Health Equity Consideration in Cochrane Systematic Reviews and Primary Studies on Add-on Therapy for Refractory Focal Epilepsy Treatment

Abstract

Objective: Health equity is defined as the absence of unequal and avoidable factors in health differences among populations. Several add-on treatments have been suggested for refractory epilepsy and epilepsy unresponsive to usual treatments in systematic reviews. The current study assessed equity concerns in Cochrane systematic reviews and original studies on additive therapies used for refractory focal epilepsy because identifying the reasons for injustice is the first step in eradicating health inequality. Methods: Cochrane systematic reviews and their primary studies on add-on therapy for treatment-resistant focal epilepsy in adults published in the Cochrane library in the last 10 years (until the end of 2022) were gathered. Two researchers independently reviewed the PROGRESS criteria in the studies based on the guide for each of the primary and review studies. Results: In the present study, 7 systematic reviews and 54 primary studies were included. based on the findings of our study, all review studies and 81.5% of the original studies were conducted in high-income countries. none of the articles mentioned the issue of justice in health or PROGRESS criteria. However, all of the articles mentioned gender distribution and patients’ place of residence, and about 35% of the original articles also mentioned patients’ race. None of these factors were analyzed as a criterion for group comparison or as a criterion for influencing the treatment process. Conclusion: The Cochrane-related reviews confirm that PROGRESS criteria are rarely considered in trials of interventions linked to add-on therapies for treatment-resistant focal epilepsy.

Keywords

• health equity
• refractory focal epilepsy
• systematic reviews