Public awareness and attitudes toward epilepsy in Saudi Arabia: A systematic review and meta-analysis

•Twenty-seven cross-sectional studies done in KSA were included.•81.5% of the population think epilepsy is a treatable disease.•37.9% would try to put something in a seizing patient’s mouth to prevent tongue biting.•38.6%, 25.2%, and 35.1% think epilepsy is a mental disorder, caused by possession, or by envy, respectively.•Only 34.6% would approve their offspring marrying someone with epilepsy. Public awareness of epilepsy and attitudes toward people with epilepsy (PWE) largely affect patients’ perceived stigma and their quality of life. Educational interventions to increase public awareness of the disease need to target areas of lowest awareness levels to achieve best results. The aim of this review was to identify these areas in Saudi Arabia. This review was based on PRISMA guidelines. Medline, PsychInfo, Embase, Ovid Evidence-Based Medicine Reviews, and Web of Science databases were searched for relevant literature. Inclusion criteria was cross-sectional studies that are done in Saudi Arabia, assess any aspect of epilepsy awareness or attitudes toward PWE, and report outcomes in proportions. Meta-analysis was done on outcomes reported in ≥5 studies utilizing random-effects model. Quality assessment was done using AXIS tool. Twenty-seven studies were included in this review. A total of 48 questions’ outcomes were reported in ≥3 studies, and 26 of them were included in the meta-analysis. The meta-analysis estimated that 6.4% (CI 4.2–9.7%) of the population think epilepsy is a contagious disease; 90.7% (CI 85.5–94.1%) have heard/read about epilepsy; 53.1% (CI 47.7–58.3%) have witnessed a seizure; 38.6% (CI 24.7–54.7%) think epilepsy is a psychological disorder; 25.2% (CI 16.5–36.7%) think it is caused by spirit possession; 35.1% (CI 22.0–50.8%) were estimated to think it is caused by evil eye (envy); 37.9% (CI 21.9–57.0%) would try to put something inside a seizing patient’s mouth to prevent tongue biting; 34.6% (CI 26.9–43.1%) would approve their offspring marrying someone with epilepsy. Areas of unsatisfactory awareness levels included etiology of epilepsy and appropriate seizure responses. Attitudes were more negative regarding marriage, children, and employment. These areas need to be properly addressed in future educational interventions.