Developing clinical practice guidelines for epilepsy: A report from the ILAE Epilepsy Guidelines Working Group

Abstract

SUMMARYClinical practice guidelines (CPGs) contain evidence-based recommendations to guide clinical care, policy development, and quality of care improvement. A recent systematic review of epilepsy guidelines identified considerable variability in the quality of available guidelines. Although excellent frameworks for CPG development exist, processes are not followed uniformly internationally, and resources to develop CPGs may be limited in certain settings. An International League Against Epilepsy (ILAE) working group was charged with proposing methodology to guide the development of future epilepsy-specific CPGs. A comprehensive literature search identified articles related to CPG development and handbooks. Guideline handbooks were included if they were publicly available, and if their methodology had been used to develop CPGs. The working group's expertise also informed the creation of methodologies and processes to develop future CPGs for the ILAE. Five handbooks from North America (American Academy of Neurology), Europe (Scottish Intercollegiate Guidelines Network & National Institute for Health and Care Excellence), Australia (National Health and Medical Research Council), World Health Organization (WHO), and additional references were identified to produce evidence-based, consensus-driven methodology for development of epilepsy-specific CPGs. Key components of CPG development include the following: identifying the topic and defining the scope; establishing a working group; identifying and evaluating the evidence; formulating recommendations and determining strength of recommendations; obtaining peer reviews; dissemination, implementation, and auditing; and updating and retiring the CPG. A practical handbook and toolkit was developed. The resulting CPG development toolkit should facilitate the development of high-quality ILAE CPGs to improve the care of persons with epilepsy.

The current state of epilepsy guidelines: A systematic review

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Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: A systematic review

“…The quality appraisal of each study was done using the qualitative assessment of diagnostic accuracy tool (QUADAS‐2) . The cumulative quality of evidence was rated using an adapted version of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology with due regard to International League Against Epilepsy (ILAE) recommendations …”

The ILAE at 110—Reflections on the last decade

“…This led to the realization that a methodologically sound and systematic approach was necessary for the creation of guidelines and recommendations. After an extensive assessment of various guideline processes used by large health organizations around the world, the League adopted and published a guiding manual and toolbox for the creation of guidelines, and recommendations for consensus statements . The League now supports dedicated methodological expertise for this purpose.…”