Teleneurology during the COVID-19 pandemic: A step forward in modernizing medical care.

Introduction The ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects. Methods Clinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time. Results A total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice. Conclusion Teleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.

Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country.

Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic.

We present a multi-objective optimization method for electroencephalographic (EEG) channel selection based on the non-dominated sorting genetic algorithm (NSGA) for epileptic-seizure classification. We tested the method on EEG data of 24 patients from the CHB-MIT public dataset. The procedure starts by decomposing the EEG data from each channel into different frequency bands using the empirical mode decomposition (EMD) or the discrete wavelet transform (DWT), and then for each sub-band four features are extracted; two energy values and two fractal dimension values. The obtained feature vectors are then iteratively tested for solving two unconstrained objectives by NSGA-II or NSGA-III; to maximize classification accuracy and to reduce the number of EEG channels required for epileptic seizure classification. Our results have shown accuracies of up to 1.00 with only one EEG channel. Interestingly, when using all the EEG channels available, lower accuracies were achieved compared to the case when EEG channels were selected by NSGA-II or NSGA-III; i.e., in patient 19 we obtained an accuracy of 0.95 using all the channels and 0.975 using only two channels selected by NSGA-III. The results obtained are encouraging and it has been shown that it is possible to classify epileptic seizures using a few electrodes, which provide evidence for the future development of portable EEG seizure detection devices.

/pdf/eeg-channel-selection-method-for-epileptic-seizure-2xwdajzvoe.pdf

EEG Channel-Selection Method for Epileptic-Seizure Classification Based on Multi-Objective Optimization.

OBJECTIVE: The COVID-19 pandemic has led to rapid changes in the delivery of medical care worldwide. The main objective of this survey was to investigate the initial experiences of neurologists with the use of telemedicine for different neurological conditions during the first phase of the COVID-19. METHODS: All hospital-based neurologists in Norway (n = 400) were invited to a questionnaire survey by e-mail in April 2020. The study focused on telemedicine and all questions were answered with regard to the first weeks of the pandemic lockdown in Norway. RESULTS: One-hundred and thirty-five neurologists responded. Overall, 87% reported a shift toward more telemedicine, with significantly more use of telephone than video consultations for both new referrals (54% vs. 30%, P < 0.001) and follow-ups (99% vs. 50%, P < 0.001). Respondents deemed it much more professionally satisfactory to conduct follow-up consultations by telephone, than to carry out consultations with new patients by telephone (85% vs. 13%, P < 0.001). Teleconsultations were better suited for headache and epilepsy patients as compared to multiple sclerosis and movement disorder patients. There was no significant difference between residents and senior consultants regarding how they experienced teleconsultations. Female neurologists found telemedicine better and more effective than male neurologists. INTERPRETATION: Telemedicine was rapidly implemented in Norwegian neurological departments during the first weeks of the COVID-19 pandemic. Teleconsultations were better suited for follow-ups than for new referrals, and better for headache and epilepsy patients as compared to multiple sclerosis and movement disorder patients.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/acn3.51293

Eliashiv Dawn

Papers

Telemedicine in epilepsy: How can we improve care, teaching, and awareness?