Telemedicine in epilepsy: How can we improve care, teaching, and awareness?

Kissani, Najib; Lengané, Yilédoma Thierry Modeste; Patterson, Victor; Mesraoua, Boulenouar; Dawn, Eliashiv; Özkara, Çiğdem; Shears, Graeme; Riphagen, Harmiena; Asadi‐Pooya, Ali A.; Bogacz, Alicia; Aarrouni, Ismael El; Nair, Pradeep Pankajakshan

doi:10.1016/j.yebeh.2019.106854

Cited by 59 publications

(43 citation statements)

References 11 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Panda

Sharawat

Panda

2020

Seizure

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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.

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Section: Discussionmentioning

confidence: 99%

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

Panda

Sharawat

Panda

2020

Seizure

View full text Add to dashboard Cite

show abstract

“…Telemedicine services can prove extremely useful in supporting remote healthcare in persons with epilepsy during the current COVID-19 pandemic, particularly for their role in facilitating the interactive exchange of information between patients and physicians [2]. Telemedicine is not inferior to traditional face-to-face visits with regard to seizure control, hospitalizations, emergency room visits, or medication adherence [3,4].…”

Section: To the Editormentioning

confidence: 99%

Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic

Brigo¹,

Bonavita

Leocani

et al. 2020

Epilepsy & Behavior

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“…Telephone consultations have been shown to be both effective and efficient in providing a remote epilepsy service, although specialised digital audiovisual technology is being rapidly deployed for both new and follow-up epilepsy clinic patients. 5,6 While there are limitations that come with telemedicine, such as reduced ability to perform physical examination, in epilepsy care physical examination is rarely necessary, particularly for chronic disease management, and epilepsy would seem an ideal condition for using telemedicine. 7 The changed human interaction may, however, diminish the ability to pick up non-verbal and some verbal cues, which are particularly important in functional presentations.…”

Section: Telemedicinementioning

confidence: 99%

Epilepsy care in the COVID-19 era

2020

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The COVID-19 pandemic will impact on how care for chronic conditions is delivered. We use epilepsy to exemplify how care for patients will be affected, and suggest ways in which healthcare systems can respond to deliver the most effective care. Where face-to-face outpatient appointments have been cancelled, telemedicine can facilitate remote clinical consultations for new and follow-up epilepsy clinic patients while reducing the risk of infection to both patients and healthcare staff. First-seizure patients will need investigation pathways rationalised, while those with chronic epilepsy will need to have reliable alternative avenues to access clinical advice. At the same time, neurologists should support emergency departments and acute medical units, advising on appropriate management of seizures and other acute neurological presentations. Ultimately, the revolution in our clinical practice is unlikely to cease after this pandemic, with reconfiguration of services likely to bring improvements in efficiency and convenience, and a reduced environmental impact.

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Telemedicine in epilepsy: How can we improve care, teaching, and awareness?

Cited by 59 publications

References 11 publications

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

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

Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic

Epilepsy care in the COVID-19 era

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