1
|
Telemedicine for Individuals with epilepsy: Recommendations from International League Against Epilepsy Telemedicine Task Force. Seizure 2023; 106:85-91. [PMID: 36803864 DOI: 10.1016/j.seizure.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Worldwide, People with Epilepsy (PWE) are confronted with several barriers to face-to-face consultations. These obstacles hamper appropriate clinical follow-up and also increase the treatment gap for Epilepsy. Telemedicine holds the potential to enhance management as follow-up visits for PWE are focused on more on clinical history and counselling rather than physical examination. Besides consultation, telemedicine can also be used for remote EEG diagnostics and tele-neuropsychology assessments. In this article, the Telemedicine Task Force of the International League Against Epilepsy (ILAE) outlines recommendations regarding optimal practice in utilizing in the management of individuals with epilepsy. We formulated recommendations for minimum technical requirements, preparing for the first tele-consultation and the specificities for follow-up consultations. Special considerations are necessary for specific populations, including paediatric patients, patients who are not conversant with tele-medicine and those with intellectual disability. Telemedicine for individuals with epilepsy should be vigorously promoted with the aim of improving the quality of care and ultimately reduce the wide clinician access related treatment gap across several regions of the globe.
Collapse
|
2
|
Munger Clary HM, Snively BM, Topaloglu U, Duncan P, Kimball J, Alexander H, Brenes GA. Patient-reported outcomes via electronic health record portal versus telephone: a pragmatic randomized pilot trial of anxiety or depression symptoms in epilepsy. JAMIA Open 2022; 5:ooac052. [PMID: 36247085 PMCID: PMC9555875 DOI: 10.1093/jamiaopen/ooac052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To close gaps between research and clinical practice, tools are needed for efficient pragmatic trial recruitment and patient-reported outcome collection. The objective was to assess feasibility and process measures for patient-reported outcome collection in a randomized trial comparing electronic health record (EHR) patient portal questionnaires to telephone interview among adults with epilepsy and anxiety or depression symptoms. Materials and Methods Recruitment for the randomized trial began at an epilepsy clinic visit, with EHR-embedded validated anxiety and depression instruments, followed by automated EHR-based research screening consent and eligibility assessment. Fully eligible individuals later completed telephone consent, enrollment, and randomization. Participants were randomized 1:1 to EHR portal versus telephone outcome assessment, and patient-reported and process outcomes were collected at 3 and 6 months, with primary outcome 6-month retention in EHR arm (feasibility target: ≥11 participants retained). Results Participants (N = 30) were 60% women, 77% White/non-Hispanic, with mean age 42.5 years. Among 15 individuals randomized to EHR portal, 10 (67%, CI 41.7%-84.8%) met the 6-month retention endpoint, versus 100% (CI 79.6%-100%) in the telephone group (P = 0.04). EHR outcome collection at 6 months required 11.8 min less research staff time per participant than telephone (5.9, CI 3.3-7.7 vs 17.7, CI 14.1-20.2). Subsequent telephone contact after unsuccessful EHR attempts enabled near complete data collection and still saved staff time. Discussion In this randomized study, EHR portal outcome assessment did not meet the retention feasibility target, but EHR method saved research staff time compared to telephone. Conclusion While EHR portal outcome assessment was not feasible, hybrid EHR/telephone method was feasible and saved staff time.
Collapse
Affiliation(s)
- Heidi M Munger Clary
- Corresponding Author: Heidi M. Munger Clary, MD, MPH, Department of Neurology, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157, USA;
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Umit Topaloglu
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Kimball
- Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Halley Alexander
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
3
|
Aquino ERDS, Rodrigues DLG, Batista CEA, Basso J, Gadenz SD, Kim KY, Pachito DV, Sperling S, Suffert SCI, Mantese CE. Teleconsultations in neurology in a universal health system amid COVID-19: a descriptive study. Rev Assoc Med Bras (1992) 2022; 68:1376-1382. [DOI: 10.1590/1806-9282.20220697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
|
4
|
Jang Y, Moon J, Lee ST, Lee SK, Chu K. Telemedicine in epilepsy and encephalitis: previous research and indication guidelines in Korea. ENCEPHALITIS 2022; 2:65-72. [PMID: 37469460 PMCID: PMC10295915 DOI: 10.47936/encephalitis.2022.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 07/21/2023] Open
Abstract
Telemedicine is an emerging field of medicine that has become more important during the coronavirus disease 2019 (COVID-19) pandemic era and is being studied actively in various medical fields. In neurology, the introduction of telemedicine is accelerating worldwide under the label of teleneurology. So far, few studies have been conducted on telemedicine for patients with epilepsy. In nonmetropolitan areas, video-based clinics have been demonstrated to be effective for seizure control, and smartphone-based diagnosis has also been confirmed to be accurate. Indeed, after the onset of the COVID-19 pandemic, telemedicine has been used to treat patients with epilepsy around the world. Few studies have examined the use of telemedicine for patients with autoimmune encephalitis. One showed that telephone-based evaluation is sufficient to assess the cognitive reserve of leucine-rich glioma inactivated-1-antibody encephalitis patients, thereby diagnosing their dementia. Telephone-based outpatient clinics are temporarily permitted under Korean medical law, and telemedicine can be attempted for clinically stable patients with epilepsy in Korea. In addition, patients with autoimmune encephalitis in stable or improving status may also be candidates for treatment with telemedicine. This review presents evidence for the safety and efficacy of telemedicine to treat epilepsy and encephalitis patients and discusses indication guidelines. Based on our literature review and current Korean medical law, we suggest tentative guidelines for telemedicine in the fields of epilepsy and autoimmune encephalitis.
Collapse
Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Assenza G, Ricci L, Lanzone J, Boscarino M, Vico C, Narducci F, Sancetta B, Di Lazzaro V, Tombini M. Understanding and managing the impact of the COVID-19 pandemic and lockdown on patients with epilepsy. Expert Rev Neurother 2022; 22:145-153. [PMID: 35098850 DOI: 10.1080/14737175.2022.2031984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic represented a relevant issue for people with epilepsy (PwE). Medical care and social restrictions exposed PwE to a high risk of seizure worsening. Medical institutions answered to the pandemic assuring only emergency care and implementing a remote assistance that highlighted the technological obsolescence of the medical care paradigms for PwE. AREA COVERED We reviewed the literature on the COVID-19-related factors influencing the epilepsy course, from the evidence of seizure risk in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected PwE to anti-Sars-Cov-2 drugs interactions with antiseizure medications and the perceived changes of seizures in PwE. EXPERT OPINION COVID-19 pandemic was a problematic experience for PwE. We must make treasure of the lessons learned during this period of social restrictions and employ the recent technological advances to improve PwE assistance, in particular telemedicine and electronic media for patients' education.
Collapse
Affiliation(s)
- Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri Foundation, Institute of Milan, Milan, Italy.,Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy
| | - Marilisa Boscarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Vico
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Biagio Sancetta
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| |
Collapse
|
6
|
Kramer ZJ, Brandt C, Havens K, Pasupuleti A, Gaillard WD, Schreiber JM. Telehealth for patients with rare epilepsies. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221076861. [PMID: 37180417 PMCID: PMC10032469 DOI: 10.1177/26330040221076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 05/16/2023]
Abstract
Recent developments in technology and exigencies of the COVID-19 pandemic have spurred innovations for telehealth in patients with rare epilepsies. This review details the many ways telehealth may be used in the diagnosis and management of rare, pharmacoresistant epilepsy and documents our experience as measured by surveying caregivers of pediatric patients with epilepsy. Most components of the epilepsy evaluation, including history and examination, neuroimaging, and electroencephalogram (EEG) can be performed or reviewed remotely, assuming similar technique and quality of diagnostic studies. Seizure and epilepsy diagnosis is enhanced through the assistance of caregiver smart phone video recordings and 'ambulatory' EEG. Monitoring patient seizure frequency through paper seizure diaries is now increasingly being replaced by electronic diaries in both clinical and research settings. Electronic seizure diaries have numerous advantages such as data durability, increased accessibility, real-time availability, and easier analysis. Telehealth enhances access to specialized epilepsy care, which has been shown to reduce mortality and improve patient compliance and outcomes. Telehealth can also enable evaluation of patients with rare epilepsy in centers of excellence and enhance enrollment in clinical trials. Reducing mortality risk in patients with epilepsy can be accomplished through remote counseling and addressing psychiatric co-morbidities. Findings from surveying caregivers of children with epilepsy treated at Children's National Hospital showed that 54/56 (96.4%) found that not having to commute to the appointment positively contributed to their telemedicine experience. Overall, most respondents had a positive experience with their telemedicine visit. Almost all respondents (98%) were either 'very happy' or 'happy' with their telemedicine visit and their ability to communicate over telemedicine with the provider and either 'very likely' or 'likely' to want to use telemedicine for some future clinic visits. Telehealth in rare epilepsies is feasible and, in many ways, comparable with traditional evaluation and management.
Collapse
Affiliation(s)
- Zachary J. Kramer
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Carrin Brandt
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Kathryn Havens
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Archana Pasupuleti
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - William D. Gaillard
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - John M. Schreiber
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC 20010, USA
| |
Collapse
|
7
|
Wong VSS, Williams MK, Akiona CK, Avalos LN, Taylor EJ, Stein AG, Asai SM, Koenig MA, Rosen MA. Demographic and technological factors influencing virtual seizure clinic visit satisfaction before and during the Covid-19 pandemic in rural Hawaii. Epilepsy Behav 2021; 124:108374. [PMID: 34757265 PMCID: PMC8552294 DOI: 10.1016/j.yebeh.2021.108374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Telemedicine clinic visits traditionally originated from spoke clinic sites, but recent trends have favored home-based telemedicine, particularly in the time of Covid-19. Our study focused on identification of barriers and factors influencing perceptions of care with use of home-based telemedicine in patients with seizures living in rural Hawaii. We additionally compared characteristics of patients using telemedicine versus in-person clinic visits prior to the Covid-19 pandemic. METHODS For the retrospective portion of our study, we queried charts of adult outpatients treated by the two full-time epileptologists at a Level 4 epilepsy center accredited by the National Association of Epilepsy Centers between November 2018 and December 2019. We included patients who live on the neighbor islands of Hawaii but not on Oahu, i.e., patients who would require air travel to see an epileptologist. There had been no set protocol at the epilepsy center for telemedicine referral; our practice had been to offer telemedicine visits to all neighbor island patients when felt to be appropriate. We collected demographic and clinic visit data. For the prospective portion we surveyed neighbor island patients or their caregivers, seen via home-based telemedicine between March 2020 and December 2020. We obtained verbal consent for study participation. Survey questions addressed satisfaction with clinical care, visit preferences, and potential barriers to care. RESULTS In a 14-month period prior to the Covid-19 pandemic, 75 (61%) neighbor island patients were seen exclusively in-person in seizure clinic while 47 (39%) had at least one telemedicine visit. 39% of patients seen only in-person were female whereas 38% of patients seen by telemedicine were female. Patients seen in-person had an older median age (47.2 years) compared to those seen at least once by telemedicine (42.4 years). The no-show rate was 13% for in-person visits versus 4% for telemedicine visits. Among patients seen in person, 17% were Asian, 32% Native Hawaiian, and 47% White, whereas patients seen by telemedicine were 15% Asian, 23% Native Hawaiian, and 57% White. Patients who were seen in person lived in zip codes with median household income of $68,516 and patients who were seen by telemedicine lived in zip codes with median household income of $67,089. Patients who were seen in person lived in zip codes in which 78% of the population had access to broadband internet, whereas patients who were seen by telemedicine lived in zip codes in which 79% of the population had access to broadband internet. During the Covid-19 pandemic, we surveyed 47 consecutive patients seen by telemedicine, 45% female with median age of 33 years. Telemedicine connection was set up by the patient in 74% of cases, or by the patient's mother (15%), other family member (9%), or other caregiver (2 %). Median patient satisfaction score was 5 ("highly satisfied") on a 5-point Likert scale with mean score of 4.6. Telemedicine visit was done using a smartphone by 62% of patients, a computer by 36% of patients, and a tablet by 2% of patients. A home WiFi connection was used in 83% of patients. CONCLUSIONS Home-based telemedicine visits provide a high-satisfaction method for seizure care delivery despite some obstacles. Demographic disparities may be an obstacle to telemedicine care and seem to relate to race and possibly age, rather than to sex/gender, household income, or access to broadband internet. Additionally, despite high satisfaction overall, more patients felt the physical exam was superior at in-person clinic visits and more patients expressed a preference for in-person visits. During the Covid-19 pandemic when there may be barriers to in-person clinic visits, home-based telemedicine is a feasible alternative.
Collapse
Affiliation(s)
- Victoria S S Wong
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States; The Queen's Medical Center Neuroscience Institute, Honolulu, HI, United States.
| | - Madison K Williams
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Charles Kawena Akiona
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Lauro Nathaniel Avalos
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Emily Jane Taylor
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Alan G Stein
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States; The Queen's Medical Center Neuroscience Institute, Honolulu, HI, United States
| | - Susan M Asai
- The Queen's Medical Center Neuroscience Institute, Honolulu, HI, United States
| | - Matthew A Koenig
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States; The Queen's Medical Center Neuroscience Institute, Honolulu, HI, United States
| | - Michael A Rosen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States
| |
Collapse
|
8
|
Khan S, Kramer A, McIver J, Cady L, Trivedi JR. New patient access via telehealth in neuromuscular medicine during COVID-19. Work 2021; 69:715-719. [PMID: 34180450 DOI: 10.3233/wor-210503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has changed the face of health care delivery. Health care institutions rapidly transitioned to telehealth to provide care to patients. Prior to the pandemic, telehealth services extended mostly to patients with established diagnoses. Driven by a necessity to provide care to all patients during the pandemic, neurologists started evaluating new patients also via telehealth. OBJECTIVE To explore opportunities, challenges, and feasibility of telehealth for new patients with neuromuscular disorders. METHODS New patient visits performed in our neuromuscular clinic were analyzed from March 18, 2020 - July 31, 2020. Data collected included visit volume, demographics, geographic distance of patient's residence from our institution, and no-show and cancellation rates. RESULTS Total number of patients seen was 1,471; 472 (32%) were new patients. No-show and cancellation rates for telehealth visits were lower than historical in-person visits. There was a wide range of ages (35-74 years) with representation of new patients from a large geographical territory. CONCLUSION This study advances our understanding regarding the adoption and implementation of telehealth for new patients. Our clinic was able to provide timely access and care to a significant number of patients who could not travel to our institution during COVID-19.
Collapse
Affiliation(s)
- Shaida Khan
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alan Kramer
- Department of Health System Strategy, UT Southwestern Medical Center, Dallas, TX, USA
| | - Johnathan McIver
- Department of Health System Strategy, UT Southwestern Medical Center, Dallas, TX, USA
| | - Leah Cady
- Department of Health System Strategy, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jaya R Trivedi
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
9
|
Aleboyeh S, Appireddy R, Winston GP, Boisse Lomax L, Shukla G. Virtual epilepsy clinics - A Canadian Comprehensive Epilepsy Center experience pre-COVID and during the COVID-19 pandemic period. Epilepsy Res 2021; 176:106689. [PMID: 34242903 PMCID: PMC8440323 DOI: 10.1016/j.eplepsyres.2021.106689] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
Objective The objective of this study is to assess the role of prior experience with virtual care (through e-visits) in maintaining continuity in ambulatory epilepsy care during an unprecedented pandemic situation, comparing in person versus e-visit clinic uptake. Methods This is an observational study on virtual epilepsy care (through e-visits) over two years, during a pre-COVID period (14 months) continuing into the COVID-19 pandemic period (10 months). For a small initial section of patients seen during the study period a physician survey and a patient satisfaction survey were completed (n = 53). Outcomes of eVisits were analyzed using descriptive statistics. Results Median numbers of epilepsy clinic visits conducted during the COVID-19 period (27.5 new and 113 follow up) remained similar to the median uptake during the pre-COVID period (28 new and 116 follow up). Prior experience with e-visits for epilepsy yielded smooth transition into the pandemic period, with several other advantages. The majority of eVisits were successful despite technical difficulties and major components of history and management were still easily implemented. Results from patient surveys supported that a significant amount of time and money were saved, which was in keeping with our health-economic analysis. Conclusion Our study is one of the first few reports of fully integrated virtual care in a comprehensive epilepsy clinic starting much before start of the COVID-19 pandemic. The results of our study support the feasibility of using virtual care to deliver specialized outpatient care in a comprehensive epilepsy center.
Collapse
Affiliation(s)
- Sallya Aleboyeh
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Gavin P Winston
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lysa Boisse Lomax
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Garima Shukla
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada.
| |
Collapse
|
10
|
Rosenthal S, Yonker M. Telemedicine in Pediatric Headache: A Review and Practical Implementation. Curr Neurol Neurosci Rep 2021; 21:27. [PMID: 33844073 PMCID: PMC8038919 DOI: 10.1007/s11910-021-01112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/15/2022]
Abstract
Purpose of Review The purpose of this review was to summarize the current literature about telemedicine in pediatric headache and to provide practical guidance for its implementation. Recent Findings There are few studies dedicated to telemedicine in pediatric headache, and existing studies are small. Patients and families report high levels of satisfaction with telemedicine, and most are willing to continue telemedicine visits in the future. Telemedicine demonstrated similar reductions in headache frequency, severity, and duration as patients treated in-person. Remotely delivered psychologic interventions have some utility in reducing headache severity acutely. Families feel telemedicine reduces geographic and financial barriers to care. Summary Telemedicine in pediatric headache is a growing field. While there is limited research available, it appears safe, efficacious, and feasible. Headache-related outcomes, including frequency, severity, and duration, were similar amongst telemedicine and in-person visits. Future studies should include larger sample sizes and detailed analysis of adverse outcomes.
Collapse
Affiliation(s)
- Scott Rosenthal
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave., Aurora, CO, 80045, USA.
| | - Marcy Yonker
- Pediatric Headache Program Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave., Aurora, CO, 80045, USA
| |
Collapse
|
11
|
Abstract
Routine outpatient epilepsy care has shifted from in-person to telemedicine visits in response to safety concerns posed by the coronavirus disease 2019 (COVID-19) pandemic. But whether telemedicine can support and maintain standardized documentation of high-quality epilepsy care remains unknown. In response, the authors conducted a quality improvement study at a level 4 epilepsy center between January 20, 2019, and May 31, 2020. Weekly average completion proportion of standardized documentation used by a team of neurologists for adult patients for the diagnosis of epilepsy, seizure classification, and frequency were analyzed. By December 15, 2019, a 94% average weekly completion proportion of standardized epilepsy care documentation was achieved that was maintained through May 31, 2020. Moreover, during the period of predominately telemedicine encounters in response to the pandemic, the completion proportion was 90%. This study indicates that high completion of standardized documentation of seizure-related information can be sustained during telemedicine appointments for routine outpatient epilepsy care at a level 4 epilepsy center.
Collapse
|
12
|
Datta P, Barrett W, Bentzinger M, Jasinski T, Jayagopal LA, Mahoney A, Pearon C, Swaminathan A, Vuppala A, Samson KK, Wang H, Taraschenko O. Ambulatory care for epilepsy via telemedicine during the COVID-19 pandemic. Epilepsy Behav 2021; 116:107740. [PMID: 33545652 PMCID: PMC8803629 DOI: 10.1016/j.yebeh.2020.107740] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess feasibility, patient satisfaction, and financial advantages of telemedicine for epilepsy ambulatory care during the current COVID-19 pandemic. METHODS The demographic and clinical characteristics of all consecutive patients evaluated via telemedicine at a level 4 epilepsy center between March 20 and April 20, 2020 were obtained retrospectively from electronic medical records. A telephone survey to assess patient satisfaction and preferences was conducted within one month following the initial visit. RESULTS Among 223 telehealth patients, 85.7% used both synchronous audio and video technology. During the visits, 39% of patients had their anticonvulsants adjusted while 18.8% and 11.2% were referred to laboratory/diagnostic testing and specialty consults, respectively. In a post-visit survey, the highest degree of satisfaction with care was expressed by 76.9% of patients. The degree of satisfaction tended to increase the further a patient lived from the clinic (p = 0.05). Beyond the pandemic, 89% of patients reported a preference for continuing telemedicine if their epilepsy symptoms remained stable, while only 44.4% chose telemedicine should their symptoms worsen. Inclement weather and lack of transportation were factors favoring continued use of telemedicine. An estimated cost saving to patient attributed to telemedicine was $30.20 ± 3.8 per visit. SIGNIFICANCE Our findings suggest that epilepsy care via telemedicine provided high satisfaction and economic benefit, without compromising patients' quality of care, thereby supporting the use of virtual care during current and future epidemiological fallouts. Beyond the current pandemic, patients with stable seizure symptoms may prefer to use telemedicine for their epilepsy care.
Collapse
Affiliation(s)
- Proleta Datta
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Wattana Barrett
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Tracy Jasinski
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Lakshman Arcot Jayagopal
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexa Mahoney
- Nebraska Medicine Hospital, Omaha, NE, United States
| | | | - Arun Swaminathan
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Aditya Vuppala
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kaeli K. Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Hongmei Wang
- Department of Health Service Research and Administration, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| |
Collapse
|
13
|
Gul ZB. Depression and sexual functions in epilepsy patients: Comparison before and during the COVID-19 pandemic. ANNALES MEDICO-PSYCHOLOGIQUES 2021; 180:127-132. [PMID: 33612845 PMCID: PMC7885697 DOI: 10.1016/j.amp.2021.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/10/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The new coronavirus disease 2019 (COVID-19) is a major health problem with a high rate of spread. We aimed to investigate herein the effects of the COVID-19 outbreak on depression and sexual dysfunction in patients with epilepsy. MATERIAL AND METHODS One hundred and sixteen epilepsy patients admitted to our hospital from October-November 2019 were evaluated for sexual functions and depression using the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Scale, respectively. These scales were re-applied in June 2020 and July 2020 to assess the impact of the outbreak on sexual function and depression in the same group of patients. The demographic and clinical characteristics of the patients were recorded and analyzed in SPSS. RESULTS During the pandemic period, the total Beck Depression Scale values increased significantly in the patients with epilepsy compared to the pre-pandemic period (p=0.048), and depressive symptoms showed an increasing trend (p=0.032). Although an increase in sexual dysfunction was also recorded, it was not statistically significant compared to the pre-pandemic period. In eight patients (6.9%), seizure frequency increased during the pandemic period. In the multivariate analysis, the only parameter that predicted the increase in seizure frequency was the number of drugs used. The Beck Depression Scale values were positively correlated with total male/female ASEX values, age, marital status, duration of illness, and seizure frequency. CONCLUSION The COVID-19 outbreak caused an increase in the tendency to depression in epilepsy patients and has also had a negative effect on sexual function. During public health outbreaks, clinicians should focus not only on seizure control in patients with epilepsy but also on their mental health.
Collapse
Affiliation(s)
- Zeynep Bastug Gul
- Department of Neurology, Bakirkoy Training and Research Hospital for Psychiatry and Neurological Disorders, University of Health Sciences, Zuhuratbaba, Doktor Tevfik Sağlam Cd. 25/2, 34147 Bakırköy/İstanbul, Turkey
| |
Collapse
|
14
|
Deana C, Verriello L, Pauletto G, Corradi F, Forfori F, Cammarota G, Bignami E, Vetrugno L, Bove T. Insights into neurological dysfunction of critically ill COVID-19 patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 36:30-38. [PMID: 38620281 PMCID: PMC7490585 DOI: 10.1016/j.tacc.2020.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 12/29/2022]
Abstract
Novel coronavirus spread rapidly around the world infecting millions of people. It was thus declared a pandemic. This new virus damages the lungs. In the most severe cases, it leads to acute respiratory failure that requires intensive care treatment. However, many clinical reports have listed different neurological symptoms, leading to increased interest in the neurological involvement of COVID-19. Various pathophysiological mechanisms have been proposed to explain these neurological aspects. Direct viral invasion of the nervous system, systemic cytokine storm and severe hypoxemia are key factors in the development of symptoms. Critically ill patients present several additional risk factors for nervous system damage. Reasons for these include deep sedation and extended muscular paralysis, bed rest for several days, and the inability to receive proper physical rehabilitation. After ICU treatment, COVID-19 patients generally require an extensive rehabilitation program. However, distancing restrictions mean that in many cases physiotherapists are unable to enter ICUs, delaying the process of rehabilitation. The role of telemedicine should be considered as an adjunctive tool in the rehabilitation of critically ill COVID-19 patients.
Collapse
Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care Department, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
| | - Francesco Corradi
- Department of Anesthesiology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara, Italy
| | - Elena Bignami
- Anesthesia, Intensive Care and Pain Therapy Service, University-Hospital of Parma, Parma, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care Department, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care Department, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| |
Collapse
|
15
|
Leung WCY, Lau EHY, Kwan P, Chang RSK. Impact of COVID-19 on seizure-related emergency attendances and hospital admissions - A territory-wide observational study. Epilepsy Behav 2021; 115:107497. [PMID: 33317939 PMCID: PMC7505596 DOI: 10.1016/j.yebeh.2020.107497] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 11/16/2022]
Abstract
This is a territory-wide study to investigate the impact of coronavirus disease 2019 (COVID-19) pandemic on Accident and Emergency Department (A&E) attendances and acute ward admissions for seizures. Adult patients who presented to the A&E with seizures from January 23, 2020 to March 24, 2020 (study period) were included and compared with parallel intervals from 2015 to 2019 (control periods). Preexisting time trend in control periods and potential changes during COVID-19 were analyzed by Poisson, negative and logistic regression models. Accident and Emergency Department attendances and ward admissions for seizures decreased significantly during the COVID-19 pandemic. A total of 319 and 230 recorded ward admissions and A&E attendances for seizures were identified during the study period in 2020, compared with 494 and 343 per annum, respectively in the control periods. The ratio of acute ward admission per A&E attendance for seizures did not change significantly. Intensive care utility and mortality rates remained stable. For some patients, delaying medical attention due to fear of nosocomial COVID-19 cross-infection may lead to severe or even life-threatening consequences. This change in medical help-seeking behavior calls for new medical care models to meet the service gap. Education to patients with epilepsy and their caregivers is of utmost importance during this pandemic.
Collapse
Affiliation(s)
- William C Y Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region
| | - Eric H Y Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region.
| |
Collapse
|
16
|
Gul ZB, Atakli HD. Effect of the COVID-19 pandemic on drug compliance and stigmatization in patients with epilepsy. Epilepsy Behav 2021; 114:107610. [PMID: 33243679 PMCID: PMC7685058 DOI: 10.1016/j.yebeh.2020.107610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Pandemics like coronavirus disease 2019 (COVID-19) bring along many individual and social problems. We aimed to investigate what changes the COVID-19 pandemic can cause in patients with epilepsy on drug compliance and stigmatization. MATERIAL AND METHOD Modified Morisky Scale (MMS) and stigmatization scales were used between October and November 2019 to assess drug compliance and stigmatization in epilepsy patients. These scales were renewed in June and July 2020 in the same patient group to assess the impact of the epidemic on drug compliance and stigmatization in patients with epilepsy. Statistical analysis was performed using the statistical software SPSS 17.0 for Windows (SPSS, Inc). Demographic and clinical characteristics of the patients were recorded in SPSS. The interviews were conducted during the interictal period. Paired-samples t-test was used to compare the stigma scale results of epilepsy patients before and during COVID-19. The Wilcoxon test was used to compare MMS groups before and during COVID-19. RESULTS A total of 110 patients were included in the study. There was no significant difference between the pre-pandemic and pandemic period in epilepsy stigma scale used to evaluate stigmatization levels in patients. During the pandemic period, it was observed that patients had higher motivation and higher knowledge than before the pandemic (p = 0.048). There were seven patients (6.4%) whose seizure frequency increased during the pandemic period. There were two patients (1.8%) who had difficulty in accessing drugs during the pandemic period. In multivariate analysis, only parameter that predicted an increase in seizure frequency was the number of drugs used In the of COVID-19 period. In correlation analysis, a negative correlation was found between the stigma total score during COVID-19 period and education level. CONCLUSION A slight increase in the frequency of seizures was observed in our patients during the pandemic period, and no significant problem was experienced in accessing drugs. The COVID-19 pandemic made patients more motivated and informed in drug compliance in the patient group and had no effect on stigmatization.
Collapse
Affiliation(s)
- Zeynep Bastug Gul
- Department of Neurology, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul, Turkey.
| | - Hayrunisa Dilek Atakli
- Department of Neurology, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul, Turkey
| |
Collapse
|
17
|
Domingues RB, Mantese CE, Aquino EDS, Fantini FGMM, Prado GFD, Nitrini R. Telemedicine in neurology: current evidence. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:818-826. [PMID: 33295422 DOI: 10.1590/0004-282x20200131] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. OBJECTIVE This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. METHODS A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. RESULTS Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. CONCLUSION Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.
Collapse
Affiliation(s)
- Renan Barros Domingues
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Santa Casa de Misericórdia de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Carlos Eduardo Mantese
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Hospital Mãe de Deus, Porto Alegre RS, Brazil
| | - Emanuelle da Silva Aquino
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Gilmar Fernandes do Prado
- Diretoria Executiva, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.,Diretoria Científica, Academia Brasileira de Neurologia, São Paulo SP, Brazil
| |
Collapse
|
18
|
Asadi-Pooya AA, Simani L, Shahisavandi M, Barzegar Z. COVID-19, de novo seizures, and epilepsy: a systematic review. Neurol Sci 2020; 42:415-431. [PMID: 33237493 PMCID: PMC7686454 DOI: 10.1007/s10072-020-04932-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Objective We discuss the evidence on the occurrence of de novo seizures in patients with COVID-19, the consequences of this catastrophic disease in people with epilepsy (PWE), and the electroencephalographic (EEG) findings in patients with COVID-19. Methods This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Scopus, and Embase from inception to August 15, 2020 were systematically searched. These key words were used: “COVID” AND “seizure” OR “epilepsy” OR “EEG” OR “status epilepticus” OR “electroencephalography”. Results We could identify 62 related manuscripts. Many studies were case reports or case series of patients with COVID-19 and seizures. PWE showed more psychological distress than healthy controls. Many cases with new-onset focal seizures, serial seizures, and status epilepticus have been reported in the literature. EEG studies have been significantly ignored and underused globally. Conclusion Many PWE perceived significant disruption in the quality of care to them, and some people reported increase in their seizure frequency since the onset of the pandemic. Telemedicine is a helpful technology that may improve access to the needed care for PWE in these difficult times. De novo seizures may occur in people with COVID-19 and they may happen in a variety of forms. In addition to prolonged EEG monitoring, performing a through metabolic investigation, electrocardiogram, brain imaging, and a careful review of all medications are necessary steps. The susceptibility of PWE to contracting COVID-19 should be investigated further.
Collapse
Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Shahisavandi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Barzegar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
19
|
Gali K, Joshi S, Hueneke S, Katzenbach A, Radecki L, Calabrese T, Fletcher L, Trandafir C, Wilson C, Goyal M, Wusthoff CJ, Le Pichon JB, Corvalan R, Golson A, Hardy J, Smith M, Cook E, Bonkowsky JL. Barriers, access and management of paediatric epilepsy with telehealth. J Telemed Telecare 2020; 28:213-223. [PMID: 33183129 PMCID: PMC8980450 DOI: 10.1177/1357633x20969531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured telehealth visit feasibility, functionality and provider satisfaction. A provider focus group assessed facilitators and barriers to telehealth. Sixty-one unique patients completed 75 telehealth visits. Paired t-test analysis demonstrated that telehealth enhanced access to epilepsy care. It reduced self-reported out-of-pocket costs ( p<0.001), missed school hours ( p<0.001) and missed work hours ( p<0.001), with 94% equal parent/caregiver satisfaction. Focus groups indicated developing and maintaining partnerships, institutional infrastructure and education as facilitators and barriers to telehealth. Telehealth shortened travelling distance, reduced expenses and time missed from school and work. Further, it provides significant opportunity in an era when coronavirus disease 2019 limits in-person clinics.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Cristina Trandafir
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine and Primary Children’s Hospital, USA
| | - Carey Wilson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine and Primary Children’s Hospital, USA
| | | | | | | | | | | | | | | | | | - Joshua L Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine and Primary Children’s Hospital, USA
| |
Collapse
|
20
|
Kobau R, Sapkota S, Pennell PB, Croft JB. Epilepsy by the numbers - From the US Centers for Disease Control and Prevention: Six in 10 adults with active epilepsy saw a neurologist or epilepsy specialist in the past year, United States, 2017. Epilepsy Behav 2020; 112:107348. [PMID: 32755817 PMCID: PMC7395900 DOI: 10.1016/j.yebeh.2020.107348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022]
Abstract
This study used the most recent national data on epilepsy from the 2017 National Health Interview Survey (NHIS) to examine the distribution of types of provider visits in the last 12 months among 2.9 million adult respondents aged ≥18 years with active epilepsy (self-reported doctor-diagnosed epilepsy taking antiseizure medications and/or having ≥1 seizure in the past year) and compared these estimates with 2010 NHIS data. We calculated age-standardized percentages of visits to a general doctor and an epilepsy specialist during the past 12 months, accounting for the complex survey design. Among US adults with active epilepsy in 2017, 27.1% saw a general doctor only, 9.0% saw a neurologist/epilepsy specialist only, 53.0% visited both a general doctor and a neurologist/epilepsy specialist, and 11.4% did not see either a general doctor or a neurologist/specialist. Overall, 62.0% [95% confidence interval (CI) = 55.2%-67.5%] of adults with active epilepsy visited a neurologist or epilepsy specialist in the past year. A visit in the past 12 months with both provider types was not significantly different in 2017 compared with 2010 (53.0% vs 46.2%) while seeing a general doctor only had declined (41.8% vs 27.1%, p < 0.05). Given that 79.8% of US adults with active epilepsy reported being seen by a general doctor within the past 12 months, epilepsy stakeholders have an opportunity to enhance epilepsy care by ensuring that general practitioners have access to the latest information about epilepsy diagnosis and new treatment options. National Health Interview Survey data can be used to track the distribution of provider visits in the coming decade to assess changes in access to primary care, specialty care, or other types of healthcare for people with epilepsy.
Collapse
Affiliation(s)
- Rosemarie Kobau
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 4770 Buford Highway NE, MS 107-6, Atlanta, GA 30341, USA.
| | - Sanjeeb Sapkota
- G2S Corporation, Epilepsy Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Mail Stop 107-6, 4770 Buford Hwy, 30341, GA, USA
| | - Page B. Pennell
- Harvard Medical School, Brigham and Women's Hospital, Hale Building for Transformative Medicine, 60 Fenwood Road, Boston, MA 02115, USA
| | - Janet B. Croft
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 4770 Buford Highway NE, MS 107-6, Atlanta, GA 30341, USA
| |
Collapse
|
21
|
LaFrance WC, Ho WLN, Bhatla A, Baird GL, Altalib HH, Godleski L. Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth. Epilepsia 2020; 61:2572-2582. [PMID: 33015831 DOI: 10.1111/epi.16689] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Previous studies have shown the effectiveness of manual-based treatment for psychogenic nonepileptic seizures (PNES), but access to mental health care still remains a problem, especially for patients living in areas without medical professionals who treat conversion disorder. Thus, we evaluated patients treated with cognitive behavioral therapy-informed psychotherapy for seizures with clinical video telehealth (CVT). We evaluated neuropsychiatric and seizure treatment outcomes in veterans diagnosed with PNES seen remotely via telehealth. We hypothesized that seizures and comorbidities will improve with treatment. METHODS This was a single-arm, prospective, observational, cohort, consecutive outpatient study. Patients with video-electroencephalography-confirmed PNES (n = 32) documented their seizure counts daily and comorbid symptoms prospectively over the course of treatment. Treatment was provided using a 12-session manual-based psychotherapy treatment given once per week, via CVT with a clinician at the Providence Veterans Affairs Medical Center. RESULTS The primary outcome, seizure reduction, was 46% (P = .0001) per month over the course of treatment. Patients also showed significant improvements in global functioning (Global Assessment of Functioning, P = < .0001), quality of life (Quality of Life in Epilepsy Inventory-31, P = .0088), and health status scales (Short Form 36 Health Survey, P < .05), and reductions in both depression (Beck Depression Inventory-II, P = .0028) and anxiety (Beck Anxiety Inventory, P = .0013) scores. SIGNIFICANCE Patients with PNES treated remotely with manual-based seizure therapy decreased seizure frequency and comorbid symptoms and improved functioning using telehealth. These results suggest that psychotherapy via telehealth for PNES is a viable option for patients across the nation, eliminating one of the many barriers of access to mental health care.
Collapse
Affiliation(s)
- William Curt LaFrance
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA.,Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Wing Lam Natalie Ho
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Alana Bhatla
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Grayson L Baird
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA.,Department of Biostatistics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hamada Hamid Altalib
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
| | - Linda Godleski
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
| |
Collapse
|
22
|
Albert DVF, Das RR, Acharya JN, Lee JW, Pollard JR, Punia V, Keller JA, Husain AM. The Impact of COVID-19 on Epilepsy Care: A Survey of the American Epilepsy Society Membership. Epilepsy Curr 2020; 20:316-324. [PMID: 32942901 PMCID: PMC7502678 DOI: 10.1177/1535759720956994] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The COVID-19 pandemic has impacted the delivery of care to people with epilepsy (PWE) in multiple ways including limitations on in-person contact and restrictions on neurophysiological procedures. To better study the effect of the pandemic on PWE, members of the American Epilepsy Society were surveyed between April 30 and June 14, 2020. There were 366 initial responses (9% response rate) and 337 respondents remained for analysis after screening out noncompleters and those not directly involved with clinical care; the majority were physicians from the United States. About a third (30%) of respondents stated that they had patients with COVID-19 and reported no significant change in seizure frequency. Conversely, one-third of respondents reported new onset seizures in patients with COVID-19 who had no prior history of seizures. The majority of respondents felt that there were at least some barriers for PWE in receiving appropriate clinical care, neurophysiologic procedures, and elective surgery. Medication shortages were noted by approximately 30% of respondents, with no clear pattern in types of medication involved. Telehealth was overwhelmingly found to have value. Among the limitation of the survey was that it was administered at a single point in time in a rapidly changing pandemic. The survey showed that almost all respondents were affected by the pandemic in a variety of ways.
Collapse
Affiliation(s)
- Dara V. F. Albert
- Division of Child Neurology, Department of Pediatrics, Nationwide Children’s Hospital/The Ohio State University, Columbus, OH, USA
| | - Rohit R. Das
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Jong Woo Lee
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - John R. Pollard
- Department of Neurology, Cristiana Care, Newark, DE, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vineet Punia
- Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Aatif M. Husain
- Duke University Medical Center and Veterans Affairs Medical Center, Durham, NC, USA
| |
Collapse
|
23
|
Fesler JR, Stanton S, Merner K, Ross L, McGinley MP, Bena J, Rasmussen P, Najm I, Punia V. Bridging the gap in epilepsy care: A single-center experience of 3700 outpatient tele-epilepsy visits. Epilepsia 2020; 61:e95-e100. [PMID: 32697361 DOI: 10.1111/epi.16619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Abstract
We describe the largest-to-date single-center implementation of tele-epilepsy. Beginning in 2017, all patients at a single tertiary care academic epilepsy center were offered the option to complete outpatient follow-up visits via video-conferencing using personal devices. A retrospective review of all patients who self-selected virtual visits over nearly 3 years showed 2140 patients completed 3698 tele-epilepsy visits, with 41% completing more than one visit during the study period. Based on the distance from the center to the home address, 26.7% of patients were local (≤50 miles), 30.5% were near regional (51-150 miles), 20.1% were far regional (151-270 miles), and 22.7% were remote (>270 miles), from 43 different states. An estimated 928 696 miles of travel was prevented, with a median travel distance saved of 124.5 miles (interquartile range = 45.0-253.0). The mean visit time was 15.7 (±10.4) minutes. More than 90% of patients gave the visit and provider experience the maximum rating, with a nearly 60% response rate on the post-visit survey. Virtual outpatient follow-up care provides a convenient way to connect with epilepsy specialists and reduce the burden of care by cutting travel time. Our experience demonstrates that outpatient tele-epilepsy is feasible, sustainable, and scalable.
Collapse
Affiliation(s)
- Jessica R Fesler
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan Stanton
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kim Merner
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lindsay Ross
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marisa P McGinley
- Mellen Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter Rasmussen
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
24
|
Panda PK, Dawman L, Panda P, Sharawat IK. Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country. Seizure 2020; 81:29-35. [PMID: 32712376 PMCID: PMC7368411 DOI: 10.1016/j.seizure.2020.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION 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.
Collapse
Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pragnya Panda
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| |
Collapse
|
25
|
Fortini S, Espeche A, Caraballo R. Telemedicine and epilepsy: A patient satisfaction survey of a pediatric remote care program. Epilepsy Res 2020; 165:106370. [PMID: 32516743 DOI: 10.1016/j.eplepsyres.2020.106370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/26/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to assess parent satisfaction three years after the implementation of a pediatric epilepsy telemedicine program. METHODS The program was developed with support from the Ministry of Health through Hospital Nacional de Pediatría J.P. Garrahan. A secure internet connection was used for high-speed, high-definition video and audio. Synchronous face-to-face consultation between the patient and the neurologist was used. To evaluate the success of the program, at the end of the consultation the parent or caregiver of the patient was asked to complete a survey evaluating satisfaction with health care, cost, and privacy issues. The survey was administered by community health workers to the parents of patients that were in follow-up or first seen at the rural health posts during 2019. RESULTS Between January and December 2019, 116 consecutive parents of patients seen at the epilepsy telemedicine clinic filled out a semistructured questionnaire. Mean age of the patients was 8.5 years (range, 1-17 years); 85 % of the patients had a follow-up of more than 6 months. All the families felt supported by the team and were satisfied with the program in terms of epilepsy management. Less work- and schooltime lost, less travel time and costs, better access to medication, and more regular follow-up visits were reported. The parents considered they had received clear information about the epilepsy of their child. CONCLUSION Telemedicine proves to be an important tool in the comprehensive management of people with epilepsy.
Collapse
Affiliation(s)
- Sebastian Fortini
- Department of Neurology, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | - Alberto Espeche
- Department of Neurology, Hospital Materno Infantil, Salta, Argentina
| | - Roberto Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina.
| |
Collapse
|
26
|
Johnson EK, Fraser RT, Lashley S, Barber J, Brandling-Bennett EM, Vossler DG, Miller JW, Caylor L, Warheit-Niemi T. Program of Active Consumer Engagement in Self-Management in Epilepsy: Replication and extension of a self-management randomized controlled trial. Epilepsia 2020; 61:1129-1141. [PMID: 32401339 DOI: 10.1111/epi.16530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The Program of Active Consumer Engagement in Self-Management in Epilepsy (PACES) is an evidenced-based self-management intervention for adults with epilepsy. Prior randomized controlled trial (RCT) data show that PACES reduces depression and improves self-management, self-efficacy, and quality of life for 6 months postprogram. The objective of this study was to replicate a PACES RCT with key extensions: more diverse patient pool from community-based epilepsy centers; option for telephone-based participation; and longer follow-up (12 months with booster support for intervention group), to examine duration of impact and inform dissemination and implementation. METHODS Participants were adults with chronic epilepsy (n = 101) without serious mental illness or substantive intellectual impairment, recruited from three epilepsy centers. Participants were randomly assigned to intervention or waitlist control groups. Outcomes included the Epilepsy Self-Management Scale (ESMS), Epilepsy Self-Efficacy Scale (ESES), Quality of Life in Epilepsy-31, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, administered at baseline, postintervention (8 weeks), and 6 and 12 months postintervention. Intervention was an 8-week group of five to eight adults co-led by a psychologist and trained peer with epilepsy that met once per week by teleconference or in person at a hospital for 60-75 minutes. Topics included medical, psychosocial, cognitive, and self-management aspects of epilepsy, as well as community integration and epilepsy-related communication. Treatment group provided program evaluation. RESULTS PACES participants (n = 49) improved relative to controls (n = 52) on the ESES (P < .022) and overall distress composite (P = .008). At 6 months, PACES participants remained improved on the ESES (P = .008) and composite (P = .001), and were improved on the ESMS (P = .005). At 12 months, PACES participants remained improved on the ESMS (P = .006) and were improved on an overall distress composite of combined measures (P = .018). Attrition was low (<6% in each group), and all program satisfaction ratings exceeded 4.0/5.0. SIGNIFICANCE A consumer-generated epilepsy self-management program with broad psychosocial and medical emphasis can be effectively delivered by telephone or in person and facilitates long-term epilepsy self-management, adjustment, and coping up to 1 year after treatment.
Collapse
Affiliation(s)
- Erica K Johnson
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA.,Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA
| | - Robert T Fraser
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA.,Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Steven Lashley
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - David G Vossler
- Department of Neurology, University of Washington, Seattle, Washington, USA.,UW Medicine, Valley Medical Center, Renton, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Lisa Caylor
- Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Tessala Warheit-Niemi
- Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA
| |
Collapse
|
27
|
|
28
|
Asadi-Pooya AA. Seizures associated with coronavirus infections. Seizure 2020; 79:49-52. [PMID: 32416567 PMCID: PMC7212943 DOI: 10.1016/j.seizure.2020.05.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022] Open
Abstract
Seizures have been reported in patients with various coronavirus infections. However, seizures seem to be a rare occurrence in people with COVID-19. Patients with COVID-19 may have hypoxia, multiorgan failure, and metabolic disarrangements. It is plausible to expect acute symptomatic seizures to happen in these patients. One should be prepared to treat seizures appropriately.
Neurotropic and neuroinvasive capabilities of coronaviruses have been described in humans. Neurological problems found in patients with coronavirus infection include: febrile seizures, convulsions, loss of consciousness, encephalomyelitis, and encephalitis. Coronavirus disease (COVID-19) is caused by SARS-CoV2. In severe cases, patients may develop severe pneumonia, acute respiratory distress syndrome, and acute cardiac injury. While seizures and status epilepticus have not been widely reported in the past five months since the onset of COVID-19 pandemic, patients with COVID-19 may have hypoxia, multiorgan failure, and severe metabolic and electrolyte disarrangements; hence, it is plausible to expect clinical or subclinical acute symptomatic seizures to happen in these patients. One should be prepared to treat seizures appropriately, if they happen in a patient who is already in a critical medical condition and suffers from organ failure.
Collapse
Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| |
Collapse
|
29
|
Kissani N, Naji Y. The terminology of epilepsy in Arabic and its consequences in Morocco. Epilepsy Behav 2020; 103:106461. [PMID: 31727546 DOI: 10.1016/j.yebeh.2019.106461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Najib Kissani
- Neuroscience Research Laboratory of Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco; Neurology Department, Hospital Mohammed VI, Marrakech, Morocco.
| | - Yahya Naji
- Neuroscience Research Laboratory of Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco; Neurology Department, Hospital Mohammed VI, Marrakech, Morocco
| |
Collapse
|
30
|
Ellis MJ, Boles S, Derksen V, Dawyduk B, Amadu A, Stelmack K, Kowalchuk M, Russell K. Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba. Int J Circumpolar Health 2020; 78:1573163. [PMID: 30714513 PMCID: PMC6366439 DOI: 10.1080/22423982.2019.1573163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Pediatric concussion patients living in northern communities in Canada can face unique challenges accessing primary and specialized healthcare. In this study we report the clinical characteristics, healthcare utilization, outcomes and estimated cost avoidance associated with a pilot pediatric concussion telemedicine program established between a multi-disciplinary pediatric concussion program in Winnipeg, Manitoba and a hospital in Thompson, Manitoba. From October 1st- July 1st, 2018, 20 patients were evaluated; mean age 13.1 years, 15 (75%) males and 14 (70%) self-identified as Indigenous. Injury mechanisms included hockey (50%), falls (35%) and assaults (15%). Median time from referral to initial consultation was 2.0 days. After screening by the neurosurgeon, 90% of patients underwent initial consultation via real-time videoconferencing with 80% managed exclusively through telemedicine. At the end of the study, 90% met the criteria for clinical recovery, one remained in treatment and one was discharged to a headache neurologist. Sixty-six telemedicine encounters were completed including 57 videoconferencing appointments and 9 telephone follow-ups representing an estimated cost avoidance of $40,972.94. This study suggests telemedicine may be a useful approach to assist pediatric concussion programs with delivering timely, safe and cost-effective care to patients living in medically underserviced remote and northern communities in Canada.
Collapse
Affiliation(s)
- Michael J Ellis
- a Department of Surgery , University of Manitoba , Canada.,b Pediatrics and Child Health , University of Manitoba , Canada.,c Section of Neurosurgery , University of Manitoba , Canada.,d Pan Am Concussion Program , Winnipeg , Manitoba , Canada.,e Childrens Hospital Research Institute of Manitoba , Winnipeg , Manitoba , Canada.,f Canada North Concussion Network , Winnipeg , Manitoba , Canada
| | - Susan Boles
- g MBTelehealth, Manitoba eHealth , Winnipeg , Manitoba , Canada
| | - Vickie Derksen
- d Pan Am Concussion Program , Winnipeg , Manitoba , Canada
| | | | - Adam Amadu
- h Thompson General Hospital , Thompson , MB , Canada
| | - Karen Stelmack
- g MBTelehealth, Manitoba eHealth , Winnipeg , Manitoba , Canada
| | | | - Kelly Russell
- b Pediatrics and Child Health , University of Manitoba , Canada.,e Childrens Hospital Research Institute of Manitoba , Winnipeg , Manitoba , Canada.,f Canada North Concussion Network , Winnipeg , Manitoba , Canada
| |
Collapse
|
31
|
Axon DR, Taylor AM, Vo D, Bingham J. Initial assessment of an interprofessional team-delivered telehealth program for patients with epilepsy. Epilepsy Res 2019; 158:106235. [PMID: 31726287 DOI: 10.1016/j.eplepsyres.2019.106235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Epilepsy affects 3.5 million people in the United States (US). Rural-dwelling individuals have less access to healthcare and consequently poorer health outcomes. This study describes the outcomes of an interprofessional telehealth program for rural-dwelling individuals with epilepsy in one US state. METHODS An academic medication therapy management pharmacist provided clinical services to rural-dwelling individuals with epilepsy between November 2015 and June 2018, using video-conferencing technology and follow-up telephonic consultation. Data collected included: demographics, prescribed seizure medications, comorbidities, drug-drug and drug-disease interactions, adverse drug reactions, therapeutic duplications, dose-related safety concerns, adherence concerns, and recommendations to resolve identified issues. Data were summarized using appropriate descriptive statistics. RESULTS A total of 168 patients (51% male, mean age 28 ± 15 years), participated in this pilot study. Most participants (94%) were prescribed at least one seizure medication including: benzodiazepines (n = 89), lamotrigine (n = 58), and levetiracetam (n = 56). The majority (55%) had at least one comorbidity including: mood disorders (n = 49) and psychiatric disorders (n = 26). Common medications with reported precautions for people with a seizure history were: selective serotonin reuptake inhibitors (n = 18), second-generation atypical antipsychotics (n = 17) and benzodiazepines (n = 16). Participants had at least one: drug-disease interaction (33%), drug-drug interaction (54%), adverse drug reaction (37%), therapeutic duplication (13%); dose-related safety concerns (35%); and medication utilization concerns (13%). DISCUSSION This pharmacist-delivered pilot program was effective in: reaching underserved patients with epilepsy, identifying and recommending resolutions to medication-related problems, and demonstrating the value of pharmacists in an interprofessional team. Further work is warranted to identify telehealth strategies to reduce medication associated problems.
Collapse
Affiliation(s)
- David Rhys Axon
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, Arizona, 85721, United States.
| | - Ann M Taylor
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, Arizona, 85721, United States.
| | - Dylan Vo
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, Arizona, 85721, United States.
| | - Jennifer Bingham
- SinfoniaRx, 100 N Stone Ave, Tucson, Arizona, 85701, United States.
| |
Collapse
|
32
|
Oppenheimer J, Leviton A, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler EW, Chan E, Loddenkemper T. Caring electronically for young outpatients who have epilepsy. Epilepsy Behav 2018; 87:226-232. [PMID: 30197227 DOI: 10.1016/j.yebeh.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability. METHOD We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems. CONCLUSIONS The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems. This system and variants have the potential to reduce seizure burden through improved management, keep children out of the emergency department and hospital, and even reduce the number of outpatient visits.
Collapse
Affiliation(s)
- Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
33
|
Konanki R, Gulati S, Prasad K, Saini L, Pandey RM, Paul VK. Comparison of telephone with face to face consultation for follow up of Neurocysticercosis. Epilepsy Res 2018; 145:110-115. [PMID: 29936301 DOI: 10.1016/j.eplepsyres.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES There is significant scarcity of specialists to provide care for children with epilepsy in many parts of the world. Telemedicine is a potential future option. This study was planned to estimate the diagnostic accuracy of telephone consultation to identify Critical Clinical Events (breakthrough seizures, drug non-compliance, drug adverse events, features of raised intracranial pressure, and other disease-related events),compared to the Face-to-Face consultation (gold standard), in children with Neurocysticercosis (NCC) and symptomatic seizures, following the completion of cysticidal therapy. METHODS Children aged 2-15 years attending a tertiary health care facility with a diagnosis of NCC and symptomatic seizures were enrolled after completion of the cysticidal therapy. The parents were contacted by a Pediatric Neurology Resident on Telephone before the scheduled hospital visit. Subsequently, all the children were seen directly in hospital the next day by another Pediatric Neurology Resident. The information was noted on a structured questionnaire. The diagnostic accuracy of telephone consultation for identifying the Critical Clinical Events was estimated using Face-to-Face consultation as the gold standard. RESULTS A total of 1145 potential events were evaluated. Of these, the face-to-face consultation identified 56 events that would need hospital visit for detailed evaluation (breakthrough seizures in 19, drug non-compliance in 15, adverse drug events in 11, features of raised intracranial pressure in 8, and other disease-related events in 3), and 1089 events that did not require hospital consultation. The sensitivity, specificity, positive and negative predictive values of telephone consultation were 89.28% (78.12-95.96), 97.61% (96.52-98.43), 65.79% (54.01-76.30), and 99.43% (98.78-99.79) respectively. The likelihood ratios when telephone consultation was positive and negative were 37.3 and 0.11 respectively. SIGNIFICANCE Telephone consultation is an acceptable mode of follow-up for children with mild Neurocysticercosis and symptomatic seizures after completion of cysticidal therapy.
Collapse
Affiliation(s)
- Ramesh Konanki
- Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Sheffali Gulati
- Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Lokesh Saini
- Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Vinod Kumar Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
34
|
Cardinale AM. The Opportunity for Telehealth to Support Neurological Healthcare. Telemed J E Health 2018; 24:969-978. [PMID: 29652625 DOI: 10.1089/tmj.2017.0290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neurological conditions affect one-third of Americans and are some of the most prevalent health issues in the country. Many sufferers have difficulty accessing treatment, however, advances in technology may be able to support availability, affordability, and convenience of care through telehealth services. This review outlines the current state of telemedicine in neurological healthcare, highlighting evidence-based research and use cases for digital services. Details on expenses associated with managing certain well-known conditions are included to shed light on the financial burden of disease and how telehealth can contribute to cost savings for patients and providers. Finally, a discussion of current telehealth legislature gives additional perspective on regulatory dynamics experienced by different stakeholders in the field. Research supports telemedicine as a solution to enhance current care models given its many benefits, including efficient and clinically useful service delivery. This movement has the opportunity to help billions of individuals globally by acting as a mechanism to provide impactful and scalable neurological healthcare.
Collapse
Affiliation(s)
- Amanda M Cardinale
- Teachers College Columbia University , Department of Biobehavioral Sciences, Neuroscience and Education, New York, New York
| |
Collapse
|
35
|
Abstract
BACKGROUND The recent growth in telehealth has been facilitated by the need to deliver healthcare to patients living in remote or rural areas. In contrast, the role of telehealth in more urban settings is less clear. A teleneurology program was established in 2011 at the Tibor Rubin VA Medical Center (TRVAMC) in Long Beach, California. A review of teleneurology encounters was conducted to assess the feasibility of applying this telehealth modality to patients with chronic neurological disorders living in an urban setting. METHODS Teleneurology encounters were conducted by clinical video telehealth (CVT) between a provider at the TRVAMC and patients at local community-based outpatient clinics from November 2011 to December 2014. In a random sampling of veterans, they were asked to complete a patient satisfaction survey. RESULTS A total of 745 teleneurology encounters were performed including 570 unique patients. Veterans with a broad range of neurological disorders were seen, including Parkinson's disease, headaches, epilepsy, dementia, cerebrovascular disease, peripheral nervous system disorders, multiple sclerosis, and other problems such as dizziness and paresthesia. Compared with patients in face-to-face clinics, patients in teleneurology clinics consistently kept their appointments. Technical problems were rare and easily resolved. The majority of patients were satisfied with the care they received through teleneurology, and preferred CVT rather than a face-to-face encounter. CONCLUSIONS This report demonstrates the successful application of telehealth to evaluate and manage a diverse group of neurological disorders in an urban setting. Despite the relatively short distances involved, the majority of patients preferred telehealth over face-to-face encounters.
Collapse
Affiliation(s)
- Steven S Schreiber
- 1 Neurology Section, Tibor Rubin VA Medical Center , Long Beach, California.,2 Departments of Neurology, Anatomy and Neurobiology, Psychiatry and Human Behavior, UC Irvine School of Medicine , Irvine, California
| |
Collapse
|
36
|
Schneider RB, Biglan KM. The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease. Lancet Neurol 2017; 16:541-551. [DOI: 10.1016/s1474-4422(17)30167-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
|
37
|
Caffery LJ, Taylor M, Lucas K, Smith AC. Substitution rates of video consultations for traditional consultations at a tertiary public hospital. J Telemed Telecare 2016; 22:453-458. [DOI: 10.1177/1357633x16672767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/11/2016] [Indexed: 11/16/2022]
Abstract
Using a case study approach, we conducted a retrospective review of 12 months of outpatient activity at the Princess Alexandra Hospital (PAH) in Brisbane, Australia. From our dataset we calculated two variables – the telehealth-eligible substitution rate and the overall telehealth substitution rate. Telehealth eligibility is specialty-specific and is based on clinical and geographical constraints. During the study period there were video consultations ( N = 1088) and traditional consultations ( N = 41,951). The telehealth-eligible and overall substitution rates were 17.5% and 2.5%, respectively. The overall telehealth substitution rate is substantially lower than the telehealth-eligible substitution rate. This is due to the majority of patients being from local catchment areas which are currently ineligible for video consultations at the PAH. The highest observed overall telehealth substitution rate was for the radiosurgery which had telehealth activity as a reportable key performance indicator since inception of the service, which may have contributed to the relatively high rate. In-home video consultations with patients who reside in metropolitan areas are needed to substantially increase the rate of telehealth substitution.
Collapse
Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Karen Lucas
- Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| |
Collapse
|
38
|
Sun J, Guo Y, Wang X, Zeng Q. mHealth For Aging China: Opportunities and Challenges. Aging Dis 2016; 7:53-67. [PMID: 26816664 DOI: 10.14336/ad.2015.1011] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/11/2015] [Indexed: 12/17/2022] Open
Abstract
The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries.
Collapse
Affiliation(s)
- Jing Sun
- 1Department of International Inpatient, Chinese PLA General Hospital, Beijing 100853, China
| | - Yutao Guo
- 2Department of Geriatric Cardiology, Institute of Health Management, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoning Wang
- 3The State Key Laboratory and Normal Aging, Chinese PLA General Hospital, Beijing 100853, China
| | - Qiang Zeng
- 1Department of International Inpatient, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|