Prevalence of Drug-Resistant Epilepsy in Low and Middle Income Countries: A Systematic Review and Meta-Analysis Publisher Pubmed



Bahadori A R ; Javadnia P ; Mohseni G ; Taherkhani T ; Sarmadi I ; Poozesh A ; Nasibi S M ; Mahzad R ; Afzalnia A ; Ranji S ; Shafiee S ; Tafakhori A
Source: Epilepsy and Behavior Published:2026

Abstract

Objective: Drug-resistant epilepsy (DRE) is a significant clinical and socioeconomic burden, particularly in low- and middle-income countries (LMICs), due to limited diagnostic and therapeutic assessments. We aimed to estimate the prevalence of DRE in LMICs and to determine predisposing factors in these settings. Methods: We did a systematic review and meta-analysis according to PRISMA guidelines. Four databases, including PubMed, Scopus, Embase, and Web of Science, were searched until November 30, 2025. We used the comprehensive meta-analysis (CMA) software to calculate the pooled prevalence of DRE among patients with epilepsy in LMICs. Subgroup analyses and meta-regression were applied to determine the effect of income level, region, age group, and diagnostic criteria on DRE prevalence. Results: Twelve studies included in the current meta-analysis. The pooled prevalence of DRE was 13.3% (95% CI: 9.6–18.0%). A higher prevalence of DRE was observed in African countries and in upper-middle-income regions. Pediatric-onset epilepsy was also associated with a higher prevalence of DRE compared with adult-onset epilepsy. Meta-regression showed that publication year was significant, whereas income level alone was not. Conclusion: The prevalence of DRE among patients with epilepsy is about 13%. Variability in DRE prevalence in LMICs reflects variability in the economy, healthcare systems, and epilepsy management. These findings highlight the targeted regional strategies to improve the identification and management of DRE in LMICs. © 2026 Elsevier Inc.