耐药性癫痫的发病率和患病率：系统评价和荟萃分析。

Incidence and Prevalence of Drug-Resistant Epilepsy: A Systematic Review and Meta-analysis.

机构信息

From the Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM) (B.S., M.-A.P., A.V.C., J.C., B.R., M.R.K.); Department of Neurosciences (B.S., M.-A.P., A.V.C., J.C., B.R., M.R.K.), Université de Montréal, Quebec; Schulich Library of Physical Sciences (G.G.), Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada; Department of Psychosomatic Medicine and Psychotherapy (P.R.B.), University Medical Center Freiburg, Germany; Department of Neurology (C.-S.K., N.J.), Icahn School of Medicine at Mount Sinai, New York; Department of Clinical Neurosciences and Hotchkiss Brain Institute (N.J., C.B.J.), University of Calgary, Alberta; and School of Public Health of the Université de Montréal (M.R.K.), Quebec, Canada.

出版信息

Neurology. 2021 Apr 27;96(17):805-817. doi: 10.1212/WNL.0000000000011839. Epub 2021 Mar 15.

DOI:10.1212/WNL.0000000000011839

PMID:33722992

Abstract

OBJECTIVE

To evaluate the incidence and prevalence of drug-resistant epilepsy (DRE) as well as its predictors and correlates, we conducted a systematic review and meta-analysis of observational studies.

METHODS

Our protocol was registered with PROSPERO, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology reporting standards were followed. We searched MEDLINE, Embase, and Web of Science. We used a double arcsine transformation and random-effects models to perform our meta-analyses. We performed random-effects meta-regressions using study-level data.

RESULTS

Our search strategy identified 10,794 abstracts. Of these, 103 articles met our eligibility criteria. There was high interstudy heterogeneity and risk of bias. The cumulative incidence of DRE was 25.0% (95% confidence interval [CI]: 16.8-34.3) in child studies but 14.6% (95% CI: 8.8-21.6) in adult/mixed age studies. The prevalence of DRE was 13.7% (95% CI: 9.2-19.0) in population/community-based populations but 36.3% (95% CI: 30.4-42.4) in clinic-based cohorts. Meta-regression confirmed that the prevalence of DRE was higher in clinic-based populations and in focal epilepsy. Multiple predictors and correlates of DRE were identified. The most reported of these were having a neurologic deficit, an abnormal EEG, and symptomatic epilepsy. The most reported genetic predictors of DRE were polymorphisms of the gene.

CONCLUSIONS

Our observations provide a basis for estimating the incidence and prevalence of DRE, which vary between populations. We identified numerous putative DRE predictors and correlates. These findings are important to plan epilepsy services, including epilepsy surgery, a crucial treatment option for people with disabling seizures and DRE.

摘要

目的

为了评估耐药性癫痫（DRE）的发病率和患病率，以及其预测因素和相关因素，我们对观察性研究进行了系统评价和荟萃分析。

方法

我们的方案在 PROSPERO 上进行了注册，并遵循了系统评价和荟萃分析以及观察性研究的荟萃分析的首选报告项目和流行病学报告标准。我们检索了 MEDLINE、Embase 和 Web of Science。我们使用双反正弦变换和随机效应模型进行荟萃分析。我们使用研究水平的数据进行随机效应荟萃回归。

结果

我们的搜索策略确定了 10794 篇摘要。其中，103 篇文章符合我们的入选标准。研究之间存在高度的异质性和偏倚风险。儿童研究中 DRE 的累积发病率为 25.0%（95%置信区间[CI]：16.8-34.3），而成人/混合年龄研究中为 14.6%（95%CI：8.8-21.6）。人群/社区人群中 DRE 的患病率为 13.7%（95%CI：9.2-19.0），而临床人群中为 36.3%（95%CI：30.4-42.4）。荟萃回归证实，临床人群和局灶性癫痫中 DRE 的患病率更高。确定了 DRE 的多个预测因素和相关因素。其中报道最多的是有神经功能缺损、异常脑电图和症状性癫痫。报道最多的 DRE 遗传预测因子是基因的多态性。