Abstracts

Rationale: The Richmond VA Medical Center Epilepsy Service is a small group with limited resources but wide geographic coverage. We are experienced with outpatient video telehealth services for epilepsy since 2014 and intermittently outsourced In-Home EEG services to cover great distance gaps. Similar to some Level 1a VA Medical Centers, 80% of our referral base require greater than one hour of travel time and 25% may drive 2 or more hours (highest being 5 hours). Despite the COVID-19 Pandemic, epilepsy patients continued to require high quality care and practices needed to pivot to effectively deliver services. Rapid shifts in diagnostic strategy were made given the closure of electroencephalography (EEG) labs and epilepsy monitoring units (EMUs). The Richmond VA EMU remains closed with its rooms reserved for emergency use given negative pressure capability. The practice shifted to outsource a proportion of EMU referrals to In-Home Prolonged Video-EEG via a third-party company. Here, we profile some methodology and lessons learned from an unexpected but necessary practice change.

Methods: We performed a chart audit of patients (n=56) who were initially intended for EMU referral that were subsequently converted to an In-Home Video-EEG study via a third-party company contracted through the Veterans Health Administration. Demographics, drive time to the VA medical center, medical history, details on the type of study, rates of capturing normal EEG, epileptic seizures as well as non-epileptic spells are profiled.

Results: As mentioned above, 80% of our referral base require greater than one hour of travel time and 25% may drive 2 or more hours (highest being 5 hours). The conversion of studies to In-Home Video-EEG eliminated the need for patients to secure long distance transportation or lodging for family members who would have typically accompanied the patient during an EMU admission. Out of those patients referred for In-Home EEG, 48% had no prior EEG testing and 16% had only routine duration EEG at our center. Seventy (70%) of studies returned normal, 25% of studies captured epileptiform activity or characterized seizures with excellent semiology detail. Twenty-five percent (25%) of studies captured Non-Epileptic Spells (NES). In general, 54% of studies increased yield in diagnostic data in the form of characterized seizures or spells or clarification of overall disease burden.

Conclusions: In-Home Video-EEG testing used in tandem with video telehealth systems can be utilized strategically to close distance gaps to epilepsy and neurodiagnostic care and can also serve to supplement services during resource limited situations. These strategies can be useful for neurologists who serve low resource or wide coverage areas.

Funding: Please list any funding that was received in support of this abstract.: None.