Lockdown measures and health service reconfiguration pose challenges to the provision of care for people with epilepsy during the COVID-19 pandemic.
Brigo et al. suggest, that although not a replacement for face-to-face consultations, telemedicine can be helpful for general clinical review, managing drug-related adverse effects, and relaying other important information for effective epilepsy management [1]. An assessment via telemedicine can determine if and when a patient should attend hospital [2]. Capturing events on smartphone video can help in the evaluation of new seizures [2].
Hernando-Requejo et al., conducted telephone consultations with 49 patients during lockdown in Spain (20th March-13th April 2020) [3] and reported that remote consultations could be effective for clinical management in the short-to-medium term. Limitations of telemedicine relate to patient/carer cognitive impairment, and lack of access to the internet or appropriate technology [1]. Patient confidentiality, data protection and maintaining the boundaries of the patient-doctor relationship should be considered [6].
Urgent assessment by healthcare professionals, and urgent neuroimaging and neurophysiological tests, may be required for particular patient subgroups with COVID-19, e.g. status epilepticus, seizure-related complications and epilepsy in diabetes, heart disease or pregnancy [1]. Although evidence that SARS-CoV-2 can directly cause de novo seizures is lacking, infection, hypoxia, electrolyte imbalances and cytokine storm syndromes may result in acute symptomatic seizures [6].
Procedures should observe appropriate infection-control regulations to protect patients and healthcare workers. Recommendations and guidelines have been issued requiring an experienced EEG technologist wearing appropriate personal protective equipment and a dedicated portable video-EEG system to perform EEGs. The EEG recording should satisfy minimum technical requirements. Verbal and tactile stimulation activation may be performed instead of hyperventilation and photic stimulation, which might provoke seizures with potential aerosol production [4,5].
Key points:
- Telemedicine, with appropriate consideration for patient confidentiality and data protection, can be a useful tool in maintaining epilepsy care during the COVID-19 pandemic.
- Telemedicine can be used to assess which patients should attend hospital and when.
- Cognitive impairment and lack of access to appropriate technology are potential barriers to the use telemedicine.
- Careful planning can ensure ongoing access to neuroimaging and neurophysiological tests while observing infection control measures to protect patients and healthcare workers.
References:
- F. Brigo, S. Bonavita, L. Leocani, et al., Telemedicine and the Challenge of Epilepsy Management at the Time of COVID-19 Pandemic, Epilepsy & Behavior, https://doi.org/10.1016/j.yebeh.2020.107164
- N. Kuroda, What should we ask the patients with epilepsy on telemedicine during COVID-19 crisis? A checklist for the clinicians, Epilepsy & Behavior (2020), https://doi.org/10.1016/j.yebeh.2020.107184
- Hernando-Requejo et. al, The epilepsy unit during the COVID-19 epidemic--the role of telemedicine and the effects of confinement on patients with epilepsy, Neurologia (2020), DOI: 10.1016/j.nrl.2020.04.014 PMID: 32364125
- Seline Haines, Amy Caccamo, Fonda Chan, German Galaso, Alexis Catinchi & Puneet K. Gupta (2020): Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases, The Neurodiagnostic Journal, DOI: 10.1080/21646821.2020.1756132
- American Clinical Neurophysiology Society (ACNS). COVID-19 Resources. March 25, 2020b. ACNS.org. Accessed March 31, 2020. Retrieved from: https://www.acns.org/practice/covid-19-resources
- Gelisse, P., Rossetti, A.O., Genton, P., Crespel, A., Kaplan, P.W., How to carry out and interpret EEG recordings in COVID-19 patients in ICU?, Clinical Neurophysiology (2020), doi: https://doi.org/ 10.1016/j.clinph.2020.05.006