The current state of epilepsy guidelines: A systematic review

Khara M. Sauro, Samuel Wiebe, Colin Dunkley, Jozsef Janszky, Eva Kumlien, Solomon Moshé, Nobukazu Nakasato, Timothy A. Pedley, Emilio Perucca, Horacio Senties, Sanjeev V. Thomas, Yuping Wang, Jo Wilmshurst, Nathalie Jetté

Research output: Contribution to journalReview article

29 Scopus citations

Abstract

Summary Objective The International League Against Epilepsy (ILAE) Epilepsy Guidelines Task Force, composed of 14 international members, was established in 2011 to identify, using systematic review methodology, international epilepsy clinical care guidelines, assess their quality, and determine gaps in areas of need of development. Methods A systematic review of the literature (1985-2014) was performed in six electronic databases (e.g. Medline, Embase) using a broad search strategy without initial limits to language or study design. Six gray literature databases (e.g., American Academy of Neurology [AAN], ILAE) were also searched to minimize publication bias. Two independent reviewers screened abstracts, reviewed full text articles, and performed data abstraction. Descriptive statistics and a meta-analysis were generated. Results The search identified 10,926 abstracts. Of the 410 articles selected for full text review, 63 met our eligibility criteria for a guideline. Of those included, 54 were in English and 9 were in other languages (French, Spanish, and Italian). Of all guidelines, 29% did not specify the target age groups, 27% were focused on adults, 22% included only children, and 6% specifically addressed issues related to women with epilepsy. Guidelines included in the review were most often aimed at guiding clinical practice for status epilepticus (n = 7), first seizure (n = 6), drug-resistant epilepsy (n = 5), and febrile seizures (n = 4), among others. Most of the guidelines were therapeutic (n = 35) or diagnostic (n = 16) in nature. The quality of the guidelines using a 1-7 point scale (7 = highest) varied and was moderate overall (mean = 4.99 ± 1.05 [SD]). Significance We identified substantial gaps in topics (e.g., epilepsy in the elderly) and there was considerable heterogeneity in methodologic quality. The findings should offer a valuable resource for health professionals caring for people with epilepsy, since they will help guide the prioritization, development, and dissemination of future epilepsy-related guidelines.

Original languageEnglish (US)
Pages (from-to)13-23
Number of pages11
JournalEpilepsia
Volume57
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • Clinical practice guidelines
  • Epilepsy guidelines
  • Evidence-based medicine

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Sauro, K. M., Wiebe, S., Dunkley, C., Janszky, J., Kumlien, E., Moshé, S., Nakasato, N., Pedley, T. A., Perucca, E., Senties, H., Thomas, S. V., Wang, Y., Wilmshurst, J., & Jetté, N. (2016). The current state of epilepsy guidelines: A systematic review. Epilepsia, 57(1), 13-23. https://doi.org/10.1111/epi.13273