Prior to the COVID pandemic, telemedicine was not well established in Spain [1] or in most other countries [2] and, in fact, its use was far from popular. However, the COVID-19 pandemic quickly changed this.
Conde-Blanco et al[1] reported the results of a survey in which 66 Spanish neurologists shared their experience with the brisk implementation of telemedicine in the field of epilepsy. Most (88%) migrated to telephone visits, even for first visits. Videoconferencing was rarely used (4.5%). However, in most cases, a typical evaluation was not performed. For instance, scales were not administered by phone. In addition, most neurologists felt that phone consultations were not the ideal way to discuss more sensitive issues (e.g., SUDEP).
The perspective of people with epilepsy (PwE) and their caregivers during this pandemic is important to consider, especially as self-management is crucial in epilepsy. Miller et al[3] reported on the experience of PwE and their caregivers in the US. Nearly one-half of responders (44.4%) believe that their ability to control seizures is much more difficult during this pandemic. This may be because of associated changes in normal sleeping routine (34.5%), new difficulties reaching healthcare providers (42.5%), and difficulty obtaining ASMs from pharmacies (72.7%). PwE and caregivers also felt that their ability to manage stress is not at its best during the pandemic. Additionally, anxiety and heightened stress levels may also impair seizure control.
The introduction of ketogenic diet therapy in paediatric patients was facilitated by telemedicine.[4] Education and training provision for carers, monitoring by dieticians and neurologists, and group support meetings were delivered with good safety and seizure-control outcomes.
Key Points:
• Telemedicine consultations can aid effective epilepsy care, even for first visits.
• People with epilepsy and their caregivers believe that their ability to control seizures is more difficult during this pandemic.
• Challenges include changes in sleep pattern, reaching healthcare providers, and difficulty obtaining ASMs.
• Initiation of ketogenic diet therapy can be facilitated by telemedicine.
References:
1. Conde-Blanco E, Centeno M, Tio E, et al. Emergency implementation of telemedicine for epilepsy in Spain: Results of a survey during SARS-CoV-2 pandemic. Epilepsy Behav. 2020 Jun 5;111:107211. doi: 10.1016/j.yebeh.2020.107211.
2. Hatcher-Martin JM, Adams JL, Anderson ET, et al. Telemedicine in neurology: Telemedicine Work Group of the American Academy of Neurology update. Neurology. 2020 Jan 7;94(1):30-38. doi: 10.1212/WNL.0000000000008708.
3. Miller WR, Von Gaudecker J, Tanner A, et al. Epilepsy self-management during a pandemic: Experiences of people with epilepsy. Epilepsy Behav. 2020 Jun 25;111:107238. doi: 10.1016/j.yebeh.2020.107238.
4. Kossoff EH, Turner Z, Adams J, et al. Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations. Epilepsy Behav. 2020;111:107181.