Attitudes and misconceptions surrounding epilepsy and first aid of seizures in the Eastern Mediterranean Region: a systematic review and meta-analysis

Misconceptions and knowledge gaps regarding epilepsy in the Eastern Mediterranean region (EMR) Arabic-speaking countries are common and may endanger people with epilepsy (PWE). This systematic review and meta-analysis aimed to quantify public knowledge, misconceptions, and attitudes and synthesize pooled evidence to guide public health and educational interventions. This is a systematic review and meta-analysis of misconceptions and attitudes within Arabic-speaking countries regarding epilepsy. A comprehensive literature search of the following databases: PubMed, Scopus, and Web of Science were conducted following PRISMA guidelines. Studies were included if they were cross-sectional studies assessing epilepsy awareness and/or attitudes and conducted in Arabic-speaking countries. The Appraisal Tool for Cross-Sectional Studies (AXIS) and the Joanna Briggs Institute (JBI) critical appraisal tool were used for quality assessment. Heterogeneity between studies was evaluated using the I² statistic. Results were reported as pooled proportions with a 95% confidence interval (CI). Sensitivity and subgroup analyses assessed how individual studies affected the pooled results. The analysis was performed by Open Meta Analyst. As of January 2024, 75 of 5,646 studies satisfied the inclusion criteria with a total sample size of 61,681. The pooled prevalence of good knowledge and positive attitude were 47.2% and 50.5%, respectively. The most common myth about seizure first aid was that placing objects in the mouth will decrease tongue biting with a pooled prevalence of 38.6%. Beliefs attributing the disorder to spirit possession and the evil eye had a pooled prevalence of 14.1% and 17.3%, respectively. Approximately 45% and 62% of participants were uncomfortable with their children playing with or marrying PWE. Contagion beliefs were common in the Levant (29.6%), while spirit possession was prevalent in North Africa (22.1%). Schoolteachers in the EMR had the lowest knowledge (42.2%) and least positive attitudes (33.9%). Pooled knowledge level showed minimal improvement over the past decade. There are still a lot of misunderstandings about epilepsy in the EMR, and these may vary depending on the demographic, study area, or historical period. Additionally, stigma around epilepsy remains a significant issue, highlighting the critical need for targeted awareness programs and legislative measures. • In this systematic review study, many cultural misconceptions surrounding epilepsy were widespread among populations of the Eastern Mediterranean Region. • There is still a belief that epilepsy is attributed to evil eyes and spirits in the region. • Wrong-handling seizures, such as restraining the person and placing objects in the mouth, were common in the region. • Misconceptions and negative attitudes regarding marriage with people with epilepsy are prevalent among nearly half of the participants. • Focused interventions are essential to address widespread misconceptions and cultural biases, thereby improving the safety of people with epilepsy.