Changing Epidemiological Patterns of Epilepsy in China, 1990–2023, with Projections to 2050

INTRODUCTION: Epilepsy remains a major source of chronic neurological morbidity and long-term care need. In China, its contemporary burden is likely being reshaped by population ageing and by shifts in the balance between idiopathic and secondary epilepsy, yet updated national evidence integrating subtype-specific burden, demographic decomposition, and future projections remains limited. METHODS: We performed a secondary analysis of the Global Burden of Disease (GBD) Study 2023 to assess epilepsy burden in China from 1990 to 2023, using global estimates for contextual comparison. We examined prevalent cases, years lived with disability (YLD) counts, the age-standardized prevalence rate (ASPR), and the age-standardized YLD rate (ASYR) for overall epilepsy, idiopathic epilepsy, and secondary epilepsy. Temporal patterns were evaluated with Joinpoint regression and age-period-cohort modeling. We additionally assessed associations with the socio-demographic index, decomposed changes in counts into population growth, population ageing, and age-specific epidemiological change, and projected burden to 2050. RESULTS: From 1990 to 2023, prevalent epilepsy cases in China increased from 4.84 million to 6.38 million, while the ASPR rose from 419.04 to 444.42 per 100,000, with an average annual percent change of 0.17% (95% CI 0.07-0.27). The increase was observed mainly in the aggregated GBD category of secondary epilepsy, whereas idiopathic epilepsy remained broadly stable after age standardization. In contrast, YLD counts declined from 1.77 million to 1.63 million, and the ASYR fell from 152.89 to 114.14 per 100,000, with an average annual percent change of -0.87% (95% CI -0.93 to -0.82). Decomposition analyses indicated that the rise in prevalent cases was driven chiefly by population growth and population ageing. By 2050, China is projected to have 6.19 million people living with epilepsy, with an ASPR of 436.94 per 100,000, while the age-standardized disability burden is expected to decline further. CONCLUSION: The burden of epilepsy in China has shifted toward a pattern characterized by prevalent case accumulation, population ageing, and a larger contribution from the aggregated GBD category of secondary epilepsy. Although age-standardized disability burden has declined, long-term epilepsy care needs are likely to remain substantial through 2050. Interpretation of secondary epilepsy should remain cautious because the available GBD estimates do not allow attribution to specific acquired causes.