02895nas a2200289   4500000000100000008004100001260001600042653002500058653001400083653002100097653001300118653001400131653002300145653001900168653002100187653001800208100001900226700001700245700001300262700001800275245015100293856015300444300001200597490000800609520197400617022001402591       2023                            d  bElsevier BV10aNeurology (clinical)10aNeurology10aGeneral Medicine10aEpilepsy10aMortality10aSub-Saharan Africa10aonchocerciasis10aNodding syndrome10aMeta-analysis1 aSiewe Fodjo JN1 aVan Cutsem G1 aAmaral L1 aColebunders R00aMortality among persons with epilepsy in onchocerciasis-endemic and non-endemic areas of sub-Saharan Africa: A systematic review and meta-analysis  uhttps://www.sciencedirect.com/science/article/pii/S1059131123001899/pdfft?md5=64d3f32106b48902bf817f49ea150b5f&pid=1-s2.0-S1059131123001899-main.pdf  a253-2610 v1103 a<p><strong>Purpose:</strong> To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity.</p>

<p><strong>Methods:</strong> Systematic review with meta-analysis. Searches were performed in PubMed and Google Scholar (search terms: ‘epilepsy’; ‘mortality/death’; ‘sub-Saharan Africa’). Included studies were classified as high-risk or low-risk for onchocerciasis based on documented endemicity data. Pooled mortality rates and annual case fatality rates (CFR) were calculated, and risk factors for mortality among persons with epilepsy (PWE) were investigated using meta-regression analysis.</p>

<p><strong>Results:</strong> The 28 eligible studies reported 30 epilepsy surveys, of which 9 (30.0%) were conducted in onchocerciasis high-risk sites. The pooled epilepsy mortality rate was 20.9 (95% CI: 5.9–74.4) per 100,000 person-years, and the pooled CFR was 36.2 (95% CI: 23.9–54.4) per 1,000 PWE per year, albeit with substantial between-study heterogeneity. Compared to onchocerciasis low-risk sites, high-risk sites had higher pooled mortality (342.9 versus 10.0 per 100,000 PY; p&lt;0.001) and CFR (57.0 versus 26.6 per 1,000 PWE per year; p = 0.001). Mortality of PWE was almost five-fold that of people without epilepsy (mortality risk ratio: 4.9; 95% CI: 3.5–6.8). Studies in onchocerciasis high-risk sites and the study which recruited only PWE with nodding syndrome were associated with higher CFR (p = 0.044 and p = 0.002, respectively). The leading causes of epilepsy-related death were status epilepticus (58.5%), drowning (15.7%), and sudden unexpected death in epilepsy (10.1%).</p>

<p><strong>Conclusion:</strong> Epilepsy mortality remains high in SSA. Most reported causes of death among PWE might be averted by improving seizure control. Better epilepsy prevention and care are urgently needed, particularly in onchocerciasis-endemic settings.</p>
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