Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2013 May;54 Suppl 2:9-12. doi: 10.1111/epi.12176.
Clinical case definitions are the cornerstone of clinical communication and of clinical and epidemiologic research. The ramifications of establishing a case definition are extensive, including potentially large changes in epidemiologic estimates of frequency, and decisions for clinical management. Yet, defining a condition entails numerous challenges such as defining the scope and purpose, incorporating the strongest evidence base with clinical expertise, accounting for patients' values, and considering impact on care. The clinical case definition of drug-resistant epilepsy, in addition, must address what constitutes an adequate intervention for an individual drug, what are the outcomes of relevance, what period of observation is sufficient to determine success or failure, how many medications should be tried, whether seizure frequency should play a role, and what is the role of side effects and tolerability. On the other hand, the principles of evidence-based medicine (EBM) aim at providing a systematic approach to incorporating the best available evidence into the process of clinical decision for individual patients. The case definition of drug-resistant epilepsy proposed by the the International League Against Epilepsy (ILAE) in 2009 is evaluated in terms of the principles of EBM as well as the stated goals of the authors of the definition.
临床病例定义是临床沟通和临床及流行病学研究的基石。确定病例定义的结果广泛，包括对频率的流行病学估计以及临床管理决策的潜在重大变化。然而，定义一种病症需要面临许多挑战，例如定义范围和目的，将最强的证据基础与临床专业知识相结合，考虑患者的价值观，并考虑对治疗的影响。此外，耐药性癫痫的临床病例定义必须解决个体药物的适当干预措施是什么、相关的结果是什么、确定成功或失败所需的观察期是多少、应该尝试多少种药物、癫痫发作频率是否应该发挥作用以及副作用和耐受性的作用是什么。另一方面，循证医学（EBM）的原则旨在为将最佳可用证据纳入个体患者临床决策过程提供一种系统方法。国际抗癫痫联盟（ILAE）在 2009 年提出的耐药性癫痫病例定义从循证医学的原则以及该定义作者的既定目标两个方面进行了评估。
