Epilepsy Guidelines for Women: What a Systematic Review Found

What was studied

Researchers systematically reviewed clinical practice guidelines for women with epilepsy published in English or Korean from January 2014 through December 2024. They searched four medical and guideline databases and included 11 guidelines developed de novo, all from the United States or Europe.

Two independent reviewers and an AI-based language model assessed each guideline using a standardized guideline-quality instrument. The researchers also checked whether each guideline addressed 13 predefined women-specific topics across different life stages.

What they found

Overall, the guidelines had generally high methodological quality. They scored highest for editorial independence, followed by clarity of presentation, scope and purpose, and rigor of development. Scores were lower for stakeholder involvement and applicability.

Pregnancy-related issues were well covered and had specific recommendations. Adolescence, catamenial epilepsy, menopause, and bone health received limited attention and often lacked actionable guidance. Recommendations varied across guidelines, especially for monitoring antiseizure medication levels during pregnancy and folic acid dosing.

Limits of the evidence

This review assessed the quality and content of guidelines, not treatments or patient outcomes. It included 11 eligible guidelines, all from the United States or Europe and published in English or Korean. The abstract does not provide details about each individual guideline or the evidence supporting each recommendation.

For families and caregivers

Guidance may be more detailed for pregnancy than for other life stages and concerns, including adolescence, menstrual-cycle-related seizure patterns, menopause, and bone health. Recommendations on folic acid dosing and medication monitoring during pregnancy also varied among guidelines. This review identifies areas needing clearer and more practical guidance but does not determine which specific recommendation is best.

What to watch next

Future guidelines should address the full lifespan, provide more practical and actionable guidance, and involve a broader range of stakeholders.

Terms in this summary

Clinical practice guideline

A set of recommendations intended to guide health care decisions.

Systematic review

A structured search and assessment conducted using predefined methods.

Editorial independence

The extent to which guideline recommendations are developed without inappropriate influence from funders or competing interests.

Stakeholder involvement

The participation of relevant groups in guideline development.

Applicability

How practical and feasible a guideline is to implement in health care settings.

Catamenial epilepsy

A pattern of seizures associated with phases of the menstrual cycle.

Therapeutic drug monitoring

Measuring medication levels to help guide treatment decisions.

Folic acid

A B vitamin for which dosing recommendations varied across the reviewed guidelines.