Kwon Churl-Su, Wagner Ryan G, Carpio Arturo, Jetté Nathalie, Newton Charles R, Thurman David J
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA.
Epilepsia. 2022 Mar;63(3):551-564. doi: 10.1111/epi.17112. Epub 2022 Jan 10.
In order to more appropriately apply and understand the "epilepsy treatment gap" (ETG) concept in current health systems, revised conceptual and operational definitions of ETG are timely and necessary. This article therefore systematically reviews worldwide studies of the ETG, distinguishing high-, middle-, and low-income regions, and provides recommendations for an updated International League Against Epilepsy (ILAE) definition of ETG.
A systematic review of the ETG was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search was conducted from January 1990 to July 2019, in the online databases of Ovid MEDLINE and Embase. Identified abstracts were reviewed in duplicate and data independently extracted using a standard proforma. Data describing treatment gap information including both diagnostic and therapeutic aspects of access to epilepsy treatment were recorded. Descriptive statistics are presented.
The treatment gap reported in the 45 distinctive populations represented 33 countries. Treatment gap definitions varied widely. The reported ETGs ranged broadly from 5.6% in Norway to 100% in parts of Tibet, Togo, and Uganda. The wide range of reported ETGs was multifactorial in origin including true differences in the availability and utilization of health care among study populations, variations in operational definitions of the epilepsy treatment gap, and methodological differences in sampling and identifying representative epilepsy cases in populations. Significance and recommendations For the ETG to be a useful metric to compare levels of unmet epilepsy care across different countries and regions, a standardized definition must be adapted, recognizing some of the limitations of the current definitions. Our proposed definition takes into account the lack of effective health care insurance, the diagnostic gap, the therapeutic gap, quality-of-care, and other unmet health care needs."
为了在当前卫生系统中更恰当地应用和理解“癫痫治疗缺口”（ETG）概念，及时修订ETG的概念和操作定义是必要的。因此，本文系统回顾了全球范围内关于ETG的研究，区分了高、中、低收入地区，并为国际抗癫痫联盟（ILAE）更新ETG定义提供建议。
采用系统评价和Meta分析的首选报告项目（PRISMA）标准对ETG进行系统评价。检索时间为1990年1月至2019年7月，在Ovid MEDLINE和Embase在线数据库中进行。对识别出的摘要进行双人复核，并使用标准表格独立提取数据。记录描述治疗缺口信息的数据，包括癫痫治疗可及性的诊断和治疗方面。呈现描述性统计结果。
报告的45个不同人群代表了33个国家的治疗缺口。治疗缺口的定义差异很大。报告的ETG范围广泛，从挪威的5.6%到西藏部分地区、多哥和乌干达的100%。报告的ETG范围广泛是多因素造成的，包括研究人群中医疗保健可及性和利用率的真正差异、癫痫治疗缺口操作定义的差异以及人群中抽样和识别代表性癫痫病例的方法学差异。意义和建议 为使ETG成为比较不同国家和地区未满足癫痫治疗水平的有用指标，必须采用标准化定义，同时认识到当前定义的一些局限性。我们提出的定义考虑了缺乏有效的医疗保险、诊断缺口、治疗缺口、医疗质量以及其他未满足的医疗需求。
