Comorbidities of epilepsy in low and middle-income countries: systematic review and meta-analysis
Résumé
Epilepsy is a major public health concern in low and middle-income countries (LMICs) and comorbidities
aggravate the burden associated with the disease. The epidemiology of these comorbidities has
not been well described, although, identifying the main comorbidities of epilepsy, and their relative
importance, is crucial for improving the quality of care. Comorbidities were defined as disorders
coexisting with or preceding epilepsy, or else compounded or directly attributed to epilepsy or to its
treatment. A meta-analysis of the proportion of main comorbidities by subcontinent as well as overall
was also conducted. Out of the 2,300 papers identified, 109 from 39 countries were included in this
systematic review. Four groups of comorbidities were identified: parasitic and infectious diseases
(44% of comorbid conditions), somatic comorbidities (37%), psychosocial (11%), as well as psychiatric
comorbidities (8%). Heterogeneity was statistically significant for most variables then random effect
models were used. The most frequently studied comorbidities were: neurocysticercosis (comorbid
proportion: 23%, 95% CI: 18–29), head trauma (comorbid proportion: 9%, 95% CI: 5–15) malnutrition
(comorbid proportion: 16%, 95% CI: 28–40), stroke (comorbid proportion: 1.3%, 95% CI: 0.2–7.0),
and discrimination for education (comorbid proportion: 34%, 95% CI: 28–40). Many comorbidities of
epilepsy were identified in LMICs, most of them being infectious.