Implementing Clinical Practice Guidelines: Considerations for Epileptologists.

Abstract

Over 5000 epilepsy-related articles are indexed annually, posing a challenge for clinicians to stay updated on all relevant research. Clinical Practice Guidelines (CPGs) are vital tools for translating evidence into practice and promoting equitable, high-quality care while addressing practice variations. This review examines CPG applicability for epileptologists, emphasizing the nuances between primary and specialty care, addressing disparities, and comparing guideline usage in the United States and internationally. CPGs are utilized differently across specialties. General practitioners often manage initial epilepsy cases guided by first-seizure and new-onset epilepsy guidelines. Specialists, dealing with complex cases like treatment-resistant epilepsy, face challenges as guidelines may lag behind emerging therapies. Yet, evidence shows specialists heavily rely on CPGs to ensure optimal care. The use of race in medical algorithms highlights disparities, with examples like race-based adjustments in glomerular filtration rate calculations raising equity concerns. While frameworks exist to reduce biases, ongoing monitoring and inclusive approaches are critical. Globally, CPG implementation varies. The UK's centralized system integrates cost-effectiveness analyses, while the United States adopts a decentralized approach prioritizing clinical efficacy. Emerging technologies, such as electronic medical records and clinical decision support systems, improve CPG adoption and patient outcomes. Success stories like the "Get with the Guidelines" stroke program illustrate the potential of structured CPG frameworks. However, challenges persist, such as inconsistencies in epilepsy guidelines for acute seizure management. Ultimately, bridging the gap between evidence and practice requires rigorous, inclusive guideline development, effective communication, and proactive implementation strategies tailored to diverse healthcare systems.