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An Evidence Based Approach to the First Unprovoked Seizure

Published online by Cambridge University Press:  14 September 2018

Samuel Wiebe
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, and the London Health Sciences Centre London, Ontario, Canada
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Abstract:

The objective is to illustrate the creation and structure of a particular type of Evidence Based Care (EBC) summary that has direct clinical relevance, the Critically Appraised Topic (CAT). The process consists of a step-by-step application of the EBC principles to a common neurological problem, ie., a patient presenting with a first, unprovoked generalized seizure. This includes asking a focused clinical question about prognosis for recurrence and the role of antiepileptic drugs; searching the literature to answer the question; selecting the relevant evidence (a meta-analysis about prognosis and a randomized controlled trial about therapy); appraising the literature for its validity and usefulness; and applying the results to the clinical scenario. The result is a one-page, user friendly CAT whose title states a declarative answer to the clinical question. It also contains a description of the literature search and of the evidence, the clinical bottom lines derived from the evidence, and general comments.

Résumé:

Résumé:

L’objectif de cet article est d’illustrer la création et la structure d’un type particulier de sommaire de soins fondés sur des preuves (evidence-based care – EBC) ayant une pertinence clinique directe, le critically appraised topic (CAT). Le processus consiste à appliquer étape par étape les principes d’EBC à un problème neurologique fréquent, i.e. celui d’un patient qui consulte pour une première crise convulsive généralisée non provoquée. Ce processus inclut: des questions cliniques ciblées sur le pronostic de récidive et le rôle des antiépileptiques; une recherche de la littérature pour répondre aux questions; la sélection des données pertinentes (une méta-analyse sur le pronostic et un essai clinique contrôlé et randomisé sur le traitement); l’évaluation de la littérature quant à sa validité et à son utilité; et l’application des résultats au scénario clinique. Le résultat est un CAT de deux pages, facile à utiliser, dont le titre énonce une réponse à la question clinique. Il contient également une description de la recherche de la littérature et des données, des conclusions cliniques tirées des données et des commentaires généraux.

Type
Review Article
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

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