Telemedicine Benefits a Range of Neurologic Disorders

Amy Guzik, MD

Results from an assessment of studies examining the use of telemedicine in neurologic disorders show that telemedicine is noninferior to traditional, in-person evaluations in terms of patient and caregiver satisfaction. Additionally, the investigators found that telemedicine has benefits in expediting care, reducing cost, increasing access to care, and improving health outcomes and diagnostic accuracy.¹

Neurologists from the American Academy of Neurology (AAN), the Department of Veteran Affairs (VA) representing major subspecialties of adult neurology defined teleneurology as “an evolving branch of telemedicine…defined as neurologic consultation at a distance, or not in person, using various technologies to achieve connectivity, including the telephone and the internet…encompassing teleconsultation, teleconferencing and tele-education.”

In February 2018, the investigators conducted a PubMed search and examined 753 references related to telemedicine and neurologic subspecialties such as concussion with traumatic brain injury (TBI), dementia, epilepsy, headache, movement disorders, multiple sclerosis (MS), neuromuscular disorders, and inpatient neurology. References reviewed for the study included those that assessed clinical feasibility of telemedicine, compared effectiveness of telemedicine and other measures, demonstrated the need for telemedicine, evaluated patient/physician acceptance/satisfaction with telemedicine, and evaluated the financial pros/cons of telemedicine versus standard care. Each subspecialty would be graded on all quality measures, using “++” to indicate randomized controlled trial or inferiority trial with direct measure, “+” if there was a small case series with indirect measurement, or “-“ indicating no study for that quality measure.

Overall, the analysis included data across various quality measures based on subspecialty. In concussion and TBI, data were available on diagnostic accuracy and improved outcomes; patient/physician satisfaction and diagnostic accuracy in dementia care; improved outcomes in epilepsy; patient/physician satisfaction, diagnostic accuracy, and improved outcomes in headache, movement disorders and MS; and patient/physician satisfaction in neuromuscular disorders.

Teleneurology Applications in Subspecialties

Concussion and TBI:

• In locker rooms and high school consultations, teleneurology was used for return-to-play decisions and determining further evaluation.
• Counseling and education for patients with TBI over the telephone were better than in-person treatment with regard to decreasing symptom burden.
• Patients with TBI who were discharged from inpatient rehabilitation units were found to exhibit lower depression symptom severity using scheduled individualized telephone interventions over a 9-month period.

Dementia

• Mini-Mental State Examination score evaluations conducted via teleneurology compared to in-person did not vary, suggesting they are equally as effective.
• Teleneurology had direct impact on travel, with an average of 67 miles and 74 minutes saved per visit.

Epilepsy

• Medication changes and discussion of surgical options can successfully be completed via teleneurology, with a lower no-show rate for appointments compared with in-person clinic visits. .
• Traditional ambulatory care and teleneurology care showed no significant differences in numbers of seizures, hospitalizations, emergency room visits, or medication compliance.

Headache

• Teleneurology proved to be an effective alternative way of diagnosing and treating nonacute headache, saving money and time, with 99% patient satisfaction.
• One study showed electronic headache diaries to be more effective than traditional paper headache diaries.

Movement Disorders

• Teleneurology evaluation for Parkinson disease (PD) resulted in medication changes and referrals for therapy and support groups.
• Patients with PD saw the average cost per visit via teleneurology to be significantly decreased compared to in-person visits.
• Depression and anxiety rates improved in patients with PD when they received technology-based cognitive behavioral therapy.

Multiple Sclerosis

• Studies of teleneurology-delivered Expanded Disability Status Scale (EDSS) assessments suggest that this method can be used for periodic follow-up assessments instead of an in-person visit.
• Functionality, such as balance, fatigue, and mood were effectively improved through teleneurology.

Neuromuscular

• Patients reported significant improvements on burden of travel, as well as a similar satisfaction with the clinical care received from teleneurology.

Inpatient general neurology

• A study found that patients had significantly shorter hospital stays with use of teleneurology compared to without. This may suggest that using teleneurology early on can cut resource costs.

Most of the studies reviewed showed similarities in the use of teleneurology across subspecialties. Although there are clear benefits, the investigators understand that the knowledge gap is still wide and there is a need for more randomized clinical trials in the future.

“Telemedicine is not the future of health care; it is how we best deliver many aspects of neurologic care to our patients today,” Amy Guzik, MD, professor of neurology at Wake Forest University School of Medicine, and Jeffrey Switzer, DO, professor and chair of neurology at Augusta University, wrote in a related editorial “To use this mode of delivery more broadly, we need further investigation into implementation strategies.”²

REFERENCES

1. Hatcher-Martin JM, Adams JL, Anderson ER, et al. Telemedicine in neurology: Telemedicine work group of the American Academy of Neurology update. Neurology. 2020;94:1-9. doi:10.12.12/WNL. 0000000000008708.

2. Guzik AK, Switzer JA. Teleneurology is neurology. Neurology. 2020;94:1-2. doi:10.1212/WNL.0000000000008693.