Original article Incidence of childhood epilepsy in Estonia Anneli Beilmann a, *, Aita Napa b , Malle Ha ¨marik a , Anu So ¨o ¨t a , Inga Talvik b , Tiina Talvik a a Department of Pediatrics, University of Tartu, Tartu, Estonia b Children’s Hospital University of Tartu, Tartu, Estonia Received 9 June 1998; received in revised form 2 November 1998; accepted 2 November 1998 Abstract The aim of this study has been to establish the incidence rate (IR) and main characteristics of childhood epilepsy in Estonia. A population-based prospective study was performed from January 1st 1995 to December 31st 1997 in seven counties (population of children 161 202). Only cases occurring in the age range of 1 month to 19 years with active epilepsy were included. Two hundred and sixteen cases met the study criteria. The total age-adjusted IR was 45/100 000. The IR was the highest, 73/100 000, in the age group from 1 month to 4 years. The IR declined markedly after the age of 15 years. Primarily generalized seizures demonstrated a higher IR, 25/100 000, than partial seizures, the IR of which was 20/100 000. The IR of symptomatic epileptic syndromes was 16/100 000, that of cryptogenic, 15.5/100 000 and that of idiopathic, 13/100 000. The cumulative incidence of epilepsy through age 19 was 0.13%. A family history of epilepsy was present in 13.9% of cases. In 40.7% of cases the cause of epilepsy was identified. Adverse perinatal events were the most frequent etiological factors: in 25%, IR 11/100 000. In 103 cases (47.6%) additional medical problems were disclosed. Strong negative univariate association was noted between partial seizures and idiopathic etiology (OR 0.37, 95%CI 0.18, 0.72; P = 0.002) and between partial seizures and motor disability (OR 0.43, 95%CI 0.24, 0.78; P = 0.003). The incidence of childhood epilepsy in Estonia was comparable with developed countries. Generalized seizures predominated. Perinatal factors were the main causes. The idiopathic etiology and motor disability of cryptogenic and symptomatic cases were associated with generalized seizures.  1999 Elsevier Science B.V. All rights reserved. Keywords: Epidemiology; Seizures; Epilepsy; Incidence; Childhood 1. Introduction Epilepsy is among those diseases of the nervous system most frequently observed in humans. Despite the recent progress in the clinical diagnosis and treatment of epilepsy, patients need to take antiepileptic drugs for an extended period and are still burdened psychologically and economic- ally [1]. The incidence of epilepsy has been studied in several countries and in several subgroups of the population [1– 17]. However, these rates are hardly comparable, due to different study designs and criteria used. Many of these studies were retrospective and a thorough description of the cases is not available. With a prospective approach, it is both easier to properly select cases and to collect informa- tion of interest, while excluding non-epileptic disorders [7]. Furthermore, a prospective study would enable a more com- plete ascertainment of cases. Hence, prospective incidence studies allow one to identify the etiology and several risk factors at the process of diagnosis and are helpful in the evaluation of prognosis and in counseling patients and their families, as well as in the selection of patients for intensive and investigational treatments. The present publication is based on an epidemiologic project of seizure disorders in Estonian children and adoles- cents. The main aim of this prospective community-based study was to prospectively characterize identified indivi- duals of ≤19 years old with newly diagnosed epileptic sei- Brain & Development 21 (1999) 166–174 0387-7604/99/$ - see front matter  1999 Elsevier Science B.V. All rights reserved. PII: S0387-7604(98)00096-5 * Corresponding author. Tel.: +372-7-449-601; fax: +372-7-449-608; e-mail: anneli@lkl.lk.cut.ee