Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country

Abstract

The ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects. Methods: Clinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time. Results: A total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice. Conclusion: Teleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.

COVID-19, de novo seizures, and epilepsy: a systematic review

“…One observational comparative study confirmed that PWE showed more psychological distress than healthy controls, and they spent significantly more time following the COVID-19 outbreak news [13]. Finally, four studies showed that telemedicine may improve access to specialized care for PWE in these difficult times [10,[20][21][22]. The development of an epilepsy electronic patient portal may promote improved patient-clinician partnerships and facilitate patient self-management [23] 1.2.…”

Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis

“…Despite all these issues, this is the first systematic review regarding neurological complications of COVID-19 in children and hence is likely to be informative to pediatricians treating these children in providing a comprehensive overview. With the reporting of more children with various neurological complications, precise information regarding the treatment, semiology of seizure, EEG and MRI brain finding and long-term prognosis is likely to be revealed [ 47 ].…”

Telephone-based follow-up of children with epilepsy: Comparison of accuracy between a specialty nurse and a pediatric neurology fellow

“…In recent years, there is quick advancement of scope and usage of telemedicine in the field of neurology, also referred to as teleneurology. Beginning with acute stroke care, it is fast expanding to the care of persons with multiple sclerosis, Parkinson’s disease, and epilepsy[ [2] , [3] , [4] , [5] , [6] ]. The two key factors driving the ever-increasing demand for telemedicine in Neurology are limited access to specialists (Neurologists) and difficulties faced by these patients while attending for face-to-face consultation[ 6 ].…”

“…Beginning with acute stroke care, it is fast expanding to the care of persons with multiple sclerosis, Parkinson’s disease, and epilepsy[ [2] , [3] , [4] , [5] , [6] ]. The two key factors driving the ever-increasing demand for telemedicine in Neurology are limited access to specialists (Neurologists) and difficulties faced by these patients while attending for face-to-face consultation[ 6 ]. As there are few pediatric neurologists in India and they are only available in large cities, most of the caregivers face a long waiting time, have to travel a large distance, face a lot of logistic difficulties, and often a lot of financial hardship also.…”

“…If successful, it has the potential to judiciously redistribute the working hours of epilepsy specialists towards the care of relatively more complicated cases. As the follow-up visits of children with epilepsy after the initial evaluation is predominantly based on parents’ reporting of symptoms and drug compliance, they are also not likely to be compromised in the quality of care[ [3] , [4] , [5] , [6] ]. However, diagnostic studies with adequate sample sizes are needed to determine whether telephone consultation by specialty nurse can be an equally effective alternative to face-to-face consultation (the gold standard for follow-up care) in stable childhood epilepsy patients.…”