Epilepsy is a common neurological disorder imposing significant global health burdens. A comprehensive understanding of its temporal and spatial trends is critical for informing policies and guiding interventions.

This study assessed the burden of epilepsy from 1990 to 2021 worldwide, in Asia, and in China, and projected trends to 2050. We used data from the Global Burden of Disease 2021 study to evaluate the incidence, prevalence, mortality, and disability‐adjusted life years (DALYs) related to epilepsy. Joinpoint regression, age‐period‐cohort analysis, and autoregressive integrated moving average forecasting were used to examine temporal trends and project future patterns. We also assessed the influence of socioeconomic development, health service coverage, and risk factors on the epilepsy burden, focusing on regional disparities.

From 1990 to 2021, the incidence and prevalence of epilepsy showed a significant upward trend, while mortality and DALY rates showed a significant downward trend. China exhibited sharper reductions in mortality (average annual percent change = −2.64) and DALY rates (average annual percent change = −1.79). Inequalities persist, with low socio‐demographic index countries showing a disproportionately higher epilepsy burden. In China, improved universal health coverage and socioeconomic development are correlated with a decreasing burden. Alcohol use remains a key modifiable risk factor, particularly among men. Projections suggest a continued shift in the epilepsy burden toward older adults, with those aged ≥ 70 years contributing the largest share of future cases.

Epilepsy remains a major global health concern with a substantial and uneven disease burden. Comprehensive burden analyses are essential for guiding public health policy, optimizing resource allocation, and developing targeted prevention and intervention strategies.