Authors :
Presenting Author: Sean Aitchison, MD, BMSc – University of Otago
Ngaire Keenan, MBChB, BMSc (hons) – University of Otago; Karen Parko, MD – University of California at San Francisco; Angie dos Santos, MBChB – University of Melbourne; John Archer, PhD, MBBS – University of Melbourne; Erik Andersen, MBChB – Te Whatu Ora, Health New Zealand; Jeannine Stairmand, MPH – University of Otago; Pamela Roach, PhD – University of Calgary; Nathalie Jetté, MD – University of Calgary; James Stanley, PhD – University of Otago; Lynette Sadleir, MBChB, MD – University of Otago
Rationale:
Indigenous peoples are sovereign groups with long-established customary and traditional links to precolonial cultures, languages, knowledge systems, and land. Despite evidence that Indigenous peoples have inequitable health access and outcomes, they are underrepresented in health research and policy. In 2022, the World Health Organization adopted the Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders (IGAP). The IGAP aims to reduce the impact and burden of epilepsy and has highlighted Indigenous people as high priority groups. We did a scoping review of epilepsy in the Indigenous peoples in Canada, Australia, New Zealand, and the United States of America (USA). These groups of Indigenous peoples share many commonalities as they were colonized by the British Empire, with resulting land, generational wealth, and cultural loss.
Methods:
The PRISMA-ScR standards were followed.
A systematic search of medical databases (from 1985 to April 16 2023) and grey literature websites was performed. Search terms included seizure*, convulsion*, epilep* and terms for the Indigenous peoples in Canada, Australia, New Zealand, and the USA. Two reviewers evaluated each abstract for eligibility. Articles with epilepsy data within an Indigenous group were included and charted by two independent reviewers. Articles were critically appraised using a methodological quality score and an Indigenous perspective appraisal score.Results:
Of the 2037, 33 peer reviewed articles and 9 grey literature reports met all eligibility criteria.
The methodological quality of the studies varied from very low (score < 50%; n=5) to high (score >75%; n=15). Most articles scored in very low or low range for the Indigenous perspective appraisal. Incidence and prevalence of epilepsy were higher in First Nations people in Canada, Navajo peoples in the USA, and Aboriginal and Torres Strait Islander peoples in Australia but equivalent in Māori children compared to non-Indigenous populations in these countries. Indigenous peoples were more likely to present to hospital for a seizure, have decreased access to specialist services, were less likely to receive antiseizure medication (ASM), wait longer for ASM, and were more likely to receive enzyme inducing ASMs. Aboriginal and Torres Strait Islander peoples had twice the rate of disability-adjusted life years than non-Indigenous people with epilepsy. Mortality rates for New Zealand Māori and Aboriginal and Torres Strait Islander peoples in Australia were higher than in non-Indigenous people with epilepsy.
Conclusions:
This review identified common inequities for Indigenous peoples with epilepsy in Canada, Australia, New Zealand, and the USA. Concerningly, there were relatively few studies and they were of variable quality, leaving significant knowledge gaps for each Indigenous group particularly with regard to aetiology and outcome. Research designed with each specific group of Indigenous peoples is urgently required to enable targeted health policy development in these countries.Funding:
Neurological Foundation, Health Research Council of New Zealand, Royal Australasian College of Physicians