The current state of clinical practice guidelines for women with epilepsy: a systematic review

Management of women with epilepsy (WWE) requires specialized guidance across different life stages. To inform priorities for future guideline development, we examined the methodological quality and the women-specific content of existing clinical practice guidelines (CPGs) for WWE.

We searched OVID Medline, Embase, the Guideline International Network, and KoreaMed for epilepsy CPGs developed de novo, including women's issues, published in English or Korean, between January 2014 and December 2024. Two independent reviewers and an AI-based language model independently assessed the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation II instrument. The coverage of thirteen predefined women-specific topics was assessed for each CPG.

Eleven CPGs met the inclusion criteria, all from the United States or Europe. The median overall quality score was 74.9% (IQR, 65.0-85.2%). Editorial independence scored the highest (median 92.5%), followed by clarity of presentation (86.3%), scope and purpose (85.7%), rigor of development (82.8%), stakeholder involvement (61.9%), and applicability (57.3%). Content analysis showed that pregnancy-related topics were well covered, with specific recommendations, whereas adolescence (n = 3), catamenial epilepsy (n = 1), menopause (n = 2), and bone health (n = 3) received limited attention and often lacked actionable guidance. Recommendations also varied across CPGs, most notably for therapeutic drug monitoring during pregnancy and folic acid dosing.

Current WWE CPGs generally show high methodological quality but have relative weaknesses in applicability and stakeholder involvement. Significant gaps exist in guidance for non-pregnancy life stages. Future guidelines should adopt a comprehensive lifespan approach, improve applicability, and broaden stakeholder engagement to better meet the diverse needs of WWE.