Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta‐analysis of population‐based studies

Abstract

Objective This study was undertaken to perform an updated systematic review and meta‐analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. Methods Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. Meta‐analyses and cumulative analyses were performed using random‐effects models. We assessed between‐study heterogeneity with sensitivity, subgroup, and meta‐regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. Results Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person‐years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72–16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94–11.44), and the incidence rate was 1.11 per 1000 person‐years (95% CI = .65–1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries’ epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. Significance The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between‐study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.

Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study

“…A change in seizure threshold among recipients of mRNA vaccines has not been observed in RCTs, and, according to our data, this is unlikely; it is possible that structural (e.g., pre-existing epilepsy) or pathological conditions (e.g., concomitant COVID-19) may explain most of the reported seizures. While vaccines may increase the frequency of febrile seizures in children, in most cases, the coexistence of structural or genetic causes explains epileptic seizures [ [17] , [18] , [19] ]. The temporal association of seizures with inactivated and live attenuated viral vaccines is well known but infrequent [ 17 ].…”

“…The temporal association of seizures with inactivated and live attenuated viral vaccines is well known but infrequent [ 17 ]. The calculated lifetime prevalence of epilepsy in Latin America is 14.9/1000 inhabitants [ 19 ]. A similar prevalence is expected in our cohort, where only a handful of epileptic seizures occurred, suggesting that mRNA vaccines are not associated with a higher frequency of new-onset seizures, and are safe even among those with a history of seizures/epilepsy (~1.5% of those immunized).…”

Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis

“…The certain of evidence assessment was conducted as in our previously published articles [ 2 , 65 , 99 ]. We adapted the evaluation for prevalence meta-analysis using the five domains described in the GRADE handbook as follows: study limitations (the risk of bias of the primary studies), imprecision (appropriateness of the sample size and width of the CI), indirectness (generalizability of results), inconsistency (between-study heterogeneity), and publication bias [ 76 ].…”

COVID-19 Incidence and Death Rate in Epilepsy: Too Early to Tell?

“…7 By contrast, an international metaanalysis calculated a prevalence of 0.64% 8 and a recent Latin America systematic review and meta-analysis found an active prevalence of 0.9%. 9 Although rates may indeed differ among different populations, a major problem is the wide variation in the completeness of case ascertainment and the definitions of epilepsy used in studies on the epidemiology of epilepsy. If the Spanish prevalence is actually higher, then the cumulative incidence of epilepsy patients with COVID-19 is probably not statistically different from the control population.…”