Telehealth
The value of telehealth in neurology has been recognized well before the COVID-19 pandemic, with particularly successful implementation in stroke care.19,20 The feasibility of telehealth in epilepsy care, including delivery of complex care to patients with refractory epilepsy, has similarly been demonstrated, with comparable outcome and high patient satisfaction.13,21-23 The lack of commensurate reimbursement has historically been the barrier to greater adoption.24
Several early studies have examined the effect of transition to telehealth during the COVID-19 pandemic. A recent survey of child neurologists conducting telehealth encounters, in which epilepsy was somewhat overrepresented, revealed >90% satisfactory encounters despite 40% reporting technical challenges. Most (86%) reported intending to pursue telehealth in future encounters.25 An international survey of pediatric neurologists treating children with epilepsy revealed that about 25% of practitioners were seeing outpatients exclusively with telehealth and 95% were seeing at least some patients by telehealth.26 A US-based single hospital system evaluation revealed that 67% of outpatient visits were completed via telehealth, 32% with phone visits, and only 1% of visits were in-person clinic encounters.27
Similar to previous studies, the respondents in the current survey overwhelmingly found value in telehealth. Many benefits were noted, including efficiency of the clinic visits. Respondents even noted that many of the examination elements that they routinely perform, such as mental status and gait evaluations, could be done via telehealth. One shortcoming that was mentioned was the lack of diagnostic monitoring and laboratory testing. However, a recent randomized trial revealed little benefit in monitoring serum levels of modern ASMs.28
Whereas previous efforts in telehealth in epilepsy care have focused on the delivery of care to resource-limited or poorly accessible regions, the current situation has affected health care delivery across all socioeconomic spectra. Unfortunately, the most socioeconomically vulnerable patients have difficulty in getting telehealth services as well due to lack of access to technology. This is an area that should be promptly and actively addressed, particularly since the near-term outlook for the pandemic remains extremely concerning.
An important consideration about telehealth raised by respondents to the survey is continued reimbursement. While there was overwhelming recognition of the value of telehealth and many respondents saw the value in continuing it long term, they expressed concern that reimbursement models changed after the pandemic, they would be unable to continue it. Encouragingly, professional societies are collaborating in a variety of way to advocate for telehealth for PWE as well as others that greatly benefit from this method of care.29