International teleneurology

Background

Traditional medical practice is not always the most efficient or convenient way to provide care to our neurology patients. With an increasing demand for neurologic services in a growing population, technology can be one way to extend our reach to our patients. As technologies develop, it is paramount that practitioners maintain high-quality care, equivalent to traditional in-person visits. Information and communication technologies (ICTs) have great potential to address some of the challenges both developed and developing countries face in providing accessible, cost-effective, and high-quality health care services. Telemedicine uses ICTs to overcome geographical barriers and increase access to health care services, and is particularly beneficial for rural and underserved communities, groups that traditionally suffer from lack of access to health care. In this chapter, we will first discuss the rationale behind using teleneurology in different parts of the world including the different aspects of telemedicine such as tele-expertise (seeking the second opinion of one or more medical professionals regarding elements of the patient’s medical file), teleconsultation (remote consultations with a patient), and tele-education; and secondly, we will include the most representative international examples of teleneurology initiatives.

The burden of neurological disorders

According to the World Health Organization (WHO) in collaboration with the World Federation of Neurology, there are inadequate resources for patients with neurological disorders in most parts of the world, highlighting inequalities in the access to neurological care across different populations, and in particular in those living in low-income countries and underserved regions of the world. Neurological disorders are increasingly recognized as major causes of death and disability worldwide. Although age-standardized incidence, mortality, and prevalence rates of many neurological disorders declined for many countries from 1990 to 2015, the absolute number of people affected by, dying from, or remaining disabled from neurological disorders over the past 25 years has been increasing globally. In the last report of the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study (GBD) 2016, globally, neurological disorders were the leading cause of Disability Adjusted Life Year (DALYs) (276 million [95% UI 247–308]) and the second leading cause of deaths (9.0 million [8.8–9.4]). The four largest contributors of neurological DALYs were stroke (42.2% [38.6–46.1]), migraine (16.3% [11.7–20.8]), Alzheimer’s and other dementias (10.4% [9.0–12.1]), and meningitis (7.9% [6.6–10.4]). As populations are growing and aging, and the prevalence of major disabling and neurodegenerative neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden and the shortage of neurological services demonstrate that new knowledge is required to develop effective prevention and treatment strategies, to ensure equitable access. In this regard, teleneurology can be considered as an efficient and feasible alternative tool.

Clinical care