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Bassa B, Hahner F, Braun S, Meyding-Lamadé U. [Telemedicine and international projects: from Asia to Africa: chances for the future?]. DER NERVENARZT 2024; 95:236-241. [PMID: 38240820 DOI: 10.1007/s00115-023-01605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/06/2024]
Abstract
Although the morbidity and mortality of neurological diseases in many Asian and African countries is high and are predicted to increase even further in the coming decades, in many areas there is a shortage of medical personnel and high-quality treatment options. This shortage, together with a frequently insufficient healthcare infrastructure, limits the access of many patients to medical treatment. The possibilities of telemedicine are multifarious. It provides new, so far unused possibilities in the diagnostics and treatment of neurological diseases, totally independent of geographical boundaries. In the future it could also be used for the education and training of physicians and medical personnel and to close the existing gaps in healthcare, especially in developing countries.
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Affiliation(s)
- B Bassa
- Klinik für Neurologie, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland.
| | - F Hahner
- Klinik für Neurologie, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland
| | - S Braun
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Sambia
| | - U Meyding-Lamadé
- Klinik für Neurologie, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland
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Yardi R, McLouth CJ, Mathias S, Jehi L. Telemedicine as a path to bridging inequities in patients with epilepsy. Epilepsia 2023; 64:3238-3245. [PMID: 37811672 DOI: 10.1111/epi.17793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Access to epilepsy specialist care is not uniform in the USA, with prominent gaps in rural areas. Understanding the reasons for nonattendance at epilepsy appointments may help identify access hurdles faced by patients. This study was undertaken to better understand clinic absenteeism in epilepsy and how it may be influenced by telemedicine. METHODS In this retrospective study, social determinants of health were collected for all adult patients scheduled in epilepsy clinic, as either an in-person or telemedicine appointment, at University of Kentucky between July 2021 and December 2022. The primary outcome measure was attendance or absence at the appointment. Subgroup analyses were done to better understand the drivers of attendance at telemedicine visits and evaluate telemedicine utilization by underserved populations. RESULTS A total of 3025 patient encounters of in-person and telemedicine visits were included. The no-show rate was significantly higher for in-person visits (32%) compared with telemedicine visits (20%, p < .001). A nominal logistic regression model identified seven factors increasing risk of absenteeism, including in-person visits, prior missed appointments, longer lead times to appointment, Medicaid/Medicare as payors, no significant other, lower mean annual income, and minority race. For each $10 000 increase in mean annual income, the odds of missing the appointment decreased by 8% (odds ratio = .92, 95% confidence interval = .89-.96, p < .001). Forty-one percent of underserved population opted for telemedicine visits, and they had a lower no-show rate (22%) as compared with in-person visits (33%, p < .001). Predictors of no-shows to televisits (1382) included Medicare/Medicaid coverage (as opposed to private insurance), no significant others, and a history of missing appointments. SIGNIFICANCE Telemedicine is effective at improving attendance, overcoming socioeconomic hurdles, and widening access to epilepsy care, particularly among underserved populations. Access to telecare depends on insurance coverage and emphasizes the need to include telemedicine in insurance plans to ensure uniform access to high-quality epilepsy care, irrespective of socioeconomic status.
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Affiliation(s)
- Ruta Yardi
- Kentucky Neurological Institute, University of Kentucky, Lexington, Kentucky, USA
| | | | - Sally Mathias
- Kentucky Neurological Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Lara Jehi
- Cleveland Clinic, Cleveland, Ohio, USA
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Mecarelli O, Di Gennaro G, Vigevano F. Unmet needs and perspectives in management of drug resistant focal epilepsy: An Italian study. Epilepsy Behav 2022; 137:108950. [PMID: 36347069 DOI: 10.1016/j.yebeh.2022.108950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to evaluate the consensus level between a representative group of Italian neurologists and people with Drug-Resistant Epilepsy (DRE) regarding a series of statements about different aspects involved in the management of epilepsy to identify the unmet needs of the People with Epilepsy (PwE) and the future perspectives for the management of this disease. This observational study was conducted using a classic Delphi technique. A 19-statement questionnaire was administered anonymously through an online platform to a panel of expert clinicians and a panel of PwE, analyzing three main topics of interest: drug resistance, access to care, and PwE's experience. The consensus was achieved on 8 of the 19 statements administered to the panel of medical experts and on 4 of the 14 submitted to the panel of PwE, particularly on the definition of DRE and its consequences on treatment, Quality of Life (QoL), and autonomy of PwE. Most of the items, however, did not reach a consensus and highlighted the lack of a shared univocal view on some topics, such as accessibility to care throughout the country and the role of emerging tools such as telemedicine, narrative medicine, and digital devices. In many cases, the two panels expressed different views on the statements. The results outlined many fields of possible intervention, such as the need for educational initiatives targeted at physicians and PwE - for example, regarding telemedicine, digital devices, and narrative medicine - as well as the spread of better knowledge about epilepsy among the general population, in order to reduce epilepsy stigma. Institutions, moreover, could take a cue from this survey to develop facilities aimed at enhancing PwE's autonomy and promoting more equal access to care throughout the country.
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Affiliation(s)
- Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome and Past President of LICE, Italian League Against Epilepsy, Rome, Italy.
| | | | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
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Long-term analysis of the effects of COVID-19 in people with epilepsy: Results from a multicenter on-line survey across the pandemic waves. Epilepsy Behav 2022; 135:108900. [PMID: 36115083 PMCID: PMC9404228 DOI: 10.1016/j.yebeh.2022.108900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/12/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The worldwide pandemic caused by SARS-CoV-2 virus posed many challenges to the scientific and medical communities, including the protection and management of fragile populations. People with epilepsy (PWE) are a heterogenous group of subjects, with different treatment regimens and severity of symptoms. During the National lockdown, in Italy many patients with chronic conditions lost their regular follow-up program. The aim of this study was to investigate the impact of COVID-19 on their health status, from the start of the pandemic (March 2020) to July 2021 and one year later. METHODS We proposed an online questionnaire to subjects followed up at different epilepsy centers located in Milano, Monza & Lodi, three of Lombardy, Northern Italy, the most affected areas by the pandemic. Survey evaluated age, sex, characteristics of patients, type of epilepsy and therapies, COVID-19 diagnosis, vaccines, sleep quality, and anxiety status. RESULTS Among 178 analyzed surveys, 37 individuals reported symptoms of COVID-19 in closed contacts, including 9 with molecular diagnosis and 16 PWE performing the nasopharyngeal swab with 3 positive cases. One year later, 35 individuals reported at least one symptom overlapping with those typical of COVID-19, 8 received COVID-19 diagnosis, among which 6 were positive for SARS-CoV-2 infection. According to the sleep quality scale assessment, most PWE (52.3%) had poor sleep quality. Assessing anxiety status, 32 (38.1%) had a pathological score. CONCLUSION In this multicenter study, we observed that PWE do not appear to be at a higher risk of severe COVID-19. It will be fundamental monitoring this group to assess possible differences in long-COVID-19 and/or neuro-COVID-19 prevalence. On the other hand, our survey confirmed the impact of the pandemic on anxiety and quality of sleep in PWE. Thus, it is important to promptly recognize and treat psychological distress in PWE, because it could be a risk factor in seizure aggravation and quality-of-life deterioration. Telemedicine appears to be a useful tool to support patients with chronic diseases, such as epilepsy.
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Burr T, Modiano Y, Raichur P, Barton C, Sah J, Farber D, Brock D, Karia S, Haneef Z, Karakas C. Predictive value of video alone in diagnosis of epileptic vs paroxysmal nonepileptic events in children. Epilepsy Behav 2022; 134:108863. [PMID: 35930919 DOI: 10.1016/j.yebeh.2022.108863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/08/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies examined the use of video-based diagnosis and the predictive value of videos for differentiation of epileptic seizures (ES) from paroxysmal nonepileptic events (PNEE) in the adult population. However, there are no such published studies strictly on the pediatric population. Using video-EEG diagnosis as a gold standard, we aimed to determine the diagnostic predictive value of videos of habitual events with or without additional clinical data in differentiating the PNEE from ES in children. METHODS Consecutive admissions to our epilepsy monitoring unit between June 2020 and December 2020 were analyzed for events of interest. Four child neurologists blinded to the patient's diagnosis formulated a diagnostic impression based upon the review of the video alone and again after having access to basic clinical information, in addition to the video. Features of the video which helped to make a diagnosis were identified by the reviewers as a part of a survey. RESULTS A total of 54 patients were included (ES n = 24, PNEE n = 30). Diagnostic accuracy was calculated for each reviewer and combined across all the ratings. Diagnostic accuracy by video alone was 74.5% (sensitivity 80.8%, specificity 66.7%). Providing reviewers with basic clinical information in addition to the videos significantly improved diagnostic accuracy compared to viewing the videos alone. Inter-rater reliability between four reviewers based on the video alone showed moderate agreement (κ = 0.51) and unchanged when additional clinical data were presented (κ = 0.51). The ES group was significantly more likely to demonstrate changes in facial expression, generalized stiffening, repetitive eye blinks, and eye deviation when compared with the PNEE group, which was more likely to display bilateral myoclonic jerking. CONCLUSIONS Video review of habitual events by Child Neurologists may be helpful in reliably distinguishing ES from PNEE in children, even without included clinical information.
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Affiliation(s)
- Tyler Burr
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States
| | - Yosefa Modiano
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, UT Health Neurosciences, Houston, TX 77030, United States
| | - Prachi Raichur
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States
| | - Christopher Barton
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States; Norton Children's Medical Group, Louisville, KY 40202, United States
| | - Jeetendra Sah
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States; Norton Children's Medical Group, Louisville, KY 40202, United States
| | - Darren Farber
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States; Norton Children's Medical Group, Louisville, KY 40202, United States
| | - Dylan Brock
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States; Norton Children's Medical Group, Louisville, KY 40202, United States
| | - Samir Karia
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States; Norton Children's Medical Group, Louisville, KY 40202, United States
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, United States; Neurology Care Line, VA Medical Center, Houston, TX 77030, United States
| | - Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, United States; Norton Children's Medical Group, Louisville, KY 40202, United States.
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Nakornchai T, Conci E, Hensiek A, Brown JWL. Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic. Postgrad Med J 2022; 98:533-538. [PMID: 37066507 PMCID: PMC8720641 DOI: 10.1136/postgradmedj-2021-141234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Telephone consultations are already employed in specific neurological settings. At Cambridge University Hospitals, the COVID-19 pandemic initially prompted almost all face-to-face appointments to be delivered by telephone, providing a uniquely unselected population to assess. OBJECTIVES We explored patient and clinician experience of telephone consultations; and whether telephone consultations might be preferable for preidentifiable subgroups of patients after the pandemic. METHODS Clinicians delivering neurological consultations converted to telephone between April and July 2020 were invited to complete a questionnaire following each consult (430 respondents) and the corresponding patients were subsequently surveyed (290 respondents). The questionnaires assessed clinician and patient goal achievement (and the reasons for any dissatisfaction). Clinicians also described consultation duration (in comparison to face to face) while patients detailed comparative convenience and preference. RESULTS The majority of clinicians (335/430, 78%) and patients (227/290, 78%) achieved their consultation goals by telephone, particularly during follow-up consultations (clinicians 272/329, 83%, patients 176/216, 81%) and in some disease subgroups (eg, seizures/epilepsy (clinicians 114/122 (93%), patients 71/81 (88%)). 95% of telephone consultations were estimated to take the same or less time than an equivalent face-to-face consultation. Most patients found telephone consultations convenient (69%) with 149/211 (71%) indicating they would like telephone or video consultations to play some role in their future follow-up. CONCLUSION Telephone consultations appear effective, convenient and popular in prespecified subgroups of neurological outpatients. Further work comparing telephone, video and face-to-face consultations across multiple centres is now needed.
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Affiliation(s)
- Tagore Nakornchai
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elena Conci
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anke Hensiek
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Streltzov NA, Schmidt S, Schommer L, Zhao W, Tosteson T, Mazanec M, Kiriakopoulos E, Chu F, Henninger H, Nagle K, Roth R, Jobst B. Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy: A Pragmatic, Randomized, Multicenter Trial. Neurology 2022; 98:e2174-e2184. [PMID: 35387855 DOI: 10.1212/wnl.0000000000200346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of HOBSCOTCH (Home-based self-management and cognitive training changes lives) in a real-world setting, and to assess feasibility of a virtual intervention, we conducted a multi-site, pragmatic replication trial at four New England epilepsy centers. METHODS HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QOL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in four states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3-months, and 6-months; intervention groups received long-term follow-up at 9- and 12-months. RESULTS A total of 108 participants were recruited, of which 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QOL score compared to controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or healthcare utilization at any timepoints, and the treatment effect for QOL diminished by 6-months. The virtual intervention demonstrated feasibility, but did not significantly improve outcomes compared to controls. Within-group analysis found improvements in QOL for both H-V and H-IP. CONCLUSIONS This study replicated the effectiveness of the HOBSCOTCH program in improving QOL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.The study was registered and listed on ClinicalTrials.gov (NCT02394509).
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Affiliation(s)
| | - Samantha Schmidt
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Lindsay Schommer
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Wenyan Zhao
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Tor Tosteson
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Morgan Mazanec
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Elaine Kiriakopoulos
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Felicia Chu
- Department of Neurology, UMass Medical School, Worcester, Massachusetts
| | - Heidi Henninger
- Department of Neurology, Maine Medical Center, Scarborough, Maine; Department of Neurology
| | - Keith Nagle
- University of Vermont Medical Center, Burlington, Vermont
| | - Robert Roth
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Barbara Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Abstract
The development of mobile health for epilepsy has grown in the last years, bringing new applications (apps) to the market and improving already existing ones. In this systematic review, we analyse the scope of mobile apps for seizure detection and epilepsy self-management, with two research questions in mind: what are the characteristics of current solutions and do they meet users’ requirements? What should be considered when designing mobile health for epilepsy? We used PRISMA methodology to search within App Store and Google Play Store from February to April of 2021, reaching 55 potential apps. A more thorough analysis regarding particular features was performed on 26 of those apps. The content of these apps was evaluated in five categories, regarding if there was personalisable content; features related to medication management; what aspects of seizure log were present; what type of communication prevailed; and if there was any content related to seizure alarm or seizure action plans. Moreover, the 26 apps were evaluated through using MARS by six raters, including two neurologists. The analysis of MARS categories was performed for the top and bottom apps, to understand the core differences. Overall, the lowest MARS scores were related to engagement and information, which play a big part in long-term use, and previous studies raised the concern of assuring continuous use, especially in younger audiences. With that in mind, we identified conceptual improvement points, which were divided in three main topics: customisation, simplicity and healthcare connection. Moreover, we summarised some ideas to improve m-health apps catered around long-term adherence. We hope this work contributes to a better understanding of the current scope in mobile epilepsy management, endorsing healthcare professionals and developers to provide off-the-shelf solutions that engage patients and allows them to better manage their condition.
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Tilahun BBS, Thompson NR, Bautista JF, Sankary LR, Stanton S, Punia V. Telepsychology May Improve Treatment Adherence in Patients with Psychogenic Nonepileptic Seizures. Telemed J E Health 2021; 28:1159-1165. [PMID: 34962145 DOI: 10.1089/tmj.2021.0463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Access to mental health care is a significant challenge in patients with psychogenic nonepileptic seizures (PNES). Telepsychology can curb the access barriers and improve adherence but the role of telepsychology in improving adherence has not been well investigated. The current study examines the utility of telepsychology during the COVID-19 pandemic and treatment adherence in PNES patients. Materials and Methods: Patients with PNES admitted to a 12-week counseling program were offered two visit types: telepsychology and in-office. Visit type, visit status, and demographic information were obtained from department database. Follow-up visits in 6 months were used to examine the effect of visit type on visit status. Adherence to treatment was measured by higher attendance of scheduled visits and less cancellation and no-show rates. Results: Two hundred fifty-seven (n) patients who scheduled virtual or telepsychology visits were included in the study. After adjusting for demographic variables, and accounting for repeated measures, telepsychology visits were significantly more likely to be attended (odds ratio [OR] = 2.40, 95% confidence interval [CI] = 1.69-3.41, p < 0.001) and were significantly less likely to be canceled (OR = 0.43, 95% CI = 0.29-0.64, p < 0.001). The regression model showed patients in the telepsychology visit group attended more than three times as many visits as in-office patients (incidence rate ratios = 3.16, 95% CI = 2.13-4.73, p < 0.001). Conclusions: Patients with PNES have logistical and psychological barriers that can impede their ability to attend counseling treatment. Receiving care remotely may have been associated with higher engagement with mental health treatment compared to having to travel to counseling clinics. Considering the symptom-related restrictions patients with PNES have and the barriers presented by the COVID-19 pandemic, telepsychology played a key role for continuation of mental health treatment.
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Affiliation(s)
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Neurological Institute, Center for Outcomes Research and Evaluation, Cleveland, Ohio, USA
| | - Jocelyn F Bautista
- The Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
| | - Lauren R Sankary
- Neuro-ethics Program, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan Stanton
- The Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
| | - Vineet Punia
- The Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
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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.
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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
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11
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Perucca E. The pharmacological treatment of epilepsy: recent advances and future perspectives. ACTA EPILEPTOLOGICA 2021. [DOI: 10.1186/s42494-021-00055-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractThe pharmacological armamentarium against epilepsy has expanded considerably over the last three decades, and currently includes over 30 different antiseizure medications. Despite this large armamentarium, about one third of people with epilepsy fail to achieve sustained seizure freedom with currently available medications. This sobering fact, however, is mitigated by evidence that clinical outcomes for many people with epilepsy have improved over the years. In particular, physicians now have unprecedented opportunities to tailor treatment choices to the characteristics of the individual, in order to maximize efficacy and tolerability. The present article discusses advances in the drug treatment of epilepsy in the last 5 years, focusing in particular on comparative effectiveness trials of second-generation drugs, the introduction of new pharmaceutical formulations for emergency use, and the results achieved with the newest medications. The article also includes a discussion of potential future developments, including those derived from advances in information technology, the development of novel precision treatments, the introduction of disease modifying agents, and the discovery of biomarkers to facilitate conduction of clinical trials as well as routine clinical management.
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von Wrede R, Surges R. Patient-zu-Arzt-Anwendungen in der ambulanten Epilepsieversorgung. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021. [PMCID: PMC8261033 DOI: 10.1007/s10309-021-00427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Die telemedizinische Behandlung von Patient*innen mit Epilepsie ist eine Erweiterung der bislang die ambulante Versorgungslandschaft im Wesentlichen prägenden klassischen persönlichen Arztbesuche. Unter administrativen, finanziellen und rechtlichen nun klareren Rahmenbedingungen konnten, durch die COVID-19-Pandemie katalysiert, rasch die zuvor langsameren Prozesse in der Umsetzung beschleunigt werden. Nationale und internationale Erfahrungen verweisen auf eine Noninferiorität im Vergleich zu Vor-Ort-Besuchen. Verbindliche Algorithmen der Zuordnung Vor-Ort-Besuch vs. telemedizinische Behandlung sind noch ausstehend und sollten zukünftig unter Berücksichtigung der Patientencharakteristika sowie Behandlungssituation erarbeitet werden.
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Gursky JM, Boro A, Escalante S, Ferastraoaru V, Hanumanthu R, Haut S, Jehle R, Molinero I, Rick L, Rosengard J, Saifeddine M, Sugrue W, Moshé SL, Ballaban-Gil K. Disparities in Access to Neurologic Telemedicine During the COVID-19 Pandemic: A Bronx Tale. Neurol Clin Pract 2021; 11:e97-e101. [PMID: 33842077 DOI: 10.1212/cpj.0000000000001028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/06/2020] [Indexed: 11/15/2022]
Abstract
Objective To determine whether there is a disparity in access to telemedical care that may be a function of socioeconomic status, language, or other demographic factors during the peak of the coronavirus disease 2019 (COVID-19) pandemic at a highly affected urban center (Montefiore Medical Center) in Bronx, NY. Methods We retrospectively investigated potential patient characteristics that might be associated with an increased likelihood of receiving a telephone visit as opposed to a televideo visit for patients followed in the pediatric neurology, adult epilepsy, and general neurology practices at Montefiore Medical Center during the 30-day period starting April 2, 2020, at the peak of the COVID-19 pandemic in New York. Results We found that patients who had telephone encounters, as opposed to televideo encounters, were overall older, less likely to have commercial insurance, and more likely to have Medicaid. Among pediatric patients, a preferred language other than English was also associated with a higher proportion of telephone encounters. New patients in both the adult and pediatric groups were more likely to have televideo visits. Conclusions Our findings identify demographic factors, including age, insurance type, and language preference, which may play a role in access to televideo encounters among neurology patients in an urban center during the COVID-19 pandemic. We suggest several potential practice, institution, and community-based interventions, which might further expand access to televideo care for neurology patients.
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Affiliation(s)
- Jonathan M Gursky
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Alex Boro
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Sheri Escalante
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Victor Ferastraoaru
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Rajani Hanumanthu
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Sheryl Haut
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Rana Jehle
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Isaac Molinero
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Lindsay Rick
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Jillian Rosengard
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Mohamad Saifeddine
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - William Sugrue
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Solomon L Moshé
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
| | - Karen Ballaban-Gil
- Comprehensive Einstein/Montefiore Epilepsy Center (JMG, AB, SE, VF, RH, SH, RJ, IM, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Saul R. Korey Department of Neurology (JMG, AB, SE, VF, RH, SH, RJ, IM, LR, JR, MS, WS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; Isabelle Rapin Division of Child Neurology (SE, RJ, IM, LR, MS, SLM, KB-G), Albert Einstein College of Medicine, Bronx, NY; and Department of Pediatrics (SLM, KB-G), Albert Einstein College of Medicine, Bronx NY
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Home video prediction of epileptic vs. nonepileptic seizures in US veterans. Epilepsy Behav 2021; 117:107811. [PMID: 33611097 DOI: 10.1016/j.yebeh.2021.107811] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Using video-EEG (v-EEG) diagnosis as a gold standard, we assessed the predictive diagnostic value of home videos of spells with or without additional limited demographic data in US veterans referred for evaluation of epilepsy. Veterans, in particular, stand to benefit from improved diagnostic tools given higher rates of PNES and limited accessibility to care. METHODS This was a prospective, blinded diagnostic accuracy study in adults conducted at the Houston VA Medical Center from 12/2015-06/2019. Patients with a definitive diagnosis of epileptic seizures (ES), psychogenic nonepileptic seizures (PNES), or physiologic nonepileptic events (PhysNEE) from v-EEG monitoring were asked to submit home videos. Four board-certified epileptologists blinded to the original diagnosis formulated a diagnostic impression based upon the home video review alone and video plus limited demographic data. RESULTS Fifty patients (30 males; mean age 47.7 years) submitted home videos. Of these, 14 had ES, 33 had PNES, and three had PhysNEE diagnosed by v-EEG. The diagnostic accuracy by video alone was 88.0%, with a sensitivity of 83.9% and specificity of 89.6%. Providing raters with basic patient demographic information in addition to the home videos did not significantly improve diagnostic accuracy when comparing to reviewing the videos alone. Inter-rater agreement between four raters based on video was moderate with both videos alone (kappa = 0.59) and video plus limited demographic data (kappa = 0.60). SIGNIFICANCE This study demonstrated that home videos of paroxysmal events could be an important tool in reliably diagnosing ES vs. PNES in veterans referred for evaluation of epilepsy when interpreted by experts. A moderate inter-rater reliability was observed in this study.
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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.
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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
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Feyissa AM. Hold the Smartphone! Tele-epilepsy in a Post-COVID-19 World. Mayo Clin Proc 2021; 96:4-6. [PMID: 33413834 DOI: 10.1016/j.mayocp.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022]
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Klotz KA, Borlot F, Scantlebury MH, Payne ET, Appendino JP, Schönberger J, Jacobs J. Telehealth for Children With Epilepsy Is Effective and Reduces Anxiety Independent of Healthcare Setting. Front Pediatr 2021; 9:642381. [PMID: 34178881 PMCID: PMC8222691 DOI: 10.3389/fped.2021.642381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The use of telemedicine has grown exponentially as an alternative to providing care to patients with epilepsy during the pandemic. We investigated the impact of the current pandemic among children with epilepsy from two distinct pediatric epilepsy centers. We also compared perceptions among those who received telemedicine against those who did not. Methods: We developed a questionnaire and invited families followed in Freiburg, Germany, and Calgary, Alberta, Canada, to participate during the initial 9 months of the pandemic. The survey contained 32 questions, 10 of which were stratified according to telemedicine exposure. Results: One hundred twenty-six families (80 in Freiburg, 46 in Calgary) participated, and 40.3% received telemedicine care. Most children (mean age 10.4 years, SD 5.1) had chronic epilepsy but poorly controlled seizures. Negative impacts were reported by 36 and 65% of families who had to reschedule appointments for visits and diagnostics, respectively. Nearly two-thirds of families reported no change in seizure frequency, while 18.2% reported either worsening or improvement of seizures. Although most families did not note behavioral changes, 28.2% reported behavior worsening. Families who received telemedicine care had a statistically significant reduction of parental self-reported anxiety level after virtual visits compared to those who did not experience telemedicine. Families with telemedicine consultations were more likely to consider future virtual care (84 vs. 65.2% of those without), even after the pandemic. Patient data safety, easy access to specialized services, and consistency with the same healthcare provider were graded as important in both centers, while a shorter waiting time was most relevant in Calgary. Conclusion: In our cohort, some children with epilepsy experienced increased seizures and worsening behavior during the first 9 months of the current pandemic. In addition, our data suggest that telemedicine might reduce parental anxiety symptoms, and families who experienced telehealth were more positive and open to similar appointments in the future.
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Affiliation(s)
- Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felippe Borlot
- Cumming School of Medicine, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Morris H Scantlebury
- Cumming School of Medicine, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eric T Payne
- Cumming School of Medicine, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Juan Pablo Appendino
- Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jan Schönberger
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Cumming School of Medicine, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Rosengard JL, Donato J, Ferastraoaru V, Zhao D, Molinero I, Boro A, Gursky J, Correa DJ, Galanopoulou AS, Hung C, Legatt AD, Patel P, Rubens E, Moshé SL, Haut S. Seizure control, stress, and access to care during the COVID-19 pandemic in New York City: The patient perspective. Epilepsia 2020; 62:41-50. [PMID: 33258109 PMCID: PMC7753328 DOI: 10.1111/epi.16779] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Objective Our epilepsy population recently experienced the acute effects of the COVID‐19 pandemic in New York City. Herein, we aimed to determine patient‐perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient‐perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic. Methods We performed a cross‐sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID‐19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one‐time survey via telephone or secure online platform (REDCap). Results Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID‐19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID‐19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control. Significance Of the nearly 20% of subjects who reported worsened seizure control during the COVID‐19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.
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Affiliation(s)
- Jillian L Rosengard
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Jad Donato
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Victor Ferastraoaru
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Dan Zhao
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac Molinero
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA
| | - Alexis Boro
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Jonathan Gursky
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Daniel José Correa
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Bronx, NY, USA
| | - Christine Hung
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Alan D Legatt
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Puja Patel
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA
| | - Elayna Rubens
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Bronx, NY, USA.,Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Sheryl Haut
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
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