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

International audienceObjective: To assess the current status of initiatives carried out in developing countries to improve therapeuticmanagement of people with epilepsy.Methods: A literature review was performed in 2015 to identify and analyze interventional programs carried outin 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 controlledtrial, 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 remainingprojectswere carried out in 18 countries, 52% (16) in Africa, 42% (13) in Asia, and 6% (2) in Latin America. Amongthose, 13% (4) were level B, 3% (1) C1, 6% (2) C2, 74% (23) D, and 3% (1) were level E. The effectiveness of theintervention, assessed by the efficacy of antiepileptic drugs, was the primary objective in 81% (25). Peoplewith 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 compliancewas 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 accessto antiepileptic drugs (AEDs) in developing countries, and the level of evidence was globally low. Phenobarbitalremains the AED predominantly used in programs. Adherence to treatment management has been pointedout to be a key element in the success of a program, sometimes not sufficiently considered. Monthly supply ofAEDs, at specific and community level, reducing the costs and time spent traveling, appeared to be the most effectivestrategies. Homogenization and standardization of evaluation practices of programs to improve themanagementof epilepsy in resource-limited settings would lead to comparison and meta-analysis which wouldultimately improve strategies of support for not only epilepsy but also other noncommunicable diseases in developingcountries