Telemedicine works well for managing epilepsy

Telephone-based clinician (specialty nurse or pediatric neurology fellow) follow-up of children with epilepsy is effective in identifying critical clinical events related to disease course or drug therapy, according to findings of a study in India.¹ Although specialty nurses’ performance lagged behind that of pediatric neurology fellows, nurses still identified most events that required immediate medical concern. During the 2-year study period, 135 participants, who ranged in age from 4 months to 18 years, completed a scheduled hospital appointment via telephone consultation with either a pediatric neurology nurse or a pediatric neurology fellow who wrote up a summary of the consultation. Most caregivers (94%) indicated they were satisfied with the advice provided via telephone. The children’s next appointment was in person with the pediatric neurologist. Investigators then compared the performance of the nurses and fellows with results of the face-to-face consultation (gold standard).

Investigators considered 3 main parameters in evaluating clinician performance: identifying whether the child had a breakthrough seizure or an adverse event, and whether drug compliance was adequate or poor. Pediatric neurology fellows performed excellently in all 3 areas, with a sensitivity of 99%, 97%, and 100%, respectively, and 100% specificity. The specialty nurses performed less well, with a sensitivity and specificity of >80% for the 3 parameters.

Thoughts from Dr. Farber

Given that children rarely seize in the office and that physical examination is usually unrewarding, it is no surprise that telemedicine works here. To capture the child whose seizures may not be well controlled, ask the parents to try and record suspicious episodes, which has proven more valuable than a verbal description in my experience.

Reference

1. Gulati S, Shruthi N.M., Kumar Panda P, et al. Telephone-based follow-up of children with epilepsy: comparison of accuracy between a specialty nurse and a pediatric neurology fellow. Seizure. 2020;83:98-103. doi:10.1016/j.seizure.2020.10.002