Jiang Meizhu, Xu Yanan, Yang Li, Yan Yilong, Zhou Han, Song Wanqing, Wang Xinyue, Sun Haiyang, Yao Xuetong, Zhao Zhigang, Li Cao
Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China.
Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China.
J Neurol. 2024 Dec 16;272(1):65. doi: 10.1007/s00415-024-12764-9.
This study aims to evaluate the methodological quality of guidelines concerning the prophylactic use of antiseizure medications (ASMs) in neurosurgery and to summarize relevant recommendations.
PubMed, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), and other guideline repositories and official organizations were searched from 2004 to 2023 (20 years). The extracted information consisted of the guideline characteristics, relevant recommendations, levels of evidence, and strength of recommendations. Using the Guideline Research and Evaluation Tool II (AGREE II), five reviewers assessed the methodological quality of the guidelines, and the intraclass correlation coefficient (ICC) is used to assess the inter-reviewer consistency.
Of 27 eligible guidelines, AGREE II scores varied with higher scores in Clarity of Presentation (88.89%), Scope and Purpose (83.33%), and Editorial Independence (72.92%), but lower in Rigor of Development (59.17%), Stakeholder Involvement (46.67%), and Applicability (41.67%). ICC ranged from 0.51 to 0.92. Nine guidelines were recommended, eight with modifications, and ten not recommended. ASMs prophylaxis are recommended for patients with a seizure history, which means secondary prophylaxis, and specific high-risk groups, but not recommended for primary prophylaxis routinely for those without a history of seizure.
Guidelines in neurosurgical perioperative prophylactic use of ASMs are of moderate quality with domains for enhancement. Guidelines lack detailed guidance on medication initiation, dosage, and duration, highlighting the need for more high-quality clinical trials comparing newer and classical ASMs.
本研究旨在评估神经外科预防性使用抗癫痫药物（ASM）指南的方法学质量，并总结相关建议。
检索2004年至2023年（20年）期间的PubMed、Embase、MEDLINE、Web of Science、中国知网（CNKI）、万方、维普中文科技期刊数据库（VIP）、国家指南交换中心（NGC）、指南国际网络（GIN）以及其他指南库和官方组织。提取的信息包括指南特征、相关建议、证据水平和推荐强度。使用指南研究与评价工具II（AGREE II），五名评审员评估指南的方法学质量，并使用组内相关系数（ICC）评估评审员间的一致性。
在27项符合条件的指南中，AGREE II评分各不相同，其中呈现清晰度（88.89%）、范围和目的（83.33%）以及编辑独立性（72.92%）得分较高，但制定严谨性（59.17%）、利益相关者参与度（46.67%）和适用性（41.67%）得分较低。ICC范围为0.51至0.92。九项指南被推荐，八项需修改，十项不被推荐。推荐对有癫痫病史的患者进行ASM预防，即二级预防，以及特定高危人群，但不建议对无癫痫病史的患者常规进行一级预防。
神经外科围手术期预防性使用ASM的指南质量中等，存在需要改进的方面。指南在用药起始、剂量和疗程方面缺乏详细指导，凸显了开展更多比较新型和经典ASM的高质量临床试验的必要性。
