The Worldwide Epilepsy Treatment Gap: A Systematic Review and Recommendations for Revised Definitions - A Report from the ILAE Epidemiology Commission
Abstract number :
3.374
Submission category :
16. Epidemiology
Year :
2021
Submission ID :
1826453
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Churl-Su Kwon, MD MPH FRSPH - Icahn School of Medicine at Mount Sinai; Ryan Wagner – MRC/Wits Agincourt Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Arturo Carpio – Research Institute, University of Cuenca School of Medicine, Cuenca, Ecuador; Nathalie Jette – Icahn School of Medicine at Mount Sinai, New York, New York, USA; Charles Newton – Department of Psychiatry, University of Oxford, Oxford, UK; David Thurman – Neuro-Epi Research. LLC, Atlanta, GA, USA
Rationale: 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 paper therefore systematically reviews worldwide studies of the ETG, distinguishing high-, middle-, and low-income regions, and provides recommendations for an updated ILAE definition of ETG.
Methods: A systematic review of the ETG was performed using 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.
Results: 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.
Conclusions: 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 healthcare insurance, the diagnostic gap, the therapeutic gap, quality-of-care and other unmet healthcare needs.
Funding: Please list any funding that was received in support of this abstract.: N/A.
Epidemiology