Specialist epilepsy nurses for treating epilepsy
Abstract
Background
Epilepsy is a common serious neurological condition with a 0.5% prevalence. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out‐patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse‐based liaison services between primary (GP) and secondary/tertiary (hospital‐based) care.
Objectives
To overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care.
Search methods
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004), MEDLINE (October 2004), GEARS, EMBASE, ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register and PsycINFO databases.
Selection criteria
Randomized controlled and quasi‐randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review.
Data collection and analysis
Two reviewers independently selected trials for inclusion and extracted data. Outcomes investigated included: seizure frequency; appropriateness of medication prescribed; social or psychological functioning scores; knowledge about epilepsy scores; costs of care and adverse effects.
Main results
Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta‐analysis.
As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (eg seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement.
There is some evidence that people who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention.
Authors' conclusions
It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made.
Plain language summary
Specialist epilepsy nurses: no clear evidence on their impact on the care of people with epilepsy
Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Problems in receiving epilepsy care include a lack of follow up, incorrect use and combination of drugs and poor communication between the person with epilepsy and their doctor. The review of trials found that there is not enough evidence to show that specialist epilepsy nurses improve the care for people with epilepsy. It is possible that certain groups of people, such as those with a disability, may find some benefit. No adverse effects in receiving help from these nurses were reported.
