A recent review examined the effectiveness of any specialized or dedicated intervention for the care of adults with epilepsy with respect to the effectiveness of usual care. Bradley and Lindsay searched a number of databases. Randomized controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies were analyzed. There are 13 trials and 16 reports included in this review. Seven distinct groups of interventions were identified: seven papers reported on five trials of specialist epilepsy nurses. Of the 13 trials, at least three (four reports) have methodological weaknesses, and some of the results from other analyzes within studies need to be interpreted with caution because of limiting factors in the studies. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and life quality of people with epilepsy. The authors concluded that two intervention types, the specialist epilepsy nurse and self-management education, have some evidence of benefit. However, they did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy.

WHAT THE STUDY MAY MEAN TO YOU: There seems to be progress being made in using self-management programs, often applied by specialty nurses, with epilepsy. At this point in time, the most important approach would be to build on the existing data and develop more effective programs. The assessment of self-efficacy should be incorporated into these programs to insure the long-term maintenance of whatever self-management skills are taught to and performed by patients with epilepsy.

P Bradley, B Lindsay. Care delivery and self-management strategies for adults with epilepsy. Cochrane Database Systematic Reviews, January 23, 2008:CD006244.