John: Epilepsy affects tens of millions of people around the world and alongside many trials and reviews of drugs and other treatments, are studies that have tested more complex strategies. In an updated Cochrane Review from February 2016, Peter Bradley, from Public Health Wales in the UK. and colleagues look at the evidence for some of these. He tells us what they found in this evidence pod.

Peter: Epilepsy is a spectrum of disorders in which an individual may experience seizures that are unpredictable in frequency. While most people can control their seizures well with medications and other treatment options, epilepsy causes problems for many, in social, school and work situations. Researchers have sometimes criticised epilepsy care for adults for its lack of impact, which has led to the development of various service models and strategies to respond to perceived inadequacies.
This is the area for our Cochrane Review. We investigated the effects of any specialised or dedicated service model or strategy for adults with epilepsy, and have found that the current evidence does not support any specific intervention type. We included 18 different studies, which considered 16 separate interventions. We classified these into seven distinct types: education on self-management; strategies to improve patient adherence to treatment; self-management through screening; alternative models of outpatient care delivery; specialist nurse practitioners; interventions designed to influence behaviour; and, finally, the use of guidelines to improve patient quality of life and quality of epilepsy care.
The interventions had varying amounts of evidence to support them. Whereas there were studies showing some benefit from education on self-management and from specialist epilepsy nurses, other intervention types did not look so promising. We also found that some of the studies were not well designed and the complexity of their interventions means that any impact is likely to vary according to where the interventions are used.
Therefore, after working carefully through all this evidence, we have reached the conclusion that it’s not currently possible to advocate for any one of these interventions to be preferred for the care of adults with epilepsy. We need the evidence base to expand through new randomised trials that, in particular, examine promising areas, such as self-management education, provide a full description of the intervention, and recruit those subgroups of patients who are most likely to benefit, including those with newly diagnosed epilepsy or with learning disabilities.

John: If you would like to find out more about the current evidence base and watch for future updates of this review, should these new trials get done, you can find it easily online at Cochrane Library dot com. Just visit the website and search 'epilepsy care delivery'.