Distribution and Incidence

In the United States the incidence of epilepsy is about 0.3 to 0.4 percent per year, or roughly one tenth the incidence of mental deficiency and perhaps one half the incidence of schizophrenia. The rate for males is slightly higher than that for females for all types of seizures combined, and is highest for ages 0 to 4 years, reaches a low level after adolescence, and peaks again after 70 years as the result of late cerebral disease (Kurland 1949).

Since the early 1970s, several good epidemiological surveys of epilepsy have been made in Iceland, England, and the United States, which report crude prevalence rates between 3.6 and 5.5 per 1,000 population (Kurland, Kurtzke, and Goldberg 1973). Epidemiological studies of epilepsy, however, are plagued by a variety of problems. Of prime importance in this regard is the lack of agreement on the definition of epilepsy itself as well as what constitutes an active or an inactive case. In addition, there are difficulties involved in estimating the size of the population universe and the number of cases not identified by the case finding procedures. The most rigorous survey conducted in a community in the United States was done in Rochester, Minnesota (Hauser and Kurland 1975). The crude rate for all types of epilepsy was 5.7 per 1,000 population. Seventy-five percent of the patients' seizures were of undetermined cause, and approximately 70 percent had generalized seizures. A prevalence rate of 2.8 per 1,000 population has been reported for Tokyo (Tsuboi 1988) and of 2.47 for rural Kashmir, India (Koul, Razdan, and Motta 1988).

Crude prevalence rates between 7.6 and 8.4 per 1,000 population have been reported for four North American Indian tribes (Levy, Neutra, and Parker 1987). Environmental factors account for the difference between Indians and the non-Indians of Rochester. The former have significantly more epilepsy attributed to trauma, postencephalopathy, and inflammatory disease. Even higher rates are found in urban ghettos, where lead poisoning and drug addiction are among the leading causes of epilepsy (Hauser, personal communication).

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