Interventional programs to improve therapeutic management of people with epilepsy in low- and middle-income countries

Abstract : Objective: To assess the current status of initiatives carried out in developing countries to improve therapeutic management of people with epilepsy. Methods: A literature review was performed in 2015 to identify and analyze interventional programs carried out in countrieswith low- and middle-income economies. Electronic databases were reviewedwith no time restriction. Each intervention was categorized according to the level of evidence achieved (A: blind randomized controlled trial, B: randomized controlled trial, C1: randomized trial, C2: controlled trial, D: prospective cohort, E: retrospective evaluation). Results: A total of 46 intervention projects were identified, 13with no quantitative assessment. The 31 remaining projectswere carried out in 18 countries, 52% (16) in Africa, 42% (13) in Asia, and 6% (2) in Latin America. Among those, 13% (4) were level B, 3% (1) C1, 6% (2) C2, 74% (23) D, and 3% (1) were level E. The effectiveness of the intervention, assessed by the efficacy of antiepileptic drugs, was the primary objective in 81% (25). People with epilepsy were on average seizure-free in 44.6% ± 14.4% of cases at one year, ranging from 25.0% to 78.4%. At two years, on average 50.9% ± 29.7% are seizure-free, ranging from 4.6 to 92.7%. The median compliance was 79.3% with a minimum of 21.6% and a maximum of 100.0%. Discussion: No blind randomized controlled trial has been used to assess the efficacy of a programto improve access to antiepileptic drugs (AEDs) in developing countries, and the level of evidence was globally low. Phenobarbital remains the AED predominantly used in programs. Adherence to treatment management has been pointed out to be a key element in the success of a program, sometimes not sufficiently considered. Monthly supply of AEDs, at specific and community level, reducing the costs and time spent traveling, appeared to be the most effective strategies. Homogenization and standardization of evaluation practices of programs to improve themanagement of epilepsy in resource-limited settings would lead to comparison and meta-analysis which would ultimately improve strategies of support for not only epilepsy but also other noncommunicable diseases in developing countries.
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Contributeur : Elisabeth Grelier <>
Soumis le : mercredi 7 février 2018 - 14:48:18
Dernière modification le : mardi 12 février 2019 - 10:53:04

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Jérémy Jost, Luz Maria Moyano, Emilie Auditeau, Farid Boumédiène, Voa Ratsimbazafy, et al.. Interventional programs to improve therapeutic management of people with epilepsy in low- and middle-income countries. Epilepsy and Behavior, Elsevier, 2018, 80, pp.337-345. ⟨10.1016/j.yebeh.2018.01.011⟩. ⟨hal-01703089⟩

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