Systematic reviews of specialist epilepsy services

BACKGROUND: Concern has been expressed over UK epilepsy service standards but the most clinically effective model of care is unknown. OBJECTIVE: To systematically review the current evidence on specialist epilepsy clinics compared to general neurology clinics and specialist epilepsy nurses compared to usual care. METHODS: Medline, Psychlit, Embase, Healthplan, GEARS, BIDS ISI, UKCHHO, international HTA websites, InterTASC databases and The Cochrane Library were searched to September 1999. Any studies comparing specialist epilepsy clinics or nurses to generalist services or usual care, reporting physical health, costs or generic quality-of-life outcomes were included. Two people independently applied inclusion and exclusion criteria and extracted data independently. Randomized controlled trial (RCT) quality was assessed by Jadad score and other studies qualitatively by the likelihood of bias. RESULTS: Findings were one RCT and two other studies on epilepsy clinics and four RCTs and a controlled trial on epilepsy nurses. Data synthesis was inappropriate. Epilepsy clinics showed no evidence of reduced seizure frequency or severity, no quality-of-life information and were more expensive. Epilepsy nurse services showed no evidence of reduced seizure frequency or severity, no effect on quality-of-life but were less expensive. CONCLUSION: There is insufficient evidence to demonstrate the superiority of any particular care model for producing better health outcomes.