Treatment Outcome of Epileptic Patients Receiving Antiepileptic Drugs in Ethiopia: A Systematic Review and Meta-Analysis

Abstract

Background. 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. Methods. 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 I 2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Results. 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. Conclusion. 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.

Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia

“…Several studies found it to be widely used in SSA countries. 12 , 16 , 18 , 20 – 23 On multivariate logistic regression analysis, the odds of an uncontrolled seizure was fourfold higher in patients with more than five pretreatment seizure episodes as compared with those who had five or less (AOR = 3.98, 95% CI: 1.81–8.75, p = 0.001). Hospital-based studies in Italy, Scotland, India, and Ethiopia showed that frequent seizures before treatment were related to poor seizure control.…”

“…The sample size was calculated using a single population proportion formula with the assumption of 95% confidence level, 5% margin of error, and taking 30% for seizure control in recent study in Ethiopia. 20 A convenience sampling method was used to recruit 320 study subjects.…”

“…Age of seizure onset, prolonged duration of epilepsy, focal or multiple seizure types, frequent pretreatment seizure episodes, symptomatic epilepsy, abnormal electroencephalography (EEG) findings, MRI lesions, poor adherence to ASMs, family history of epilepsy, coexisting psychiatric problems, and alcohol consumption were condemned as risk factors for poor seizure control. 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Poorly controlled seizures lead to excessive bodily injury, psychological distress, lower educational achievements, lower employment opportunities, reduced marriage prospects, social stigma and discrimination, impairment of quality of life and shortened lifespan. [3][4][5][6][7][8][9][10][11]15,17 The study aimed to find strategies for optimal seizure control in the study setting and similar institutions.…”

Medicinal plants utilized in the management of epilepsy in Ethiopia: ethnobotany, pharmacology and phytochemistry

“…It is reported that almost 80% of epilepsy cases are found in low—and middle-income countries (LMICs) [ 4 ] due to lack of sufficient antiepileptic drugs (AEDs), high cost if any AEDs available, and undesirable outcomes of the existing AEDs [ 8 ]. In the case of Ethiopia, epilepsy is one of the 20 leading causes of mortality, and 5.2 out of 1000 people are prone to ES in their lifetime [ 9 , 10 ]. In general, epilepsy has substantial economic implications, predominantly in Africa, as it triggered a great burden on the underprivileged healthcare system of poor nations [ 11 ] as well as on patients owing to the epilepsy-bound poor QOL, stigma, and discrimination in patients and relatives [ 12 ] that could ominously increase healthcare expenditure and diminish overall productivity [ 10 ].…”

Assessment of Low and Medium Anti-epileptic Medication Adherence among Epileptic Patients in Dessie Comprehensive Specialized Hospital, North-East Ethiopia: Cross Sectional Study

“…In Ethiopia, there was discrepancy on the prevalence of controlled seizure among patients receiving antiepileptic drugs that ranges from 8-93.8% [19]. Most patients rely on traditional treatments of epilepsy such as local herbs, holy water, and amulets [20]. Even though there are a number of studies on AED nonadherence, but there is no study about the underlying causes for each low and medium medication adherence.…”