Published in PLOS One on 2025-11-19, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Zhijun Wang, Minheng Zhang, Hongwei Liu, Haixia Fan
Source: PLOS One • DOI 10.1371/journal.pone.0336588
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Epilepsy remains one of the most widespread and severe neurological disorders worldwide. This study aims to evaluate the burden of late-onset epilepsy (LOE) and investigate its temporal trends and inequalities among older adults at global, regional, and national scales between 1990 and 2021.
This analysis utilizes data from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Temporal trends in the age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years (DALYs) rate for LOE were quantified through the calculation of average annual percentage change over the study period.
In 2021, the global ASPR and ASIR of LOE in adults aged 65 and older were estimated at 472.74 (95% UI: 332.21 to 654.96) and 33.12 (95% UI: 18.68 to 50.29) per 100,000 population, respectively. The global ASMR was 4.76 per 100,000 population (95% UI: 3.80 to 5.26), while the age-standardized DALYs rate reached 189.08 per 100,000 population (95% UI: 137.47 to 259.90). Among the five sociodemographic index (SDI) regions, high-SDI areas exhibited the greatest ASPR, ASIR, ASMR, and age-standardized DALY rate, whereas high-middle SDI regions reported the lowest. Geospatially, Andean Latin America recorded the highest ASPR, while Western Europe reported the highest ASIR. The highest ASMR and age-standardized DALY rate were observed in Central and Eastern Sub-Saharan Africa, respectively. Among 204 countries, Equatorial Guinea displayed the highest ASPR, while Germany had the highest ASIR. Notably, Zambia exhibited both the highest ASMR and age-standardized DALY rate for LOE. However, the inequalities associated with the SDI across countries gradually diminished over time.
The study suggest that regions with high SDI continued to experience elevated ASPR, ASIR, ASMR, and age-standardized DALY rates. These findings highlight the importance of integrating LOE care into health systems, particularly for adults aged 65 years and older.
Introduction
Epilepsy is a long-standing neurological disorder, identified by the brain’s persistent tendency to generate repeated seizures, impacting individuals across various geographies, ages, and ethnicities [1,2]. Although there have been therapeutic advancements, the majority of people with active epilepsy, over 75%, remain untreated, with the treatment gap being especially wide in low- and middle-income countries [3]. In the context of global population ageing, late-onset epilepsy (LOE), defined as seizure onset at ≥65 years [4], is gaining prominence as a clinical and public-health priority due to its links with vascular and neurodegenerative comorbidity. Although its pathogenesis remains incompletely resolved, converging evidence implicates cerebrovascular injury, neurodegenerative processes, multimorbidity, and frailty as key contributors to susceptibility and poorer outcomes [3,5]. Current management in older adults remains largely symptomatic, targeting seizure suppression rather than underlying pathophysiology [6,7]. Importantly, LOE is associated with substantially higher mortality than in age-matched populations without epilepsy, with excess deaths frequently linked to comorbid conditions such as stroke and dementia [8]. Thus, premature mortality is a critical issue for LOE patients worldwide, placing a heavy load on healthcare systems and impacting the patients and their families. It is vital for healthcare experts in every discipline to have a thorough understanding of this condition [9–12].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Zhijun Wang, Minheng Zhang, Hongwei Liu, Haixia Fan. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: A 30-year analysis of urolithiasis burden in the North Africa and Middle East region: Findings from the global burden of disease study 2021
- Evidence brief: Trends in the burden of sickle cell disorders in Sierra Leone, 1990–2023: An analysis of Global Burden of Disease Study 2023 estimates
- Evidence brief: Predictors of tuberculosis mortality among patients on treatment: A retrospective cohort study at a rural general hospital in Zambia
