Abstract
OBJECTIVES: This study presents global, regional, and national rates and trends of incidence, prevalence, and disability-adjusted life years (DALYs) for epilepsy among adolescents and young adults from 1990 to 2021, and provides projections for future trends up to 2044. METHODS: Data on epilepsy incidence, mortality, and DALYs were retrieved from the Global Burden of Disease 2021 (GBD 2021) study. Joinpoint regression was applied to determine the average annual percentage changes (AAPCs), while decomposition analysis was applied to quantify the contributions of aging, population growth, and epidemiological shifts to changes in the epilepsy burden. Frontier analysis was used to compare countries’ epilepsy burden relative to their socioeconomic development. Future trends were projected using the Bayesian Age-Period-Cohort (BAPC) model. RESULTS: From 1990 to 2021, the age-standardized incidence rate of epilepsy among adolescents and young adults increased from 35.88 to 40.48, while mortality and DALYs decreased from 1.91 and 219.90 to 1.61 and 198.23, respectively. In high SDI regions, mortality and DALYs significantly declined, while in low SDI regions, incidence increased with an AAPC of 0.32%. Decreasing incidence was observed in regions like Eastern Europe and Latin America, while increases were recorded in sub-Saharan Africa and high-income North America. Decomposition analysis revealed that population growth primarily drove global changes in epilepsy burden in adolescents, especially in low SDI regions, while reductions in high SDI regions were attributed to epidemiological improvements. Projections based on the BAPC model suggest that from 2022 to 2044, the global number of incident cases will continue to rise, reaching approximately 1.47 million by 2044, while DALYs and deaths are expected to decline slightly, accompanied by a decrease in age-standardized DALY and mortality rates. CONCLUSION: While epilepsy mortality and DALYs have decreased globally, incidence in low SDI regions has increased, highlighting healthcare and diagnostic inadequacies. The epilepsy burden is primarily driven by population growth and aging, especially in low SDI regions. Improving access to diagnostic tools and treatment in low SDI regions and optimizing epilepsy management systems in high SDI regions are recommended to mitigate the global burden. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-025-04331-0.