Epidemiology of Drug-resistant Epilepsy in Latin America and the Caribbean: Systematic Review Update and Meta-analysis
Niels Pacheco1, Carlos Alva-Diaz2, Andre Lapeyre Rivera3, Luis Purisaca Neira4, Daniel Fernandez-Guzman5, Poul Espino-Alvarado6, John Rolston7, Jorge Burneo6
1Harvard Medical School, 2Universidad Cientifica del Sur, 3Universidad Nacional de San Marcos, 4UNIVERSIDAD NACIONAL PEDRO RUIZ GALLO, 5Unsaac, 6University of Western Ontario, 7Brigham and Women’s Hospital
Objective:
To determine the prevalence of drug-resistant, controlled and non-optimally controlled epilepsy in Latin America and the Caribbean.
Background:
Drug-resistant epilepsy (DRE) is a challenging condition that demands more specialized management compared to other forms of epilepsy. Despite a global prevalence of approximately 30%, Latin American and the Caribbean (LAC) socioeconomic and cultural factors could suggest a higher prevalence and incidence of this condition in the region.
Design/Methods:
A systematic search was performed in PubMed, Embase, SCOPUS, Cochrane Central, WOS, Lilacs and Scielo, for studies conducted up to September 11th, 2023. Studies aiming to assess the epidemiology (prevalence and incidence) of DRE, controlled epilepsy (CE) and non-optimally controlled epilepsy (NOCE) were selected. In addition, only observational studies written in English, Spanish and Portuguese were included. NOCE was defined as a composite outcome of drug resistant epilepsy, partially controlled, indeterminate, uncontrolled, and pseudo-refractory epilepsy. Quality assessment was performed using the Newcastle-Ottawa scale for observational studies. A single-arm, random effects model meta-analysis of proportions was conducted, using the I2 statistics to measure the statistical heterogeneity.
Results:
A total of 1653 studies were screened, resulting in 11 selected studies, representing a total of 2294 patients. The pooled proportion of drug resistant epilepsy was 41% CI 95 [25%,56%; I2=99%]. In addition, the pooled proportion of CE and NOCE was 46% CI 95 [26%, 67%; I2=98%] and 68% CI 95 [48%, 87%; I2=99%]. Quality assessment showed medium to high risk of bias.
Conclusions:
In LAC, the prevalence of DRE is higher than global estimates. In addition, the estimates for CE and NOCE are shown below and above, respectively, compared to global data. This could indicate that there are determinants different from those that produce DRE that generate worse control of seizures due to epilepsy in LAC. These determinants could be cultural, economic and health-related.