An evidence based approach to the first unprovoked seizure

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, i.e., 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.