To determine if there is an association between social deprivation and the incidence of first seizures, new diagnosis of epilepsy and seizure mimics. 

Some epidemiological studies have suggested that social deprivation is associated with incidence epilepsy but results are conflicting, especially in children. To our knowledge, no study has investigated if provoked seizures or seizure mimics are associated with social deprivation.

Multiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542,868) to identify all incident cases of first seizure (provoked and unprovoked), new diagnosis of epilepsy and seizures mimics presenting during the calendar year 2017. Seizure mimics were defined as cases in whom a working diagnosis of seizure was considered, but in whom an alternate diagnosis was subsequently reached. A relative measure of social deprivation based on census data was assigned to each case according to address on record. The annual incidence per 100,000 population was calculated and compared for each of five quintiles of increasing social deprivation.

The annual incidence of first unprovoked seizures (n=372), first provoked seizures (n-189), new diagnosis of epilepsy (n=336) and seizure mimics (n=510) was highest in the most deprived areas compared to the least deprived areas (incidence ratio of 1.79 (95%CI 1.26-2.52), 1.55 (95%CI 1.04-2.32), 1.83 (95%CI 1.28-2.62) and 1.30 (1.00-1.69), respectively). This finding was robust in both adults and children and in those with structural, genetic and unknown aetiologies of epilepsy. 

The incidence of seizures, epilepsy and seizure mimics is associated with increased social deprivation. The increased incidence may be multifactorial and not caused by solely genetic or environmental factors. Areas of social deprivation require increased services to address diagnostic and treatment requirements.