Brigo, Simona Lattanzi, Eugen Trinka, Johan Zelano
The overall burden of epilepsy of genetic/unknown cause decreased across Europe from 1990 to 2023, but trends differed substantially between macroareas, with Eastern Europe experiencing the most rapid improvements. These findings provide a coherent epidemiological foundation for future research and policy aimed at reducing regional disparities in epilepsy outcomes.
BACKGROUND: In Global Burden of Disease (GBD) framework, idiopathic epilepsy corresponds to epilepsy of genetic/unknown cause, encompassing cases without identifiable etiologies. Despite major health-system changes across Europe, long-term, regionally disaggregated assessments of its burden remain limited.
METHODS: Using GBD 2023 estimates, we analysed age-standardized Disability‑Adjusted Life Years (DALYs), Years of Life Lost (YLL), and Years Lived with Disability (YLD) rates for epilepsy of genetic/unknown cause across Central, Eastern, and Western Europe from 1990 to 2023. We applied log-linear models with cluster-robust inference, assessed linearity using polynomial terms, estimated annual percentage changes (EAPCs), evaluated sex- and area-specific differences through interaction models and Benjamini-Hochberg-adjusted pairwise contrasts, and decomposed long-term changes into mortality and disability components using Shapley-style averages.
RESULTS: The overall burden decreased across Europe, but temporal trends differed considerably between macroareas. Linearity checks supported a log-linear specification, and diagnostic analyses identified no influential observations. Sex-specific slopes did not differ significantly for any outcome, whereas strong heterogeneity emerged across macroareas: Eastern Europe showed the steepest declines, while Western Europe showed largely stable or less favourable trends. Area-year interactions showed evidence of heterogeneity, and pairwise contrasts confirmed robust differences. In decomposition analyses, YLL and YLD components contributed to reductions in DALYs.
CONCLUSION: The overall burden of epilepsy of genetic/unknown cause decreased across Europe from 1990 to 2023, but trends differed substantially between macroareas, with Eastern Europe experiencing the most rapid improvements. These findings provide a coherent epidemiological foundation for future research and policy aimed at reducing regional disparities in epilepsy outcomes.