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Methodologies for developing and applying consensus-based recommendations in epilepsy care: A narrative review.

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Τίτλος: Methodologies for developing and applying consensus-based recommendations in epilepsy care: A narrative review.
Συγγραφείς: Haffner R; Department of Neuroscience, Duke University, Durham, North Carolina, USA., Mathew B; School of Osteopathic Medicine, Rowan University, Stratford, New Jersey, USA., Brigo F; Innovation, Research, and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy., Qasim A; Alimentiv Inc., London, Ontario, Canada., Antonio-Arce VS; Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Germany., Ayed HB; Department of Preventive Medicine and Hospital Hygiene, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia., Ferlazzo E; Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy., Kwon CS; Department of Neurology, Neurosurgery, Epidemiology and the Sergievsky Center, Columbia University, New York, New York, USA., Lim KS; Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia., Mitchell JW; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK., Salisu MA; Department of Pediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Nigeria., Valente K; Neurophysiology Laboratory, Faculty of Medicine of University of Sao Paulo (FMUSP), São Paulo, Brazil., Vinayan KP; Department of Pediatric Neurology, Amrita Institute of Medical Sciences, Cochin, Kerala, India., Josephson CB; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada., Jette N; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Πηγή: Epilepsia [Epilepsia] 2026 Mar; Vol. 67 (3), pp. 1032-1048. Date of Electronic Publication: 2025 Dec 15.
Τύπος έκδοσης: Journal Article; Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Blackwell Science Country of Publication: United States NLM ID: 2983306R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1167 (Electronic) Linking ISSN: 00139580 NLM ISO Abbreviation: Epilepsia Subsets: MEDLINE
Imprint Name(s): Publication: Malden, MA : Blackwell Science
Original Publication: Copenhagen : Munskgaard
Ιατρικοί όροι (MeSH): Epilepsy*/therapy , Consensus Statements as Topic*, Humans ; Delphi Technique
Περίληψη: Consensus-based recommendations (CBRs) are essential for health care decision-making when evidence is limited or conflicting. They can be developed using established methodologies such as the Delphi technique, the nominal group technique (NGT), and the RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method (RAM). This review explores the advantages and disadvantages of these methods and their applications in epilepsy. A narrative review using PubMed (November 22, 2017 to November 22, 2022) was undertaken examining publications describing Delphi, NGT, and RAM. The frequency of use of each method and their applications in epilepsy care were also reviewed (1966 to October 31, 2023). Sixteen articles were included describing the different consensus-based methods. The advantages and disadvantages of each method varied widely. The Delphi technique, the most widely used method, emerged as adaptable for instances with limited evidence or impracticality of face-to-face interactions. Although NGT favors prompt consensus in single-session formats, the RAM offers a balanced approach with its hybrid structure. We identified 64 epilepsy studies that used consensus methods, with 58 utilizing the most widely used technique, the Delphi. The Delphi guided consensus mostly for management including for individuals with rare conditions such as myoclonic-atonic seizures or in those with epilepsy and pregnancy. The NGT guided expert consensus on the use of cannabidiol for Dravet and Lennox-Gastaut syndromes and facilitated decision-making among pharmacy students addressing ethical issues related to patients with epilepsy who drive. The RAM was applied in four studies for its combined individual and group evaluative approach. It was used to develop recommendations or imaging, create quality-of-care indicators for infantile spasms, and establish a web-based tool for assessing surgical candidacy. Consensus methodologies are crucial to inform robust CBR for epilepsy management where clinical practice guidelines are not possible due to limited evidence. The best method depends on the study goal and available resources.
(© 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)
References: Z Evid Fortbild Qual Gesundhwes. 2022 Aug;172:1-11. (PMID: 35718726)
Arthroscopy. 2018 Feb;34(2):349-351. (PMID: 29413182)
Health Technol Assess. 1998;2(3):i-iv, 1-88. (PMID: 9561895)
J Child Neurol. 2013 Jan;28(1):13-20. (PMID: 22566712)
Med Teach. 2017 Jan;39(1):14-19. (PMID: 27841062)
Front Psychol. 2021 May 04;12:637547. (PMID: 34017283)
Environ Manage. 2013 Mar;51(3):511-23. (PMID: 23288149)
Trials. 2021 Feb 15;22(1):142. (PMID: 33588938)
Epilepsia. 2023 Oct;64(10):2550-2570. (PMID: 37655702)
J Clin Pharm Ther. 2001 Feb;26(1):5-14. (PMID: 11286603)
J Am Coll Radiol. 2020 May;17(5S):S293-S304. (PMID: 32370973)
Am J Public Health. 1984 Sep;74(9):979-83. (PMID: 6380323)
Health Res Policy Syst. 2017 Oct 9;15(1):87. (PMID: 28992810)
Epilepsia. 2026 Mar;67(3):1032-1048. (PMID: 41396016)
Curr Med Res Opin. 2020 Nov;36(11):1873-1887. (PMID: 32866051)
Neurology. 2012 Sep 11;79(11):1084-93. (PMID: 22895589)
Epilepsia. 2024 Nov;65(11):3155-3185. (PMID: 39320421)
Acad Med. 2016 May;91(5):663-8. (PMID: 26796090)
Acad Med. 2017 Oct;92(10):1491-1498. (PMID: 28678098)
Aliment Pharmacol Ther. 2021 Apr;53(8):873-886. (PMID: 33641221)
J Med Internet Res. 2022 Aug 26;24(8):e33898. (PMID: 36018626)
J Immunother Cancer. 2022 Mar;10(3):. (PMID: 35296560)
Brain Behav. 2022 Jul;12(7):e2622. (PMID: 35765698)
Nurse Res. 2021 Mar 11;29(1):14-20. (PMID: 33629547)
Nurs Res. 2018 Sep/Oct;67(5):404-410. (PMID: 30052591)
AEM Educ Train. 2023 Jul 11;7(4):e10891. (PMID: 37448627)
Seizure. 2021 Feb;85:12-18. (PMID: 33383403)
Clin Gastroenterol Hepatol. 2023 Oct;21(11):2938-2950.e6. (PMID: 37308036)
Res Social Adm Pharm. 2022 Jan;18(1):2230-2236. (PMID: 34244078)
BMJ Open. 2019 Dec 3;9(12):e029589. (PMID: 31796475)
BMJ. 1995 Aug 5;311(7001):376-80. (PMID: 7640549)
Semin Arthritis Rheum. 2011 Oct;41(2):95-105. (PMID: 21420149)
Epilepsia. 2023 Jan;64(1):170-183. (PMID: 36347817)
J Neurosurg Pediatr. 2009 Apr;3(4):249-56. (PMID: 19338401)
Acta Psychol (Amst). 2000 Mar;104(1):1-15. (PMID: 10769936)
Front Neurol. 2021 Oct 25;12:734612. (PMID: 34759881)
MethodsX. 2021 May 28;8:101401. (PMID: 34430297)
BMJ Open. 2019 Apr 3;9(4):e024942. (PMID: 30948575)
BMC Nurs. 2021 Aug 18;20(1):149. (PMID: 34407815)
Ther Adv Rare Dis. 2022 Mar 8;3:26330040221076861. (PMID: 37180417)
J Gen Intern Med. 2021 Jun;36(6):1746-1750. (PMID: 33742303)
BJOG. 2017 Mar;124(4):661-667. (PMID: 27860117)
Epilepsy Behav. 2020 Jan;102:106703. (PMID: 31786471)
Epilepsia. 2022 Aug;63(8):1920-1929. (PMID: 35722680)
Ann Intern Med. 1997 Mar 1;126(5):376-80. (PMID: 9054282)
World J Methodol. 2021 Jul 20;11(4):116-129. (PMID: 34322364)
Int J Clin Pharm. 2016 Jun;38(3):655-62. (PMID: 26846316)
Patient. 2020 Feb;13(1):11-21. (PMID: 31544219)
BMJ. 1999 Feb 20;318(7182):527-30. (PMID: 10024268)
Epilepsy Curr. 2021 Jun 30;21(5):385-388. (PMID: 34924843)
Expert Opin Pharmacother. 2023 Apr;24(5):655-663. (PMID: 37021712)
Contributed Indexing: Keywords: expert panel; guidelines; seizure; standards; structured judgment
Entry Date(s): Date Created: 20251215 Date Completed: 20260323 Latest Revision: 20260813
Update Code: 20260813
PubMed Central ID: PMC13007833
DOI: 10.1111/epi.70039
PMID: 41396016
Βάση Δεδομένων: MEDLINE
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  Data: Methodologies for developing and applying consensus-based recommendations in epilepsy care: A narrative review.
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  Data: <searchLink fieldCode="AU" term="%22Haffner+R%22">Haffner R</searchLink>; Department of Neuroscience, Duke University, Durham, North Carolina, USA.<br /><searchLink fieldCode="AU" term="%22Mathew+B%22">Mathew B</searchLink>; School of Osteopathic Medicine, Rowan University, Stratford, New Jersey, USA.<br /><searchLink fieldCode="AU" term="%22Brigo+F%22">Brigo F</searchLink>; Innovation, Research, and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.<br /><searchLink fieldCode="AU" term="%22Qasim+A%22">Qasim A</searchLink>; Alimentiv Inc., London, Ontario, Canada.<br /><searchLink fieldCode="AU" term="%22Antonio-Arce+VS%22">Antonio-Arce VS</searchLink>; Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Germany.<br /><searchLink fieldCode="AU" term="%22Ayed+HB%22">Ayed HB</searchLink>; Department of Preventive Medicine and Hospital Hygiene, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia.<br /><searchLink fieldCode="AU" term="%22Ferlazzo+E%22">Ferlazzo E</searchLink>; Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy.<br /><searchLink fieldCode="AU" term="%22Kwon+CS%22">Kwon CS</searchLink>; Department of Neurology, Neurosurgery, Epidemiology and the Sergievsky Center, Columbia University, New York, New York, USA.<br /><searchLink fieldCode="AU" term="%22Lim+KS%22">Lim KS</searchLink>; Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.<br /><searchLink fieldCode="AU" term="%22Mitchell+JW%22">Mitchell JW</searchLink>; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.<br /><searchLink fieldCode="AU" term="%22Salisu+MA%22">Salisu MA</searchLink>; Department of Pediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Nigeria.<br /><searchLink fieldCode="AU" term="%22Valente+K%22">Valente K</searchLink>; Neurophysiology Laboratory, Faculty of Medicine of University of Sao Paulo (FMUSP), São Paulo, Brazil.<br /><searchLink fieldCode="AU" term="%22Vinayan+KP%22">Vinayan KP</searchLink>; Department of Pediatric Neurology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.<br /><searchLink fieldCode="AU" term="%22Josephson+CB%22">Josephson CB</searchLink>; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.<br /><searchLink fieldCode="AU" term="%22Jette+N%22">Jette N</searchLink>; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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  Data: Consensus-based recommendations (CBRs) are essential for health care decision-making when evidence is limited or conflicting. They can be developed using established methodologies such as the Delphi technique, the nominal group technique (NGT), and the RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method (RAM). This review explores the advantages and disadvantages of these methods and their applications in epilepsy. A narrative review using PubMed (November 22, 2017 to November 22, 2022) was undertaken examining publications describing Delphi, NGT, and RAM. The frequency of use of each method and their applications in epilepsy care were also reviewed (1966 to October 31, 2023). Sixteen articles were included describing the different consensus-based methods. The advantages and disadvantages of each method varied widely. The Delphi technique, the most widely used method, emerged as adaptable for instances with limited evidence or impracticality of face-to-face interactions. Although NGT favors prompt consensus in single-session formats, the RAM offers a balanced approach with its hybrid structure. We identified 64 epilepsy studies that used consensus methods, with 58 utilizing the most widely used technique, the Delphi. The Delphi guided consensus mostly for management including for individuals with rare conditions such as myoclonic-atonic seizures or in those with epilepsy and pregnancy. The NGT guided expert consensus on the use of cannabidiol for Dravet and Lennox-Gastaut syndromes and facilitated decision-making among pharmacy students addressing ethical issues related to patients with epilepsy who drive. The RAM was applied in four studies for its combined individual and group evaluative approach. It was used to develop recommendations or imaging, create quality-of-care indicators for infantile spasms, and establish a web-based tool for assessing surgical candidacy. Consensus methodologies are crucial to inform robust CBR for epilepsy management where clinical practice guidelines are not possible due to limited evidence. The best method depends on the study goal and available resources.<br /> (© 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: Z Evid Fortbild Qual Gesundhwes. 2022 Aug;172:1-11. (PMID: <searchLink fieldCode="PM" term="%2235718726%22">35718726)</searchLink><br />Arthroscopy. 2018 Feb;34(2):349-351. (PMID: <searchLink fieldCode="PM" term="%2229413182%22">29413182)</searchLink><br />Health Technol Assess. 1998;2(3):i-iv, 1-88. (PMID: <searchLink fieldCode="PM" term="%229561895%22">9561895)</searchLink><br />J Child Neurol. 2013 Jan;28(1):13-20. (PMID: <searchLink fieldCode="PM" term="%2222566712%22">22566712)</searchLink><br />Med Teach. 2017 Jan;39(1):14-19. (PMID: <searchLink fieldCode="PM" term="%2227841062%22">27841062)</searchLink><br />Front Psychol. 2021 May 04;12:637547. (PMID: <searchLink fieldCode="PM" term="%2234017283%22">34017283)</searchLink><br />Environ Manage. 2013 Mar;51(3):511-23. (PMID: <searchLink fieldCode="PM" term="%2223288149%22">23288149)</searchLink><br />Trials. 2021 Feb 15;22(1):142. (PMID: <searchLink fieldCode="PM" term="%2233588938%22">33588938)</searchLink><br />Epilepsia. 2023 Oct;64(10):2550-2570. (PMID: <searchLink fieldCode="PM" term="%2237655702%22">37655702)</searchLink><br />J Clin Pharm Ther. 2001 Feb;26(1):5-14. (PMID: <searchLink fieldCode="PM" term="%2211286603%22">11286603)</searchLink><br />J Am Coll Radiol. 2020 May;17(5S):S293-S304. (PMID: <searchLink fieldCode="PM" term="%2232370973%22">32370973)</searchLink><br />Am J Public Health. 1984 Sep;74(9):979-83. (PMID: <searchLink fieldCode="PM" term="%226380323%22">6380323)</searchLink><br />Health Res Policy Syst. 2017 Oct 9;15(1):87. (PMID: <searchLink fieldCode="PM" term="%2228992810%22">28992810)</searchLink><br />Epilepsia. 2026 Mar;67(3):1032-1048. (PMID: <searchLink fieldCode="PM" term="%2241396016%22">41396016)</searchLink><br />Curr Med Res Opin. 2020 Nov;36(11):1873-1887. (PMID: <searchLink fieldCode="PM" term="%2232866051%22">32866051)</searchLink><br />Neurology. 2012 Sep 11;79(11):1084-93. (PMID: <searchLink fieldCode="PM" term="%2222895589%22">22895589)</searchLink><br />Epilepsia. 2024 Nov;65(11):3155-3185. (PMID: <searchLink fieldCode="PM" term="%2239320421%22">39320421)</searchLink><br />Acad Med. 2016 May;91(5):663-8. (PMID: <searchLink fieldCode="PM" term="%2226796090%22">26796090)</searchLink><br />Acad Med. 2017 Oct;92(10):1491-1498. (PMID: <searchLink fieldCode="PM" term="%2228678098%22">28678098)</searchLink><br />Aliment Pharmacol Ther. 2021 Apr;53(8):873-886. (PMID: <searchLink fieldCode="PM" term="%2233641221%22">33641221)</searchLink><br />J Med Internet Res. 2022 Aug 26;24(8):e33898. (PMID: <searchLink fieldCode="PM" term="%2236018626%22">36018626)</searchLink><br />J Immunother Cancer. 2022 Mar;10(3):. (PMID: <searchLink fieldCode="PM" term="%2235296560%22">35296560)</searchLink><br />Brain Behav. 2022 Jul;12(7):e2622. (PMID: <searchLink fieldCode="PM" term="%2235765698%22">35765698)</searchLink><br />Nurse Res. 2021 Mar 11;29(1):14-20. (PMID: <searchLink fieldCode="PM" term="%2233629547%22">33629547)</searchLink><br />Nurs Res. 2018 Sep/Oct;67(5):404-410. (PMID: <searchLink fieldCode="PM" term="%2230052591%22">30052591)</searchLink><br />AEM Educ Train. 2023 Jul 11;7(4):e10891. (PMID: <searchLink fieldCode="PM" term="%2237448627%22">37448627)</searchLink><br />Seizure. 2021 Feb;85:12-18. (PMID: <searchLink fieldCode="PM" term="%2233383403%22">33383403)</searchLink><br />Clin Gastroenterol Hepatol. 2023 Oct;21(11):2938-2950.e6. (PMID: <searchLink fieldCode="PM" term="%2237308036%22">37308036)</searchLink><br />Res Social Adm Pharm. 2022 Jan;18(1):2230-2236. (PMID: <searchLink fieldCode="PM" term="%2234244078%22">34244078)</searchLink><br />BMJ Open. 2019 Dec 3;9(12):e029589. (PMID: <searchLink fieldCode="PM" term="%2231796475%22">31796475)</searchLink><br />BMJ. 1995 Aug 5;311(7001):376-80. (PMID: <searchLink fieldCode="PM" term="%227640549%22">7640549)</searchLink><br />Semin Arthritis Rheum. 2011 Oct;41(2):95-105. (PMID: <searchLink fieldCode="PM" term="%2221420149%22">21420149)</searchLink><br />Epilepsia. 2023 Jan;64(1):170-183. (PMID: <searchLink fieldCode="PM" term="%2236347817%22">36347817)</searchLink><br />J Neurosurg Pediatr. 2009 Apr;3(4):249-56. (PMID: <searchLink fieldCode="PM" term="%2219338401%22">19338401)</searchLink><br />Acta Psychol (Amst). 2000 Mar;104(1):1-15. (PMID: <searchLink fieldCode="PM" term="%2210769936%22">10769936)</searchLink><br />Front Neurol. 2021 Oct 25;12:734612. (PMID: <searchLink fieldCode="PM" term="%2234759881%22">34759881)</searchLink><br />MethodsX. 2021 May 28;8:101401. (PMID: <searchLink fieldCode="PM" term="%2234430297%22">34430297)</searchLink><br />BMJ Open. 2019 Apr 3;9(4):e024942. (PMID: <searchLink fieldCode="PM" term="%2230948575%22">30948575)</searchLink><br />BMC Nurs. 2021 Aug 18;20(1):149. (PMID: <searchLink fieldCode="PM" term="%2234407815%22">34407815)</searchLink><br />Ther Adv Rare Dis. 2022 Mar 8;3:26330040221076861. (PMID: <searchLink fieldCode="PM" term="%2237180417%22">37180417)</searchLink><br />J Gen Intern Med. 2021 Jun;36(6):1746-1750. (PMID: <searchLink fieldCode="PM" term="%2233742303%22">33742303)</searchLink><br />BJOG. 2017 Mar;124(4):661-667. (PMID: <searchLink fieldCode="PM" term="%2227860117%22">27860117)</searchLink><br />Epilepsy Behav. 2020 Jan;102:106703. (PMID: <searchLink fieldCode="PM" term="%2231786471%22">31786471)</searchLink><br />Epilepsia. 2022 Aug;63(8):1920-1929. (PMID: <searchLink fieldCode="PM" term="%2235722680%22">35722680)</searchLink><br />Ann Intern Med. 1997 Mar 1;126(5):376-80. (PMID: <searchLink fieldCode="PM" term="%229054282%22">9054282)</searchLink><br />World J Methodol. 2021 Jul 20;11(4):116-129. (PMID: <searchLink fieldCode="PM" term="%2234322364%22">34322364)</searchLink><br />Int J Clin Pharm. 2016 Jun;38(3):655-62. (PMID: <searchLink fieldCode="PM" term="%2226846316%22">26846316)</searchLink><br />Patient. 2020 Feb;13(1):11-21. (PMID: <searchLink fieldCode="PM" term="%2231544219%22">31544219)</searchLink><br />BMJ. 1999 Feb 20;318(7182):527-30. (PMID: <searchLink fieldCode="PM" term="%2210024268%22">10024268)</searchLink><br />Epilepsy Curr. 2021 Jun 30;21(5):385-388. (PMID: <searchLink fieldCode="PM" term="%2234924843%22">34924843)</searchLink><br />Expert Opin Pharmacother. 2023 Apr;24(5):655-663. (PMID: <searchLink fieldCode="PM" term="%2237021712%22">37021712)</searchLink>
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      – PersonEntity:
          Name:
            NameFull: Qasim A
      – PersonEntity:
          Name:
            NameFull: Antonio-Arce VS
      – PersonEntity:
          Name:
            NameFull: Ayed HB
      – PersonEntity:
          Name:
            NameFull: Ferlazzo E
      – PersonEntity:
          Name:
            NameFull: Kwon CS
      – PersonEntity:
          Name:
            NameFull: Lim KS
      – PersonEntity:
          Name:
            NameFull: Mitchell JW
      – PersonEntity:
          Name:
            NameFull: Salisu MA
      – PersonEntity:
          Name:
            NameFull: Valente K
      – PersonEntity:
          Name:
            NameFull: Vinayan KP
      – PersonEntity:
          Name:
            NameFull: Josephson CB
      – PersonEntity:
          Name:
            NameFull: Jette N
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 03
              Text: 2026 Mar
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1528-1167
          Numbering:
            – Type: volume
              Value: 67
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Epilepsia
              Type: main
ResultId 1