如何正确应用癫痫治疗指南.pptVIP

如何正确应用《癫痫治疗指南》 为什么我们需要指南 主要癫痫治疗指南的重要结论 指南对各类癫痫患者的具体指导意见 如何正确看待使用指南 抗癫痫药物的发展 癫痫临床诊治的过程The Process of Clinical Inference 临床指南的目的 “指南是指一种系统性阐述，用以帮助执业医师以及患者对于特定临床情况作出适当医疗决定的指导性文件。” －Institute of Medicine,1990 为什么我们需要指南 主要癫痫治疗指南的重要结论 指南对各类癫痫患者的具体指导意见 如何正确看待使用指南 Newer drugs for epilepsy inadults （NICE） March, 2004 Contents 1 Guidance 2 Clinical need and practice 3 The technology 4 Evidence and interpretation 5 Recommendations for further research 6 Implications for the NHS 7 Implementation and audit 8 Related guidance 9 Review of guidance Appendix A: Appraisal Committee Appendix B: Sources of evidence Appendix C: Detail on criteria for audit In the UK, the National Institute for Clinical Excellence Committee examined randomised clinical trials and systematic reviews comparing new antiepileptic drugs with placebo, with older drugs, or with other new compounds. The UK guidelines did not consider zonisamide (not yet available in Europe) and felbamate (a last resort agent because of bone marrow and liver toxicity) but included vigabatrin in the review. Pregabalin has not been reviewed, possibly because of insufficient evidence at the time of preparation of the guidelines. NICE指南成人及儿童的抗癫痫新药（2004） 推荐用于以下患者的新药 (TPM, LTG, LEV, OXC, TGB, GBP, VGB) 一种传统抗癫痫药无效 或 因以下原因不适合应用传统抗癫痫药: 存在药物禁忌症 与患者正在服用的其他药物存在相互作用 已知个体对其耐受性差 患者是一个存在怀孕可能的妇女患者(或需要治疗至育龄期) NICE GuidelinesDiagnosis and management of the epilepsies in adults and children in primary and secondary care (2004) AED treatment strategy should be individualised seizure type epilepsy syndrome co-medication and co-morbidity the individual’s lifestyle preferences of the individual and their family and/or carers as appropriate NICE GuidelinesCriticisms Largely driven by economic concerns under NHS Proportion of prescriptions: 0.1% (1991) to 20% (2002) Proportion of costs: 69% (2002) Scope narrow Criteria to rate evidence not clearly defined Classification of evidence not clearly described Old AEDs no