Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, P.O. Box 272, Debre Tabor, Amhara, Ethiopia.
Clinical Pharmacy Unit and Research Team, Department of Pharmacy, College of Health Sciences, Debre Tabor University, P.O. Box 272, Debre Tabor, Amhara, Ethiopia.
Behav Neurol. 2021 May 13;2021:5586041. doi: 10.1155/2021/5586041. eCollection 2021.
The prevalence and incidence rate of epilepsy were found to be higher in low- and middle-income countries. Uncontrolled epilepsy has a high risk of disability, stigma, discrimination, human rights violations, and premature death. The available studies of controlled seizure in Ethiopia have showed inconsistent results which calls for systematic review and meta-analysis. Therefore, this review intended to show the pooled prevalence of controlled seizure among people with epilepsy receiving antiepileptic drugs at outpatient department.
A systematic literature search was conducted using PubMed/Medline, Science Direct, PsycINFO, Hinnarri databases, and Google Scholar for grey literatures. Data were extracted with structured format prepared using Microsoft Excel and exported to Stata/MP 16.0 software for analyses. The test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI).
A total of 23 primary studies were included in the review showing the pooled prevalence of controlled seizure to be 46% (95% CI: 35, 56). A subgroup analysis of the primary studies showed a considerable variation in magnitude of seizure freedom by study regions, age groups, and seizure-free period. The highest prevalence was found in Addis Ababa 52% (95% CI: 29, 75), pediatric patients 77% (95% CI: 71, 83), and a seizure-free period of less than six months 58% (95% CI: 32, 83). On the other hand, the lowest prevalence of controlled seizure was found in Tigray 27% (95% CI: 11, 65), adult patients 43% (95% CI: 32, 54), and a seizure-free period of six or more 41% (95% CI: 32, 51). Higher frequency of seizure before treatment (2.23, 95% CI: 1.15, 3.31) and medication nonadherence (2.7, 95% CI: 1.25, 4.15) had statistically significant association with uncontrolled seizure.
In this review, the prevalence of controlled seizure was found to be low. This warrants that clinicians should give more focus to epileptic patients regarding monitoring and evaluation of treatment outcome of epilepsy and factors that affect seizure control in routine clinical services. The use of standardized definition of controlled seizure, designing strategies to identify pharmacoresistant epilepsy and its treatment, and increasing medication adherence are recommended in Ethiopia. The review protocol has been registered with PROSPERO registration number CRD42021215302.
癫痫的患病率和发病率在中低收入国家较高。未得到控制的癫痫有很高的致残风险、耻辱感、歧视、侵犯人权和过早死亡的风险。在埃塞俄比亚，已有研究显示抗癫痫药物治疗下癫痫的控制率结果不一致，因此需要进行系统评价和荟萃分析。本综述旨在展示在接受抗癫痫药物治疗的癫痫患者中门诊控制发作的总体患病率。
通过 PubMed/Medline、Science Direct、PsycINFO、Hinnarri 数据库和 Google Scholar 对英文文献进行系统检索，对灰色文献进行了系统检索。使用 Microsoft Excel 制定的结构化格式提取数据，并将数据导出到 Stata/MP 16.0 软件进行分析。采用 检验评估初级研究间的异质性，相应的 95%置信区间（CI）。
本综述共纳入 23 项初级研究，结果显示控制发作的总体患病率为 46%（95%CI：35，56）。对初级研究的亚组分析表明，不同研究区域、年龄组和无发作期的癫痫无发作比例存在较大差异。在亚组分析中，发现控制发作比例最高的是亚的斯亚贝巴 52%（95%CI：29，75），儿童患者 77%（95%CI：71，83），无发作期少于 6 个月的患者 58%（95%CI：32，83）。另一方面，在提格雷发现控制发作比例最低为 27%（95%CI：11，65），成年患者为 43%（95%CI：32，54），无发作期 6 个月或更长时间的患者为 41%（95%CI：32，51）。治疗前发作频率较高（2.23，95%CI：1.15，3.31）和药物不依从（2.7，95%CI：1.25，4.15）与未控制的癫痫发作有统计学显著关联。
在本综述中，控制发作的比例较低。这表明临床医生应该更加关注癫痫患者，监测和评估癫痫的治疗效果以及影响癫痫发作控制的因素。建议在埃塞俄比亚使用标准化的控制发作定义、制定识别耐药性癫痫及其治疗的策略以及提高药物依从性。本综述的方案已在 PROSPERO 注册，注册号为 CRD42021215302。
