July 24, 2020

Feasibility and Effectiveness of Teleconsultation in Children with Epilepsy Amidst the Ongoing COVID-19 Pandemic in a Resource-Limited Country

Abstract, published in Seizure

Introduction: The ongoing COVID-19 pandemic and the lockdown measures used by the government have forced neurologists across the world to view telemedicine as the only feasible and practical option to continue providing health care for children with epilepsy isolated at home. But children with epilepsy are challenging for teleconsultation because direct information about seizures and adverse effects, especially behavioral side effects, from the patient is missing. The aim of this study was to determine the effectiveness of teleconsultation under these difficult circumstances

Methods: Clinical and epilepsy-related details of telephone consultations for children from 1 month to 18 years of age, were done in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income)

Results: A total of 153 children (95 males, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers were contacted for teleconsultation. One hundred and-thirteen children were found to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy [108], adverse side effects related [13] and unrelated [24] to the antiepileptic drug (AED), and worsening of associated co-morbidities [7]). In the rest of the patients, questions asked of the caregiver included availability of AED/prescribed commercial brand in the locality, dose of AED(s), substitute for a scheduled routine visit, concern regarding COVID-19 related symptoms, and concern about the effect of COVID-19 itself as well as the resulting lockdown. Ninety-three (60%) patients required an increase in the AED dose, whereas 29 (17%) patients required the addition of a new AED/commercial brand. Five children were advised to immediately go to a nearby hospital. Overall, 147 (96%) caregivers were satisfied with the quality of medical advice.

Conclusions: Teleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.

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