Abstracts

Rationale: Telehealth systems distribute subspecialty care throughout healthcare networks reducing costs. Veterans afflicted with epileptic and non-epileptic seizures (NES) have been a target for tele-health initiatives to improve diagnosis and treatment throughout the VA network. The New England VA network has multiple VA facilities with neurology care, but most lack resources for prolonged EEG testing and epilepsy subspecialist services. We established a local telehealth network to provide epilepsy diagnostic services. Here, we examine the diagnostic yield and clinical impact of this program as it pertains to ambulatory EEG monitoring.Methods: A telehealth EEG agreement was established between VA Boston Healthcare system (VABHS) and Providence VA Medical Center (PVAMC ) in 2013 allowing for remote interpretation of EEG studies recorded at PVAMC by epileptologists at VABHS. All tele-ambulatory EEGs recorded prior to 6/1/2015 were analyzed for: captured spells, electrographic seizures, epileptic discharges, and slowing. VA records were reviewed to assess AED changes as a result of the EEG study. Ambulatory EEGs were graded as: Epilepsy confirmed (electrographic seizure captured), Epilepsy supported (presence of epileptic discharges), NES supported (captured events with no associated EEG changes), normal (normal EEG, no events captured), and indeterminate (findings of uncertain significance).Results: 26 ambulatory EEG studies were recorded at PVAMC and interpreted at VABHS from 2/7/2014 – 5/5/2015. These were performed on 24 male and 2 female patients, ages 36-77. Mean recording time was 63.8 hours (range 22–75 hours). Fifteen patients were prescribed anticonvulsant medications (AEDs), 8 for suspected epilepsy. Seven studies captured typical events marked by pushbutton/ log with no associated EEG findings suggesting epileptic seizures. A single electrographic seizure was recorded in an untreated patient and two studies captured questionable artifact vs seizures EEG changes. Grading distributions were: normal (14), NES supported (7), Epilepsy supported (4), Epilepsy confirmed (1), and indeterminate (2). Seven studies (27%) resulted in medication changes: 2 added AEDs (1 Epilepsy supported, 1 Epilepsy confirmed), 2 increased AEDs (Epilepsy supported), 3 decreased AEDs (1 NES suspected, 2 normal). Subsequent inpatient video EEG monitoring was planned only for 1 study (artifact vs seizure). Based on 2014 Medicare rates, the estimated cost of these studies outside the VA would have exceeded $31K. In the year prior to this tele-EEG agreement (FY2012), PVAMC costs for non-VA ambulatory EEGs were $29,056.Conclusions: For select VA epilepsy and NES patients with frequent spells, tele-ambulatory EEG is a cost-effective alternative to epilepsy monitoring and non-VA EEG services. The cost savings include: avoidance of out-of-network care or transportation to distant VA facilities, reduced need for inpatient EEG monitoring, and earlier diagnosis and treatment of Epilepsy and NES. Wider use of Tele-EEG in the VA hospital network may produce further cost savings and improve quality of epilepsy care in our veterans.