Arun Swaminathan MD, Assistant Professor of Neurology and Epilepsy at the University of Nebraska explores the challenges and benefits of telemedicine following the COVID-19 pandemic
Epilepsy is a highly prevalent condition affecting 50-65 million people worldwide, with a higher incidence and prevalence seen in developing countries. Chronic management of epilepsy is a complicated process that entails seizure control, adjustment of medications, management of side effects, surgical evaluation and social and legal adjustments by the treating physician.
The COVID-19 pandemic has affected medical care in myriad ways with newer and increasing difficulties noted with the patient burden, healthcare system overloads and medication and medical gear supply shortfalls and deficiencies, among others. The delivery of medical care has evolved quickly and efficaciously to combat these shortcomings produced by the pandemic and enable safe and prompt delivery of care to patients.
Epilepsy patients have noted difficulties in arranging for follow up visits and medication refill requests due to delays and slowdowns imposed by the pandemic. Many centres have established telemedicine consultation systems to continue to offer care to their epilepsy patients. It is now a given fact that telemedicine is here to stay and will form a cornerstone of healthcare delivery for the near and probably distant future as well.
Epilepsy patients represent a good representative cohort of neurological patients that can be managed using telemedicine protocols. Most epileptic patients do not often need comprehensive neurological examinations, especially at follow up visits. If anything, a greater proportion of time can be spent in counselling and discussion to enable a better quality of care for them. Many patients are physically or mentally impaired, and travelling to a doctors’ office can be a challenge for them and their caretakers or families. Telemedicine enables them to receive good quality care from the comfort of their own homes and minimises difficulties associated with travel.
Numerous studies have been published during the pandemic highlighting the benefits of telemedicine consultation for patients and providers. Patients have benefited from saving time in travelling, saved money by limiting travel and taking time off work and felt comfortable discussing their medical issues from the comfort and privacy of their homes. These findings have been reported across multiple centres in different countries and healthcare settings as well.
Telemedicine has faced its challenges as well. Healthcare systems have needed to work closely with their IT services to ensure quick and easy implementation of telemedicine software across multiple centres. Privacy concerns have also slowed down the implementation of telemedicine due to vulnerabilities exploited by hackers and cybercriminals raising concern for the loss of patient and hospital data. Older patients and caretakers have had difficulties in adopting newer software for the use of telemedicine causing some frustration and concern as well.
Many epilepsy patients with implanted devices like vagal nerve stimulators have been unable to have them interrogated virtually. Internet accessibility has been an issue for many patients as well, especially those living in remote regions with slower internet speeds. Technical glitches, while few and far in between, have improved over the last few months of the pandemic due to improved services from the IT support teams.
Epilepsy surgical evaluations have progressed similar to before, despite the use of telemedicine services. While surgical procedures have themselves slowed down during the pandemic, patients have been able to discuss surgical evaluations and surgical plans in a comfortable manner using telemedicine. Physicians and patients alike have commented on the utility of telemedicine for counselling patients about presurgical and post-surgical care in detail without additional difficulties from this technique. Patients have been able to have detailed discussions about different aspects of surgery with the physicians, surgeons, neuropsychologists and have been satisfied with the multimodal nature of care offered using telemedicine.
Telemedicine has always been touted as a panacea for many difficulties faced by physicians and patients due to a limited number of providers and appointments. Ease of travel and convenience of use have also added to the attractiveness of telemedicine as a viable treatment option. Regional hospitals have now been able to tie up with larger medical centres to offer telemedicine consultation with experts in a variety of conditions and epilepsy physicians are taking advantage of this to reach out to previously inaccessible patients that would be waiting a long time for an expert opinion.
Basic epilepsy care has involved routine follow up with lab tests for monitoring and both of these can be offered using telemedicine. The patients are able to have labs drawn at a clinic or hospital of their choice and have these results sent to the treating physicians for analysis. Advanced care is often limited to specialised regional or national centres and telemedicine enables these centres to share their expertise with local or community hospitals and improve care for patients that were previously geographically dispersed across their area of coverage.
WHO reports have often described the difficulties in offering epilepsy care to developing nations due to the limitation in resources and physicians. Telemedicine would serve as an effective, simple and comprehensive way to counter these difficulties and offer care to those who need it. This would result in increased partnership between local or regional physicians and national experts who could then offer their expertise and develop better treatment paradigms at the grassroots level for less complicated patients while quickly identifying and escalating care for the more complicated ones. Telemedicine would also allow these countries and centres to offer quality care to those needful of it at a much lower price than the cost of conventional healthcare settings.
In summary, telemedicine is expected to become a strong and permanent part of epilepsy care worldwide and healthcare centres need to establish protocols and paradigms to ensure that they stay abreast of the latest and best treatment guidelines and standards of care to achieve their aims of maintaining seizure control and quality of life for epilepsy patients and their families or caretakers.
References
WHO GBD Survey, 2016.
French JA, Brodie MJ, Caraballo R, et al. Neurology. 2020;94(23):1032-1037.
Datta P, Barrett W, Bentzinger M, et al. Epilepsy Behav. 2021;116:107740.
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© 2019. This work is licensed under a CC BY 4.0 license.
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