Download Critical Appraisal Topics Outline

Critical Appraisal Topics Outline
Title:
Clozapine-Induced Seizures: Recognition and Treatment
Clinical bottom line:
Once a first seizure has occurred, the dosage of clozapine should be decreased
and any other seizure-provoking factors (such as sleep deprivation) eliminated.
The dosage is usually reduced by about 40% to 50%, to maintain the therapeutic
effect of clozapine. But there was no clinical trail supported this conclusion
Citation/s:
The Canadian Journal of Psychiatry, Vol 52, No 7, July 2007
Lead author's name and fax:
Jason Wong, Nicholas Delva, MD, FRCPC
Three-part Clinical Question:
P: patient with schizophrenia who seizure induced by clozapine
I: valproate acid
C:
O: reduce of seizure
Type of Question: treatment
Search Terms & Strategy:
Database: Pubmed
Key words: seizure, convulsion, epilepsy, clozapine
Search stratedy:
#1 Search clozapine and (seizure or epilepsy or convulsion)
03:07:23
174
#2 Search clozapine and (seizure or epilepsy or convulsion) Limits: Review 03:09:06 38
The Study: Level of Evidence: 3-4
We performed a MEDLINE search of English-language publications from 1978 to July 2006, using the search words
seizures and electroencephalography cross-referenced with clozapine. Bibliographies of these articles were used to
identify additional relevant papers. One of the goals of this review was to provide unbiased estimates of the frequencies
of the types of seizure associated with clozapine. Most of the literature-cited cases described were included in the
calculations of frequencies, but several were excluded:
The Evidence:
Comments:
1. 所 review 個案均為 case serial 並無做 case control trial 但因案例少,且為 side effect
2. 提出之方法未做統計上的分析，大部分為作者或其他作者依藥理學或現象之推論
3. 治療方法待驗證
Appraised by: R2 王智仁 ate: 2007/12/20
Kill or Update By:
2009/1/1