Abstracts

Rationale: The Institute Of Medicine report in 2013 emphasized the importance in improving quality, access and value of health care for those diagnosed with epilepsy. With tele-services, patients have easier and faster access to specialist services, hastening the diagnosis and appropriate treatment of epilepsy. Methods: There are very few studies that describe the use of tele-services in epilepsy. A general search was done using PubMed and Google scholar using the keywords “telemedicine” and “epilepsy” to identify all studies that specifically address epilepsy and/or EEG using tele-services. We focused on patient services excluding those focused on methodology and logistics. Results: PubMed search generated 33 items and Google Scholar 8620 items during 1900-2018. After careful review, only 24 reports are specific to epilepsy/EEG.  These are reports from around the world and include UK, Canada, Spain, Ireland, France, Iceland, Malaysia, India, Pakistan and U.S.A.Most of these included EEG done as record and review, with the UK study reporting it as a feasible alternative to improve the care of neurological patient: 1007 EEGs done (all reported within 24 hours) over 13 months. In Ireland 142 EEGs were recorded for review over 20 weeks. They reported a 5 fold increase in access, decreased waiting time by 50% to obtain EEGs; 82% of patients and 100% of physicians were satisfied. Spain had 116 EEG consultations over 6 months with 99% patient satisfaction for ease of access. The report from France (2016) stated that record and review EEG services has been in use for over 10 years, but no details were available. Iceland reported 66 EEGs requiring 12 consultations over 1 month, using online interactive with video and/or offline use, but did not provide further details.Clinical consultation with tele-services were reported from several countries: Canada had clinical consults on 18 conventional vs. 23 tele patients over 6 months with 90% of patients satisfied with both services; 83% of patients preferred tele services. There are also reports from Pakistan using video-conferencing for consultation for 17 patients over 2 years; India and Malaysia reports using mobile phones (calls and texts) and apps, no specific details available.There are only 2 reports from USA, both utilizing tele-services for consultation: 1) UT Galveston compared ambulatory clinic (72 patients) vs tele (83 patients) over 3 months in 2004 and found tele as an acceptable alternative. 2) University of Arkansas used tele-consultation for 24 patients over 3 years: only 11% no-show rates (vs. 22% clinic) Conclusions: Tele services are especially useful for locations without or limited specialist access, and in remote/rural locations with limited transportation availability or extreme climates. Although all studies report the benefit of using tele-services in epilepsy, and are being used to some extent globally, there still exists a wide gap in implementation. Limited experience with epilepsy/EEG services in USA. Availability of appropriate technology may be a limiting factor, especially in developing nations. Funding: None