Managing Epilepsy by Telemedicine in Resource-Poor Settings

Abstract

Epilepsy is a common and treatable disease; in rich countries the expectation is that two-thirds of people will have their seizure episodes controlled on medication. In low- and middle-income countries (LMICs) however most people are not on treatment either because no doctors live near them or the logistics of affordable drug supply is absent. People with epilepsy then are prone to the bad effects of this disease—death, disfigurement from accidents and burns, and social problems due to the stigma with which the disease is associated. So this represents a failure of conventional face-to-face medicine. Might a telemedicine approach do better? The World Health Organization has suggested that non-physician health workers are empowered to diagnose and manage epilepsy; to do this they will need considerable medical support, which might be provided by telemedicine through the telephone, smartphone applications or a combination. This paper sets out what telemedicine does at present for people with epilepsy in LMICs and suggests how it might be developed in the future.

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

“…Atypical seizure semiologies and complex electroclinical epilepsy syndromes, as well as adverse effects of variable severity, were recognized by the investigators with excellent accuracy and precise medical advice was provided without any untoward events and medication errors. Previous clinical studies exploring teleconsultation in epilepsy depended almost entirely on traditional telephone calls and text messages, included mainly adult population and enrolled preferably stable children with epilepsy, who only needed continuation of previous prescription [8,9]. Few recent studies have employed innovative methods like smartphone-based applications, epilepsy nursing workers (ENW), and epilepsy helplines.…”

“…The algorithm used pre-test odds for having epilepsy, a probability score based on response to questions in the algorithm, and finally a posttest probability score. Subsequently, they converted it into a smartphone-based application, which was found to be more useful than other paper-based, electronic, or online web-based platforms [9,11].…”

“…But this has forced neurologists across the globe to explore innovative measures including telemedicine to continue providing quality care to patients with epilepsy. Telemedicine, which has been previously proven to be highly efficacious in various neurological disorders like stroke, epilepsy, and parkinsonism remains the most promising and practically the only feasible option to provide uninterrupted health care currently [ [6] , [7] , [8] , [9] ]. Recently high-speed internet connectivity, availability of smartphones, and internet data at nominal prices, with the opportunity of video calling, free pictures, and video messages in various social media services have revolutionized the telecommunication sector in developing countries like India.…”

Decision Making on Telemedicine for Patients With Epilepsy During the Coronavirus Disease 2019 (COVID-19) Crisis

“…Telemedicine consultation between clinicians and patients with epilepsy has certain advantages. First, the patients can save time, consultation fees, and travel expenses required to visit their doctors ( 3 ). Second, Patients living in areas with poor medical resources can have access to professional doctors of the required fields ( 3 ).…”

“…First, the patients can save time, consultation fees, and travel expenses required to visit their doctors ( 3 ). Second, Patients living in areas with poor medical resources can have access to professional doctors of the required fields ( 3 ). Third, patients can avoid public exposure, which is highly recommended during COVID-19 crisis ( 2 ).…”