Telemedicine Feasible For Large-Scale Use in Epilepsy

Jessica R. Fesler, MD, neurologist, Akron General Epilepsy Center and Cleveland Clinic

Jessica R. Fesler, MD

The results of a single-center study experience with telemedicine in the outpatient treatment of epilepsy suggest that the use of tele-neurology tools on a larger scale is feasible for clinical use.¹

Overall, the study included more than 3600 total virtual visits with 2140 patients with epilepsy, with data indicating not only high rates of satisfaction with the telemedicine visits but a significant rate of repeat utilization of the service. In total, 41.6% (n = 890) of patients completed more than 1 virtual visit during the study period.

Study author Jessica R. Fesler, MD, a neurologist at Akron General Epilepsy Center and Cleveland Clinic, and colleagues wrote that these high ratings, coupled with the sustained demand for the practice during the study period, suggest an overall positive patient experience. The data were presented at the 73^rd annual meeting of the American Epilepsy Society (AES), December 6-10, 2019, in Baltimore, Maryland.

Fesler and colleagues did note that the effect of tele-epilepsy on costs, utilization, and outcomes in healthcare is not entirely known, and thus future studies should investigate this value for patients and healthcare systems. “We should seek to understand in what context tele-epilepsy is most effective and beneficial to patients to better leverage technology to serve our patients and enable access to epilepsy care,” they detailed.

READ MORE: Breastfeeding Rates Are Lower Among Women With Epilepsy

This study period covered January 1, 2017, until November 12, 2019, with tele-epilepsy visits conducted via the American Well platform on smartphones, computers, or tablets that allowed video conferencing with an epilepsy care provider. Over the 35-month study period, 3698 visits were conducted with patients from 43 different states.

On a 5-point scale, with 5 representing the best possible, patients rated their overall experience with the virtual visit a mean of 4.77 and rated their provider a 4.91. The number of visits drastically increased over time. There were just under 50 visits in the period between July and September 2017, increasing to more than 150 from October to December 2017, and surpassing 300 from January to March 2018, and maintaining through the end of the study. Overall, in 2017, the visits numbered at 260, increasing drastically to 1484 in 2018, and up again to 1954 in 2019.

The visits were mostly completed with epilepsy physicians (74%; pediatric: 25%; adult: 49%), with the remaining conducted by advanced practice providers (22%), neuropsychologists (1%), and neurosurgeons (3%). Based on their distance from the Cleveland Clinic Epilepsy Center, 26.7% (n = 571) of patients were local, defined as within 50 miles, while 30.5% (n = 652) were deemed near regional (within 51 to 150 miles), 20.1% (n = 431) considered far regional (within 151 to 270 miles), and 22.7% (n = 486) were considered remote, defined as further than 270 miles.

Using those distances, roughly 928,696 miles of travel were saved for patients. The median travel distance saved was 124.5 miles (interquartile range [IQR], 45—253). The average time spent on a virtual visit was 15.7 (±10.4) minutes.

“Such a service allows patients to connect remotely with their care provider from any convenient location,” Fesler and colleagues wrote. “Virtual clinical care may be especially relevant and beneficial for patients with epilepsy with unique issues making transportation to the physical outpatient clinic more onerous. These include loss of driving privileges with seizures, the unpredictable occurrence of seizures in public, socioeconomic hardship with unemployment, and potential for neurological disability affecting ambulation.”

These results showed a similar trend to those seen in other areas of neurology, with several recent works hinting at the potential of telemedicine to improve care for remote patients. Recent results from an assessment of studies examining the use of telemedicine in neurologic disorders suggested that the practice is noninferior to traditional, in-person evaluations in terms of patient and caregiver satisfaction. Additionally, the investigators of that review found that telemedicine has benefits in expediting care, reducing cost, increasing access to care, and improving health outcomes and diagnostic accuracy.²

Specifically, within epilepsy, the results suggest that it could have application for the completion of medication changes and discussion of surgical options, with a lower no-show rate for appointments compared with in-person clinic visits, as well as no significant difference from traditional ambulatory care in the number of seizures, hospitalizations, emergency room visits, or medication compliance.

For more coverage of AES 2019, click here.

REFERENCES

1. Fesler JR, Stanton S, Merner K. Bridging the Gap in Epilepsy Care: A Single-Center Experience of More Than 1000 Tele-Epilepsy Visits. Presented at: AES 2019; December 6—10; Baltimore, Maryland. Abstract 2.36.

2. 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.