Telemedicine for evaluation of clinical epilepsy

Introduction

Epilepsy management encompasses a spectrum of disease acuity and locations. Whether providing chronic disease management in the outpatient setting, acute consults in the hospital for new onset or breakthrough seizures, or critical care management of status epilepticus, there are now opportunities for this care to occur virtually rather than in-person. Technology to facilitate video-enabled communication between provider and patient has been available for some time, but use for epilepsy care was limited and largely restricted to inpatient consultations provided as a component of broader hospital teleneurology services. The ongoing COVID-19 pandemic has fostered the rapid embrace of telemedicine for routine outpatient epilepsy care. While many previous financial and bureaucratic barriers to adoption of virtual care have been removed, providers must still prepare for the unique considerations and challenges of seizure management provided remotely.

Opportunities in virtual epilepsy care

Once the current global pandemic is stabilized, it is likely that the demand for video epilepsy visits will remain high. Convenience has been one obvious benefit described by many telemedicine users. Video visits can offer greater efficiency than in-person visits, minimizing the need to arrange time away from work, home, and other activities. Many adults with epilepsy face specific challenges with travel to doctor visits because of the legal restriction of driving privileges with this diagnosis. In the United States, people with epilepsy are five times more likely to report transportation as a barrier to accessing health care than others. Even those who have access to means of transport in their locale may not have in-person neurologic care within reach. A 2012 Institute of Medicine report found that close to half of people living with epilepsy have limited to no access to specialized epilepsy care from a neurologist or epileptologist. This is particularly true in rural and underserved urban areas. Telemedicine offers a means to expand timely access to providers with expertise in seizure management by removing the barrier of physical access to a clinic or hospital. The pool of individuals who would benefit from virtual epilepsy care is even larger when one considers the international market.

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