Telehealth and Patient Care
Timely access to medical care is vital for patients with neurological disorders. This need, however, is continuing to be challenged during the ongoing COVID-19 pandemic and can have drastic consequences on a patient’s health and quality of life. With medical services primarily being redirected toward COVID care, including clinical staff and hospital beds typically reserved for epilepsy monitoring, patients with epilepsy risk being “overlooked by a saturated health care system.”1
How has COVID-19 Impacted Patients with Epilepsy?
Recent publications examined patient and physician experiences during the COVID-19 pandemic. For patients with epilepsy there has been no decrease in the need for services. In fact, the data would indicate these patients have an increased need for services.
- 25% of patients reported increased seizure frequency since the start of the pandemic1, 2
- Over half of patients with epilepsy have reported severe psychological distress (e.g., anxiety, depression) 2
- Almost two-thirds of those who reported increased seizures also reported disrupted sleep routines1
While the need for services remains high, the publications also point out challenges with care access for these patients. The primary challenges to accessing health care services were reported to be a mixture of personal concern for safety (i.e., canceling appointments or avoiding services out of fear of contracting the SAR-CoV2 virus) and limited availability of services (e.g., limited transportation, closures of offices, limited availability of telehealth options) 2.
- 29% of patients reported the fear of needing to go to the hospital or emergency room as the main source of their anxiety.1
- Approximately 7.4% of US patients experienced challenges in obtaining critical antiseizure medications.2
Concerns for personal safety may be causing some patients to delay necessary treatments or procedures, leading to cases becoming more complicated or severe by the time they do seek treatment.3
Attitudes Toward Remote Care
With sudden closures and deferred access to treatment, patients and physicians have had to quickly adjust to remote and telehealth services.
- A substantial percentage of neurologists (87.3%) have reported transitioning to at least partial teleneurology, with an estimated 40% of consultations completed remotely. 2
- About nine in ten clinicians report that teleneurology is a useful tool for both patients and clinicians as it is accessible, allows for prompt feedback and quick follow-ups, as well as reduced costs.2
- 30% of patients have indicated they desire telehealth care and 25% prefer home delivery of services2
However, there are certain drawbacks for clinicians, such as being unable to conduct physical exams or pick up on nonverbal patient cues, as well as challenges to reimbursements.2 For patients, reliable internet service can significantly impact accessible care.
Moving Toward Increased Remote Care
Calls for both increased use of remote care and improved coverage for telehealth services have been placed by major medical societies, such as the American Epilepsy Society, AES and the American Academy of Neurology, AAN. A joint position statement from the International League Against Epilepsy, ILAE and the International Federation of Clinical Neurophysiology, IFCN specifically outlines why long-term video EEG monitoring should be considered a vital and necessary procedure and not be discontinued as an elective tool during the pandemic. This position statement argues that while video EEG is primarily a diagnostic tool, these study results directly impact epilepsy care as well as the detection of co-occurring disorders.4
While the primary goal of the ILAE/IFCN paper is to preserve the operation of inpatient video EEG monitoring, they highlight an important way that remote video EEG monitoring can supplement these services. For patients that do not require a reduction of antiseizure medication or direct supervision by clinical staff, at-home video EEG monitoring can provide quality diagnostic information in a timely fashion without having to wait for inpatient availability. The appropriate use of remote care services like the in home VEEG services provided by Stratus, can reduce the overall burden on the medical system without sacrificing patient care.
- Casassa C, Moss R, Goldenholz DM. Epilepsy during the COVID-19 pandemic lockdown: a US population survey. Epileptic Disord. 2021;23(2):257-67. doi:10.1684/epd.2021.1259
- Cross JH, Kwon CS, Asadi-Pooya AA, Balagura G, Gomez-Iglesias P, Guekht A, et al. Epilepsy care during the COVID-19 pandemic. Epilepsia. 2021. doi:10.1111/epi.17045
- Khoshsirat NA, Qorbani M, Farivar AM, Mohammadpoor Nami S, Mohammadian Khonsari N. Effects of the covid-19 pandemic on neurological diseases. Brain Behav. 2021;11(8):e2246. doi:10.1002/brb3.2246
- Beniczky S, Husain A, Ikeda A, Alabri H, Cross JH, Wilmshurst J, et al. Importance of access to epilepsy monitoring units during the COVID-19 pandemic: consensus statement of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology. Epileptic Disord. 2021;23(4):533-6. doi:10.1684/epd.2021.1292
About the Author
Hans Klein, Ph.D., is the Manager of Scientific Publications for Stratus. Dr. Klein is a social neuroscientist by training and received his doctorate at the University of Texas at Dallas, where his research focused on the neural underpinnings of social cognitive deficits within schizophrenia spectrum disorders, as well as methods for improving measurement and research design.