The current state of clinical practice guidelines for women with epilepsy: a systematic review.
Hyun Kyung Kim, Hye Jeong Lee, Su-Hyun Han et al.
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In 30 seconds
This systematic review assessed the methodological quality and women-specific content of clinical practice guidelines for women with epilepsy. It included 11 guidelines developed in the United States or Europe and published between January 2014 and December 2024. The median overall quality score was 74.9% (IQR, 65.0-85.2%). Pregnancy-related topics were generally covered with specific recommendations, but guidance was limited for adolescence, catamenial epilepsy, menopause, and bone health. Recommendations also differed across guidelines, particularly on therapeutic drug monitoring during pregnancy and folic acid dosing.
Key findings
- Across 11 guidelines, the median overall quality score was 74.9% (IQR, 65.0-85.2%).
- Applicability scored a median 57.3% and stakeholder involvement 61.9%, the lowest-rated quality domains.
- Adolescence (n = 3), catamenial epilepsy (n = 1), menopause (n = 2), and bone health (n = 3) received limited attention.
- Guidelines varied most notably in recommendations for therapeutic drug monitoring during pregnancy and folic acid dosing.
Why it matters
Guidelines can support care across the different life stages of women with epilepsy, but this review identifies uneven coverage beyond pregnancy and weaknesses in applicability and stakeholder involvement. These gaps may leave clinicians with less actionable guidance for important life-stage concerns, while variation in recommendations highlights areas where future guideline development could improve consistency.
What to keep in mind
The review included only 11 guidelines, all from the United States or Europe, and was restricted to guidelines published in English or Korean.