Epilepsy clinics - there was no evidence of improvement of seizure frequency or seizure severity when compared to neurology outpatient clinics. There was no information available on quality of life outcomes. Epilepsy clinics were found to be more expensive but no test of statistical significance was available.
Epilepsy nurses- there was no evidence of improvement of seizure frequency or seizure severity when compared to usual care but some evidence of decreased rates of depression. No effect on generic quality of life measurement was shown. Care by specialist nurses was found to be cheaper than usual care but not significantly so.
A separate review compared specialist to generalist clinics or specialist nurses to 'usual care' for other chronic medical conditions. The 3 RCTs of specialist clinics found showed no clear benefits or differences in costs. Of the 5 RCTs of specialist nurses, three showed no differences on the main physical outcome measure and two had improved outcomes for the specialist nurse group. One had a lower point estimate of cost for the specialist nurse group.
More research is needed to determine the most clinically effective model of service provision for people with epilepsy. Despite the lack of evidence, it should be borne in mind that present quality of care for people with epilepsy is generally poor and improvements need to be made.
