Abstracts

People with epilepsy express a desire to see nurse specialists as well as neurologists. Epilepsy Centres are one way of achieving this but are impractical for patients in rural areas.We had used real-time telemedicine previously for acute neurological emergencies and neurological outpatients and wished to see if we could use this technique to improve the care of people with epilepsy in rural areas. Patients with epilepsy attending the neurology clinic at 2 rural hospitals were studied. They were seen by an epilepsy specialist nurse(EB); if necessary telephone consultation was made to a neurologist (VP) who was at the Regional Neurology Centre 80 miles away; if the neurologist was still uncertain a videolink consultation was started directly using commercially-available videoconferencing equipment over ISDN lines at a bandwith of 384 kilobits per second. Specifically we measured the proportion of patients seen by each of the 3 possible consultation methods, the savings in the time of a neurologist, and satisfaction by means of a 3-question questionnaire at the beginning and end of a 3-year period. The total number of patients seen increased from 214 in 2001 to 365 in 2003. The percentage of patients requiring videolinks to the neurologist decreased from 23% to 13%. Satisfaction levels were similarly high at the beginning and end of the study. The saving in the direct time of the neurologist over the period studied was 79%. This method of practice is highly acceptable, saves neurologists[apos] time, and is sustainable in practice. It should become the norm for patients with epilepsy in rural areas where the problems of transport to epilepsy centres-of-excellence are often prohibitive.