Epidemiologic studies of epilepsy, which are indispensable to estimate the magnitude of a problem, are limited in Japan. A 1-day population-based survey of children under the age of 13 years, conducted in Okayama Prefecture in 1999, showed the prevalence rate of seizure disorders to be 8.9 per 1,000 population (2,222 per 250,997). When febrile seizures and other single provoked seizures and acute symptomatic seizures were excluded (848 cases), the rate was 5.5 per 1,000.¹⁴ The figures are comparable with those in the United States and Europe.⁵ According to a 1-day survey done by the Ministry of Health in 2002, on the estimated number of patients with epilepsy whose medical fees were subsidized by any one of the governmental health insurance systems, 74,000 patients were hospitalized and 195,000 patients visited outpatient clinics.⁷

The issue of medically refractory epilepsy is a topic of special significance in epilepsy treatment. A series of nationwide surveys was carried out to establish the number of people with refractory epilepsy in Japan. People with refractory epilepsy were defined as those with an increase or no change in seizure frequency despite at least 3 years of intensive medical treatment at either a university hospital or a specialized center. The number of patients identified in these surveys as having refractory epilepsy was over 100,000. Most of these patients also had multiple neurologic and psychosocial problems. Of patients 15 years of age or younger, 13.5% were found to have medically refractory epilepsy,¹⁵ and the epilepsy of 25.3% of patients over 16 years of age was medically refractory.¹³

In Japan, epilepsy patients were treated by psychiatrists until 1950s. For this reason, mental hospitals are the final stop for individuals with most refractory and disabling epilepsy. The Handbook for Mental Health and Hygiene reported, in 2002, that 4,243 (1.3%) of 330,050 patients institutionalized in mental hospitals in Japan on a long-term basis had intractable seizures in addition to personality and psychiatric disorders or mental disabilities.⁸ The number of patients with epilepsy who were admitted to mental hospitals has decreased markedly over the past decade. The numbers have dropped yearly since 1995. Between 1995 and 1997, respectively, 8,997, 8,574, and 8,332 patients with epilepsy were hospitalized in mental hospitals in Japan. This decrease in numbers of hospitalized patients presumably represents improvements in epilepsy care in general in Japan.¹

In a 1966 article, Wada²⁰ noted that Japan’s progress in the scientific aspects of epileptology was on par with that of North America and Europe, although Japan lagged behind in its support of comprehensive medical services for epilepsy. Unlike the nations of North America and Europe, where custodial facilities for people with epilepsy and other disabilities were established in the middle of the 19th century,^2,3 state-sponsored institutional care for people with disabilities was not introduced in Japan until the mid 20th century. Legislation for the creation of institutions for individuals with severe mental disabilities was introduced in 1959. This legislation was established only after the state was pressured by lay people and professionals to take responsibility for the support for individuals with severe disabilities. Thus, although the influential 1969 Reid Report² was shelved for lack of funding and political will in Great Britain,¹⁸ its recommendations concerning the general care and management of patients with epilepsy, as well as for the creation of special epilepsy centers, were welcomed with great enthusiasm by Japanese professionals.

Although the need for establishing comprehensive multidisciplinary treatment programs for people with epilepsy in Japan was advocated by Nakata as early as 1966,¹² it was only in the 1970s that a special center for the treatment of epilepsy was established.¹⁹ Inspired by the Reid Report,² the Japanese Ministry of Health and Welfare decided in 1975 to convert a tuberculosis hospital located in Shizuoka into a special center for epilepsy.²³ The center was defined as an integrated organization from which delivery of the following services would be possible: (a) long-term, longitudinal care of individuals with epilepsy from infancy through adolescence to adulthood; (b) multidisciplinary team treatment by neurologists, pediatricians, neurosurgeons, psychiatrists, nurses, and comedical personnel; (c) occupational therapy and rehabilitation activities; and (d) training and research in epileptology. In addition, during the 1980s and 1990s, several governmental sanatoriums Tokyo, Kyoto, Niigata, and Yamagata converted their neurology/psychiatry clinics into epilepsy assessment centers. The total number of these converted beds was approximately 250 in 2005.

The remainder of this chapter is devoted to a description of the current therapeutic activities and demographic features of the National Epilepsy Center in Shizuoka, based on statistics from 1975 to 2002. From 1975 to 2001, a total of 22,950 new patients with epilepsy visited our Center. The number of patients younger than 15 years of age has deceased since the mid 1980s, whereas the number of patients older than 15 years of age has gradually increased. The electroencephalogram (EEG) was the most frequently performed clinical investigation. A total of 187,600 EEGs was performed between 1975 and 2001.