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OBJECTIVE: This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS: Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS: Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE: The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.

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Resumen: A nivel global, la tuberculosis de localización extrapulmonar representa el 18% de los casos de la enfermedad, teniendo como lugares más frecuentes de afectación la pleura (54%), ganglios (11,1%), sistema nervioso central (9%) y sistema osteoarticular (3,6%), entre otros. La manifestación clínica de la meningoencefalitis tuberculosa se presenta con fiebre, cefalea, vómitos, alteración de la conciencia, fotofobia, afectación de pares craneales, alteraciones audiovisuales, signos de irritación meníngea y focalización neurológica. La tuberculosis ostearticular es consecuencia de una diseminación hemática, linfática o, excepcionalmente, por inoculación directa. La clínica es insidiosa, con dolor, inflamación y disminución del rango articular, pudiendo presentar abscesos y cavidades supurativas. Sin embargo, existen otros síntomas de baja frecuencia de aparición, dificultando el diagnóstico adecuado. Se describe el caso clínico infrecuente de tuberculosis extrapulmonar, destacando la diseminación de Mycobacterium tuberculosis con foco en la articulación coxofemoral izquierda hacia meninges y cerebro, y el uso inapropiado del tratamiento con corticoesteroides en un paciente seronegativo para VIH.

Abstract: Extrapulmonary tuberculosis accounts for 18% of tuberculosis cases, with the pleura (54%), lymph nodes (11.1%), central nervous system (9%) and osteoarticular system (3.6%) as sites of involvement, among others. Clinical manifestations of tuberculous meningoencephalitis are fever, headache, vomiting, altered consciousness, photophobia, cranial nerve involvement, audiovisual alterations, signs of meningeal irritation and neurological focalization. Ostearticular tuberculosis is the result of hematic, lymphatic dissemination or, exceptionally, by direct inoculation. The clinic is insidious, with pain, inflammation and diminished joint range, and can present abscesses and suppurative cavities. However, there are other symptoms of low frequency of appearance, making the diagnosis difficult. For this reason, an infrequent clinical case of extrapulmonary tuberculosis is described, highlighting the spread of Mycobacterium tuberculosis with focus on the left coxofemoral joint to the meninges and brain, and the inappropriate use of adrenal cortex hormones therapy in a seronegative patient for HIV.

Resumo: A tuberculose extrapulmonar é responsável por 18% dos casos de tuberculose, com pleura (54%), linfonodos (11,1%), sistema nervoso central (9%) e sistema osteoarticular (3,6%) como locais de envolvimento. entre outros. A manifestação clínica da meningoencefalite tuberculosa é febre, dor de cabeça, vômitos, consciência alterada, fotofobia, comprometimento dos nervos cranianos, alteraçõesaudiovisuais, sinais de irritação meníngea e focalização neurológica. A tuberculose ostearticular é o resultado de disseminação hemática, hemática ou, excepcionalmente, por inoculaçãodireta. A clínica é insidiosa, comdor, inflamação e diminuição do leque de articulações, podendoapresentarabscessos e cavidades supurativas. No entanto, existemoutrossintomas de baixafrequência de aparecimento, dificultando o diagnóstico. Por esta razão, nósdescrevemosum caso clínico raro de tuberculoseextrapulmonar, com destaque para a disseminação de Mycobacterium tuberculosis com foco naarticulação do quadrilesquerdo para meninges e cérebro, e uso inadequado de corticoterapiaem paciente soronegativa HIV.