NICE response to World Report on epilepsy guidance

We write in response to David Holmes’s World Report, “NICE epilepsy guidance ‘may be detrimental to patient care’” (Feb 4, p 399), which details several comments made by the UK Group of Consultant Epileptologists (UKGCE). It is disappointing that the National Institute for Health and Clinical Excellence (NICE) was not asked to respond to these accusations before the World Report was published. The UKGCE is wrong to state that our guidelines do not draw on “clinical experience”. The Guideline Development Group in question consisted predominantly of practising clinicians from multidisciplinary backgrounds who, together with the patient representatives, applied their expertise to interpret the clinical and costeff ectiveness evidence. We also sought comments from many stakeholders. Indeed, the reason why the publication of the guideline was “delayed by the best part of a year” was because of further methodological work, which we undertook in response to comments received during the consultation periods. This was to ensure that our interpretations and fi ndings were correct and a sound basis for recommendations. It is disappointing that the UKGCE has claimed that we ignored their concerns, given that we consulted on our proposed updates on three separate occasions. Throughout the process, stakeholder comments were addressed or, where changes were not made, a clear reason for not doing so has been given. These responses are on our website. Detailed explanations regarding the International League Against Epilepsy classifi cation used, the evidencebase, the pharmacological focus of the update, and the discussions and debates surrounding all of our recommendations are in the full version of our guideline. We are confi dent that our clinical guideline refl ects best cost-eff ective practice in the National Health Service, and so it is in the interests of people with epilepsy and clinicians that careful consideration is paid to the recommendations.