A Cochrane review included 18 different studies of 16 separate interventions, which were classified into 7 distinct groups. It was not possible to combine study results in a meta-analysis because of the heterogeneity of the studies. Two intervention types, the specialist epilepsy nurse and self management education, have some evidence of benefit. However, there was no clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not apply to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision.
Comment: The quality of evidence is downgraded by study quality (unclear or missing allocation concealment), inconsistency (heterogeneity in outcomes, study populations, interventions, and time scales) and indirectness (differences in country-spesific settings).