Introduction: During the current pandemic, measures for preventing SARS-CoV-2 virus exposure has severely impacted the delivery of outpatient clinical care to patients with a chronic neurological condition. Telemedicine has emerged as an obvious choice to counter these impediments. However, its potential for maintaining outpatient care at pre-pandemic levels during these rapidly changing times is untested. Therefore, we analyzed our experience in a tertiary care epilepsy center. Methods: We divided the study period from March 1, 2020 to April 15, 2020 into a baseline, transition (to telemedicine), and current phase. We divided outpatient encounters into clinic, virtual (using Cleveland Clinic Express Care Online platform), and telephone (including commercial video conferencing platforms). Results: Completed outpatient visits during baseline and current period were 595 and 590, respectively. Nearly 1 out of 4 patients missed outpatient visits during the transition period. The virtual visits accounted for 19.7% of completed visits during baseline and increased to 66.8% during the current period. There were no telephone visits during the baseline phase but accounted for 26.1% of completed visits during the current phase. Less than 1 percent of completed visits in the current phase were in the clinic. Conclusion: We provide evidence that telemedicine's robust and rapid scalability can help maintain a seamless transition of outpatient care during the pandemic.
Neurologists are in short supply, with projections that the deficit will worsen as the population ages. 1 Access to subspecialists may be even more problematic. Despite the increasing and creative use of telemedicine to treat many neurological diseases, there are limited data to validate and guide future use. 2,3 Although it is an established paradigm in acute stroke, much less information exists on the implementation of telemedicine in the outpatient chronic-care setting. 4,5 Only a handful of studies exist on the use of telemedicine for people with epilepsy (PWE). They vary in methodology and context, cumulatively describing experience in a few hundred patients, with most models requiring patients to travel to a local medical site, where staff coordinates virtual connection with a provider at a remote site. 6-10 Technological advances have allowed a more elegant virtual practice of medicine with time. In recent years, video-conferencing and high-speed internet have become ubiquitous on personal devices in developed and many developing countries. As a result, a more convenient and accessible telemedicine has emerged, where providers can connect
This small series suggests that the presence of subclinical status epilepticus and traumatic brain injury correlated with the presence of SIRPIDs signifying that SIRPIDs may be due to a more focal etiology and may represent a more ictal pattern than previously thought. Longer recording times in those patient populations may yield more cases of SIRPIDs in which to base further studies.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractObjective: We present a model for the outpatient care of patients undergoing continuous electroencephalography (cEEG) monitoring during a hospitalization, named the post-acute symptomatic seizure (PASS) clinic. We investigated whether establishing this clinic led to improved access to epileptologist care. Methods: As part of the PASS clinic initiative, electronic health record (EHR) provides an automated alert to the inpatient care team discharging adults on first time antiepileptic drug (AED) after undergoing cEEG monitoring. The alert explains the rationale and facilitates scheduling for a PASS clinic appointment, three-month after discharge, along with a same-day extended (75 minutes) EEG. We compared the initial epilepsy clinic visits by patients undergoing cEEG in 2017, before ("Pre-PASS" period and cohort) and after ("PASS" period and cohort) the alert went live in the EHR. Results: Of the 170 patients included, 68 (40%) suffered a seizure during the mean follow-up of 20.9 ± 10 months. AEDs were stopped or reduced in 66 out of 148 (44.6%) patients discharged on AEDs. Pre-PASS cohort included 45 patients compared to 145 patients in the PASS cohort, accounting for 5.8% and 9.9% of patients, respectively, who underwent cEEG during the corresponding periods (odds ratio [OR] = 1.8, 95% CI = 1.26-2.54, P = .001). The two cohorts did not differ in terms of electrographic or clinical seizures. The PASS cohort was significantly more likely to be followed up within 1-6 months of discharge (OR = 4.6, 95% CI = 2.1-10.1, P < .001) and have a pre-clinic EEG (51.2% vs 11.1%; OR = 8.39, 95% CI = 3.1-22.67, P < .001). Significance: PASS clinic, a unique outpatient transition of care model for managing patients at risk of acute symptomatic seizure led to an almost twofold increase in access to an epileptologist. Future research should address the wide knowledge gap about the best post-hospital discharge management practices for these patients. K E Y W O R D S acute seizures, antiepileptic drugs, continuous EEG, epilepsy clinic, model of care, PASS clinic 256 | PUNIA et Al.
Introduction : Refractory status epilepticus (RSE) is seizure activity that persists despite acute administration of standard anticonvulsant therapy. It often occurs after cardiac arrest, indicating a poor prognosis. Therapeutic hypothermia (TH) reduces neurological injury in this patient population, and post cardiac arrest protocols now incorporate TH into the treatment algorithm. However, TH is not routinely used in RSE from other etiologies and little is known about the appropriate role of TH as an adjunct therapy.Methods: Five consecutive patients with RSE admitted to our neurocritical care unit treated with TH were retrospectively reviewed. Three patients had anoxic brain injury post cardiac arrest and two had epilepsy secondary to remote traumatic brain injury. All five patients received similar medical treatment for RSE. Results:The two post-traumatic epilepsy patients became seizure free with TH and remained seizure free after rewarming. Both had good neurological recovery and were discharged from rehabilitation back to baseline. Seizures persisted despite TH in the three postcardiac arrest patients and all three expired. Conclusion:Currently, there are only five reported cases of TH use in adult patients with status epilepticus. Our additional five cases suggest that RSE from etiologies other than anoxic brain injury post-cardiac arrest may have better outcomes with TH. The benefit of TH in RSE may depend on seizure etiology and may have a more favorable outcome in post-traumatic epilepsy patients.
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