Guía Andaluza de Epilepsia 2009 The Andalusia Guideline on Epilepsy 2009
Diagnóstico y Tratamiento de la Epilepsia en Niños y Adultos The Diagnosis and Treatment of Epilepsy in Children and Adults

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WELCOME TO THE ANDALUSIAN GUIDE TO EPILEPSY

The Andalusian Guide to Epilepsy, whose online version you are now visiting, is the result of the collaborative effort of a multidisciplinary group of professional from medical disciplines related to the care and treatment of epileptic patients, who worked together to produce an evidence-based Clinical Practice Guide (CPG) on diagnostic and therapeutic aspects of epilepsy.

This is an unprecedented project in Spanish-language scientific literature, whose quality has already been acknowledged following a quality assessment by Guiasalud (www.guiasalud.es), a National Health System (NHS) organisation in which all 17 Autonomous take part, which was created in 2002 and adopted in 2003 by the Inter-Territory Council as a tool for the improvement of health care in the NHS.

In the Andalusian Guide to Epilepsy, you will find detailed answers, based on scientific evidence, to 200 specific questioned related to diagnostic and therapeutic aspects of epilepsy, which are given in the chapter and question index.

This guide is addressed to the following:

  1. 1. All health workers involved in the management of epileptic crises, including: Medical Specialists (neurologists, neuro-pediatricians, neuro-surgeons, neuro-physiologists, neuro-radiologists, Nuclear Medicine specialists, internists, intensive care specialists, and emergency doctors), GPs, and nursing staff.
  2. Los pacientes epilépticos y sus familiares.

The online version is meant to make this work more accessible, contribute to its dissemination and implementation, and serve as a source of feedback and enrichment for the Guide itself.

Methodology for the production of The Andalusian Guide To Epilepsy

The sequence of steps taken to produce the Guide was the following:

  1. Formulation of research questions: the drafting of the 200 research questions was carried out following the PICR method (Patients-Intervention-Comparison-Results) in accordance with the National Health Care CPF workgroup recommendations.

The advantage of formulating the specific clinical questions in this format is that they unambiguously what is meant to be known and contribute to the bibliographic search, as every type of question corresponds to a type of study with the adequate design to answer it.

  1. B) Search and selection of the relevant scientific evidence: the search in scientific literature was carried out for each of the questions taking as a starting point its drafting in PICR format, and following a standardised schema which can be summed up in the following steps:
    1. 1.The keywords related with the question topic were selected, and in all cases an initial selective search was carried out in the following evidence search engines:
      1. Tripdatabase (www.tripdatabase.com)
      2. TheCochraneLibrary / TheCochraneLibrary Plus (http://www.update-software.com/Clibplus/Clibplus.asp)
    2. 2. Complementing the search for evidence in the following search engined was recommended according to the specific topic of the research question:
      1. Questions on treatment: DARE (http://www.crd.york.ac.uk/crdweb)
      2. Questions on prognosis or aetiology: EMBASE (http://www.embase.com)
    3. 3. As a last step to complete the search, it was recommended to carry out a selective keyword search in Pubmed-MEDLINE using scientific evidence filters for the selection of Meta-analysis and Controlled Clinical Essays.
    4. 4. After the initial search, all articles retrieved were classified according to its methodological features following the indications of the European Federation of Neurological Societies (EFNS) for the classification of scientific evidence published in 2004 [12]. In the case of prognosis studies, a modified version of the evidence classification proposed by the Oxford Centre for Evidence-Based Medicine was used.

The evidence classification used by our group is the one given in Tables 2, 3 and 4.

In the final drafting of the document, only the citations deemed most relevant in each of the chapters were selected in the bibliography section, avoiding the multiplicity of citations for the same evidence. This is the reason why in certain cases the bibliography does not include all the studies retrieved.

  1. C) Formulation of Recommendations: once the scientific evidence was selected, the recommendations were formulated. Each recommendation underwent the following filtering process:
      1. Formulation by the authors of the respective chapters.
      2. Modulation by revisers.
      3. Consensus approval by the whole group.

Efforts were made in all cases for recommendations to consider the health benefits, secondary effects, risks and costs of each of the measures proposed

Timeline for the pr oduction of the Andalusian Guide To Epilepsy

The group was formally constituted during the 5th Annual Meeting of SAdE, which took place in Córdoba on 29th March 2008. In said face-to-face meeting, the mechanics for the drafting of the CPG was established, the 200 research questions to be answered were distributed among the various authors, the revisers for each section were assigned, and a preliminary landmark Schedule was established. Before each face-to-face meeting, the promoters and revisers of the SAdE CPG had drafted a preliminary version of the 200 research questions to be answered, distributed by topics and sections.

Each topic was assigned to two authors who collaborated in its drafting. Once the first draft of each chapter was written, it was sent to the revisers for the corresponding section. Said revisers provided suggestions for changes to the first draft, which resulted in a second draft of each chapter. This second draft was sent back to its authors. The draft exchange took place until a final draft was reached at by consensus for every chapter.

Once all the final drafts were for each chapter had been written, the two global CPG revisers carried out the integration and homogenisation of all the material, thus producing the final version of the 2009 SAdE CPG, which required the final approval of the group.

On 22nd November 2008 the second face-to-face meeting took place, in which all members of the group, after analysing the final result, approved the final version of the 2009 SAdE CPG. Thus the document was ready 238 days following the group constitution meeting.

In a later stage, the SAdE CPG was sent to certain renowned experts in epilepsy, who were requested to comment on it.

The printed version of the Andalusian Guide to Epilepsy was officially presented in the course of the 6th Annual Meeting of SAdE, which took place in Almería on 17th April 2009.