title: Systematic review and meta-analysis of incidence studies of epilepsy and unprovoked seizures.
abstract: OBJECTIVE
  To evaluate the methodology of incidence studies of epilepsy and unprovoked seizures and to assess the value of their findings by summarizing their results.
  
  
  METHODS
  A Medline literature search from January 1966 to December 1999 was conducted. In each selected study, key methodologic items such as case definition and study design were evaluated. Furthermore, a quantitative meta-analysis of the incidence data was performed.
  
  
  RESULTS
  Forty incidence studies met the inclusion criteria. There was considerable heterogeneity in study methodology, and the methodologic quality score was generally low. The median incidence rate of epilepsy and unprovoked seizures was 47.4 and 56 per 100,000, respectively. The age-specific incidence of epilepsy was high in those aged 60 years or older, but was highest in childhood. Males had a slightly higher incidence of epilepsy (median, 50.7/100,000) than did females (median, 46.2/100,000), and partial seizures seemed to occur more often than generalized seizures. Developing countries had a higher incidence rate of epilepsy (median, 68.7/100,000) than did industrialized countries (median, 43.4/100,000). Similar results were found for unprovoked seizures. The incidence of epilepsy over time appears to decrease in children, whereas it increases in the elderly.
  
  
  CONCLUSIONS
  The age-specific incidence of epilepsy showed a bimodal distribution with the highest peak in childhood. No definitive conclusions could be reached for the incidence of unprovoked seizures and other specific incidence rates of epilepsy. More incidence studies with an adequate study methodology are needed to explore geographic variations and time trends of the incidence of epilepsy and unprovoked seizures.
authors.affiliation: Department of Neurology, Maastricht University Hospital, The Netherlands. iko@sneu.azm.nl
authors.forename: Irene A W
authors.initials: IA
authors.lastname: Kotsopoulos
authors.forename: Tiny
authors.initials: T
authors.lastname: van Merode
authors.forename: Fons G H
authors.initials: FG
authors.lastname: Kessels
authors.forename: Marc C T F M
authors.initials: MC
authors.lastname: de Krom
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003710:Demography; D004812:Epidemiologic Methods; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013997:Time Factors