The Scottish Intercollegiate Guidelines Network (SIGN) have recently produced a new and updated clinical guideline for the Diagnosis and management of epilepsy in adults. SIGN 143 is a clinical guideline based on the most up to date evidence available to us. Evidence is reviewed by clinical and academic experts in epilepsy and carefully graded to represent the strength of the available evidence. The presence of high-quality meta analysis or systematic reviews with a low risk of bias may receive a level “A” rating whereas data where the evidence is supported by weaker studies may receive a “D” level rating.
This system allows the practitioner to consider the strength of data informing their practice and makes clear areas that require future research.
Since the SIGN 70 publication in 2003 we have seen the number of specialists in epilepsy increase with more specialist clinics becoming available to people with epilepsy. The range of drugs available has expanded and we have more surgical and non-pharmacological treatments than ever before. Initially the new guideline was going to be updated but in fact only stopped short of being an entirely new guideline. The section on diagnosis and treatment was updated and new areas included in
2015 include psychiatric comorbidity, sleep, and mortality. Women’s health, models of care, provision of information, how to implement the guideline and the evidence base have all been completely revised.
We hope that this guideline will be used by people managing epilepsy and those involved in commissioning epilepsy services including general practitioners, practice nurses, epilepsy specialist nurses, neurologists, obstetricians, psychologists, psychiatrists, public health professionals, relatives of people with epilepsy and the people with epilepsy themselves. Whilst a very practical day to day tool for the individual involved in providing care it is also an aspirational guideline, aiming for the very best in epilepsy care.