Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Epilepsy Behav. 2021 Mar;116:107748. doi: 10.1016/j.yebeh.2020.107748. Epub 2021 Jan 26.
In epilepsy, patients who receive appropriate care receive treatment that differs substantially from those that do not. Given the need for a more detailed assessment of the role of specialty referral in the care of patients with epilepsy, this systematic literature review identified epilepsy care guidelines and recommendations that specifically address when and why people with epilepsy should be referred to specialty care.
This study identified recent (in the last 10 years) publications that made best-practice recommendations for referring people with epilepsy to a neurologist or epileptologist. We searched six databases in December 2018: MEDLINE (PubMed), Cochrane Library, ProQuest, Web of Science, CINAHL (Ebsco), Scopus (Elsevier). Search terms included "Epilepsy" OR "Seizures," "Guideline" OR "Practice Parameter," and "Referral."
The 15 full-text articles identified included formal guidelines, summaries of these guidelines, or professional commentary that builds upon existing guidelines. Most of these publications came from the U.K and its National Institute for Health and Care Excellence. Overall, the included recommendations for referral varied considerably both for new-onset and refractory epilepsy. Although these recommendations were not consistent, it is reasonable to refer patients following the failure of 2 anti-seizure medication (ASM) trials.
Guidelines and informal recommendations are not consistent regarding best practices for specialty care referral for patients with epilepsy. These guidelines and recommendations should consider the context of care in real-world settings and suggest pragmatic approaches that optimize seizure control and functioning.
在癫痫中，接受适当治疗的患者所接受的治疗与未接受治疗的患者有很大的不同。鉴于需要更详细地评估专科转诊在癫痫患者治疗中的作用，本系统文献回顾确定了专门针对癫痫患者何时以及为何应转诊至专科治疗的癫痫护理指南和建议。
本研究确定了最近（在过去 10 年中）发表的针对将癫痫患者转介给神经科医生或癫痫专家的最佳实践建议的出版物。我们于 2018 年 12 月在六个数据库中进行了搜索：MEDLINE（PubMed）、Cochrane 图书馆、ProQuest、Web of Science、CINAHL（Ebsco）、Scopus（Elsevier）。搜索词包括“癫痫”或“癫痫发作”、“指南”或“实践参数”和“转诊”。
确定的 15 篇全文文章包括正式指南、这些指南的摘要或在现有指南基础上进一步阐述的专业评论。这些出版物大多来自英国及其国家卫生与保健卓越研究所。总体而言，对于新发和难治性癫痫，转诊的建议差异很大。尽管这些建议不一致，但在 2 种抗癫痫药物（ASM）试验失败后，有理由转介患者。
指南和非正式建议在癫痫患者专科治疗转诊的最佳实践方面并不一致。这些指南和建议应考虑现实环境中的护理背景，并提出优化癫痫控制和功能的实用方法。
