Temporal trends in the epilepsy treatment gap in low- and low-middle-income countries: A meta-analysis

Earlier systematic reviews estimated the epilepsy treatment gap in low- and low-middle-income countries to be above 75%. Reduction in the gap since then due to healthcare improvements and socio-economic changes is plausible but unproven.

To review the epilepsy treatment gap evidence and determine if it has decreased over time.

We identified articles in English reporting estimates of the treatment gap in community samples from low- and low-middle-income countries from 1980 onwards. We performed meta-proportion analyses to determine the treatment gap's pooled estimates and meta-regression analyses to determine time trends for all countries and separately for African and Asian countries.

The analysis included 58 full studies and 12 abstracts covering 31 countries. We retrieved a single report for 18 countries. The pooled estimate for treatment gap for all countries was 71% (95% Confidence Intervals: 65%, 77%; I²: 98.4%), for Africa, 73% (95% CIs: 66%, 80%; I²: 97.9%) and for Asia, 69% (95% CIs: 58%, 79%; I²: 98.8%). We found wide between studies variance and observed a trend towards reduction in the pooled gap from all countries. The reduction was significant for African countries (Regression Coefficient: -0.025; 95% CI, -0.048 to -0.0005; P = 0.045) but not for Asia (Regression Coefficient: -0.0008; 95% CI, -0.023 to 0.007; P = 0.26).

Despite limitations of large variances, small sizes of individual studies, limited or no data from many countries, there is progress in reduction of the epilepsy treatment gap in low- and low-middle-income countries. This progress is considerable in Africa compared to Asia.