B Lindsay, PM Bradley. Care delivery and self-management strategies for children with epilepsy. Cochrane Database Systematic Review, December 8, 2010;12:CD006245.

Epilepsy care for children has been criticized for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision for children and their families. Lindsay and Bradley set out to compare the effectiveness of specialist or dedicated teams or individuals in the care of children with epilepsy with usual care services. They searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library February issue, 2010), MEDLINE (1950 to March 2010), EMBASE (1988 to May 2006), PsycINFO (1806 to March 2010) and CINAHL (1982 to March 2010). The scientists included randomized controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies. Each review author independently selected studies, extracted data and assessed the quality of included studies. Four trials and five reports are included in the review. They report on four different education and counseling programs for children, children and parents, or teenagers and parents. Each program showed some benefits for the well being of children with epilepsy, but each trial had methodological flaws and no single program was evaluated by more than one study.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that while each of the programs in this review showed some benefit to children with epilepsy, their impacts were extremely variable. No program showed benefits across the full range of outcomes. No study appeared to have demonstrated any detrimental effects but the evidence in favor of any single program is insufficient to make it possible to recommend one program rather than another. More trials, carried out by independent research teams, are needed.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER:
The self-management studies on any chronic condition, especially during the development phase, show great heterogeneity when compared to one another. However, as occurred here, it is great that such programs are being developed and tested.