Instruments for investigation of epilepsy in low- and middle-income countries: A systematic review

Vergonjeanne, Marion; Auditeau, Emilie; Thébaut, Clémence; Boumédiène, Farid; Preux, Pierre‐Marie

doi:10.1016/j.eplepsyres.2022.106865

Cited by 8 publications

(3 citation statements)

References 33 publications

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“…This suggests that with socioeconomic development, the pattern of disease burdens in the above-mentioned regions is gradually shifting to a predominantly chronic non-communicable disease pattern, leading to a continuous increase in the incidence of chronic diseases. The increase may also be related to environmental pollution [ 26 ], lifestyle changes [ 27 ], and advances in diagnostic methods in those regions [ 28 ]. Metabolic risk factors and poor lifestyles (eg, smoking and a lack of exercise) are now prevalent in these regions, concurrent with a significant increase in the incidence of obesity, diabetes, and hypertension [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide

Huang,

Li,

Pan

et al. 2023

J Glob Health

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Background We aimed to determine the incidence and disability-adjusted life-years (DALYs) of neurological disorders worldwide from 1990 to 2019. Methods We obtained age-standardised incidence and DALY rates of neurological disorders in 204 countries and territories from 1990 to 2019 from the Global Burden of Disease (GBD) database. We determined trends stratified by age, sex, region, country, and Social Development Index (SDI) and the risk factors contributing to DALYs associated with these neurological disorders. Results The largest increases in the age-standardised incidence rates of neurological disorders in 1990-2019 occurred in four regions (East Asia: estimated annual percentage change (EAPC) = 0.19, tropical Latin America: EAPC = 0.07, Southern Latin America: EAPC = 0.03, Western Europe: EAPC = 0.03) and three countries (China: EAPC = 0.20, Ecuador: EAPC = 0.13, Italy: EAPC = 0.13). We observed the largest increases in age-standardised incidence rates for Parkinson disease, idiopathic epilepsy, and bipolar disorder, and in age-standardised DALY rates for Alzheimer disease and other dementias. High-SDI regions showed the highest EAPC for age-standardised incidence rates of Parkinson disease, depression, and motor neuron disease, and age-standardised DALY rates of neurological disorders. Conclusions There is a need to control the increase in age-standardised incidence rates of neurological disorders in East Asia, tropical Latin America, Southern Latin America, and Western Europe, particularly in China, Ecuador, and Italy.

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Section: Discussionmentioning

confidence: 99%

Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide

Huang,

Li,

Pan

et al. 2023

J Glob Health

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“…A partnership between the Congolese Ministry of Health and LICOCE has the potential to establish a standardized, evidence‐based national policy to guide epilepsy care. Furthermore, the consolidation of efforts by the government, healthcare providers, and the local community can streamline the implementation of widespread epilepsy screening using diagnostic tools based on mobile apps, 33 thereby enabling early detection. This collaborative effort can lead to the creation of a national epilepsy registry and surveillance system, furnishing essential data for monitoring prevalence, treatment outcomes, and emerging challenges.…”

Section: Discussionmentioning

confidence: 99%

Review of epilepsy care in the Democratic Republic of the Congo

Tshimbombu,

Shin,

Thesen

et al. 2024

Epilepsia Open

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Epilepsy imposes a substantial burden on the Democratic Republic of Congo (DRC). These challenges encompass the lack of comprehensive disease surveillance, an unresolved understanding of its pathophysiology, economic barriers limiting access to essential care, the absence of epilepsy surgical capabilities, and deeply ingrained societal stigmas. Notably, the national prevalence of epilepsy remains undetermined, with research primarily concentrating on infectious factors like Onchocerca volvulus, leaving other potential causes underexplored. Most patients lack insurance, incurring out‐of‐pocket expenses that often lead them to opt for traditional medicine rather than clinical care. Social stigma, perpetuated by common misconceptions, intensifies the social isolation experienced by individuals living with epilepsy. Additionally, surgical interventions are unavailable, and the accessibility of anti‐seizure medications and healthcare infrastructure remains inadequate. Effectively tackling these interrelated challenges requires a multifaceted approach, including conducting research into region‐specific factors contributing to epilepsy, increasing healthcare funding, subsidizing the costs of treatment, deploying mobile tools for extensive screening, launching awareness campaigns to dispel myths and reduce stigma, and promoting collaborations between traditional healers and medical practitioners to enhance local understanding and epilepsy management. Despite the difficulties, significant progress can be achieved through sustained and compassionate efforts to understand and eliminate the barriers faced by epilepsy patients in the region. This review outlines essential steps for alleviating the epilepsy burden in the DRC.Plain Language summaryThere are not enough resources to treat epilepsy in the DRC. PWEs struggle with stigma and the lack of money. Many of them still use traditional medicine for treatment and hold wrong beliefs about epilepsy. That is why there is a need for more resources to make the lives of PWEs better in the DRC.

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“…Third, the preponderance of SSA studies including only convulsive seizures, which are more easily detected in resource-limited settings [40], leaves non-convulsive seizures underrated. Most screening questionnaires exclude non-convulsive seizures a priori [41][42][43][44]. The epilepsy prevalence in a study in urban Tanzania more than doubled when including non-convulsive seizures [45], and a study in rural Kenya reported an overall epilepsy prevalence three times that of active convulsive epilepsy [46].…”

Section: Discussionmentioning

confidence: 99%

Very high epilepsy prevalence in rural Southern Rwanda: The underestimated burden of epilepsy in sub‐Saharan Africa

Garrez,

Teuwen,

Sebera

et al. 2023

Tropical Med Int Health

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ObjectivesUp to 85% of people living with epilepsy (PwE) reside in low‐and middle‐income countries. In sub‐Saharan Africa, the lifetime prevalence of epilepsy is 16 per 1000 persons. In Northern rural Rwanda, a 47.7 per 1000 prevalence has been reported. As variations in prevalence across geographical areas have been observed, we studied the prevalence in Southern rural Rwanda using the same robust methodology as applied in the North.MethodsWe conducted a three‐stage, cross‐sectional, door‐to‐door survey in two rural villages in Southern Rwanda from June 2022 to April 2023. First, trained enumerators administered the validated Limoges questionnaire for epilepsy screening. Second, neurologists examined the persons who had screened positively to confirm the epilepsy diagnosis. Third, cases with an inconclusive assessment were separately reexamined by two neurologists to reevaluate the diagnosis.ResultsEnumerators screened 1745 persons (54.4% female, mean age: 24 ± 19.3 years), of whom 304 (17.4%) screened positive. Epilepsy diagnosis was confirmed in 133 (52.6% female, mean age: 30 ± 18.2 years) and active epilepsy in 130 persons. Lifetime epilepsy prevalence was 76.2 per 1000 (95% CI: 64.2–89.7‰). The highest age‐specific rate occurred in the 29–49 age group. No gender‐specific differences were noted. In 22.6% of the PwE, only non‐convulsive seizures occurred. The treatment gap was 92.2%, including a diagnosis gap of 79.4%.ConclusionWe demonstrated a very high epilepsy prevalence in Southern rural Rwanda, with over 20% of cases having only non‐convulsive seizures, which are often underdiagnosed in rural Africa. In line with previous Rwandan reports, we reiterate the high burden of the disease in the country. Geographic variation in prevalence throughout Africa may result from differences in risk and aetiological factors. Case–control studies are underway to understand such differences and propose adapted health policies for epilepsy prevention.

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Instruments for investigation of epilepsy in low- and middle-income countries: A systematic review

Cited by 8 publications

References 33 publications

Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide

Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide

Review of epilepsy care in the Democratic Republic of the Congo

Very high epilepsy prevalence in rural Southern Rwanda: The underestimated burden of epilepsy in sub‐Saharan Africa

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