Authors' objectives:

The objective of this evidence report was to systematically review the best available evidence in the published literature regarding health care services pertinent to the diagnosis, treatment, and monitoring of patients with a first diagnosis of epilepsy.

Authors' results and conclusions: Of 13,128 citations, 120 studies covering 21,213 patients met all eligibility criteria. Diagnostic interventions to rule in a diagnosis of epilepsy, as well as predict remission outcomes, are a complete history and physical examination, including neuropsychologic assessment, and a standard EEG. Other diagnostic interventions (e.g., CT or MRI) are more important to rule out secondary causes of seizures or to resolve uncertain diagnoses (e.g., video EEG) in a minority of selected patients. The monitoring interventions that may have an impact on outcomes are clinical/pharmacologic expertise, periodic blood tests (routine hematology and chemistries) for antiepileptic drug (AED)-related side effects, and possibly cognitive assessments in certain populations. Compliance with AED regimens predicts remission, but approaches to ensure compliance are not substantiated. Treatment interventions important for patients with a first diagnosis include clinical/pharmacologic expertise to inform choices of AED treatment, which are dictated more by differing side effect profiles than efficacy. Monotherapy AEDs appear comparable in efficacy for many epilepsy syndromes, but not all, for example juvenile myoclonic epilepsy, which require expertise not only to diagnose but to inform treatment choice. The literature has multiple limitations, including lack of a universally accepted gold standard for diagnosis, low methodologic rigor, widespread terminology confusion, lack of patient-centered outcomes, including quality of life, health care utilization and costs, and gaps in coverage of virtually all nonclinical/pharmacologic treatment interventions in newly diagnosed patients.

Authors' recommendations: The best available evidence from the literature is not conclusive regarding the appropriate and necessary diagnostic, monitoring, and treatment services for patients with newly diagnosed epilepsy. This literature review, however, can be used to generate testable hypotheses. We urge the health services research community to test these hypotheses in new and more rigorous studies in the future.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/epilepsum.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)