国内外のてんかんガイドライン

Epilepsy Guidelines: Japanese and International Guidelines

はじめに

　Evidence based medicine（EBM）の普及に伴い，各学会では診療ガイドラインの作成が盛んに行われ，近年ではEBMの隆盛初期に作成されたガイドラインの改定時期を迎えている。2010年10月には，2002年より8年ぶりに，てんかんガイドラインの改訂版が，日本神経学会監修のもと，医学書院より出版された。2010年版は，ガイドラインの記述をクリニカルクエスチョン（clinical question：CQ）方式に変えたため，改定とはいえ形式は新規に作成されたものである。筆者らは，2010年ガイドライン作成に携わっており，その経験を踏まえて本稿を著す。さらに，諸外国のてんかんガイドラインについての概要を紹介する。

Abstract

　Many guidelines for the management of epilepsy have been published since the introduction of evidence-based medicine.　In Japan,the first clinical guideline for epilepsy management was published by the Japanese Society of Neurology (JSN) in 2002.　The Japan Epilepsy Society (JES) has been publishing guidelines for several topics since 2005.　However,owing to recent advances in epileptology and the accumulation of related knowledge,it has become necessary to revise these guidelines.　Four medical societies―JSN,JES,the Japanese Society of Neurological Therapeutics,and the Japanese Society of Child Neurology―have together published new epilepsy-related clinical guidelines for practitioners.　The guideline committee consists of 23 specialists representing the 4 societies.　The guidelines primary target general practitioners treating epilepsy patients and are designed to be user friendly―in the form of 81 "clinical questions" (CQs).　The CQs comprehensively cover various aspects of epilepsy management including those related to diagnosis,treatment,surgery,pregnancy,and social issues.　Recommendations are concisely described with levels from A to D.　The evidence level (I to IV) of the references is based on the literature review conducted by the committee.　These guidelines were published in October 2010.