Authors :
Presenting Author: Rodolfo Roman-Guzman, MD – Universidad Autónoma de San Luis Potosí
Arturo Gonzalez-Lara, Neurology – Resident, Neurology, Universidad Autónoma de San Luis Potosí; ildefonso Rodriguez-Leyva, Neurology – Head Professor, Neurology, Universidad Autónoma de San Luis Potosí; Adriana Martinez-Mayorga, Neurology – Professor, Neurology, Universidad Autónoma de San Luis Potosí; Louis Guzman-Martinez, School of Medicine – Medical Student, Neurology, Universidad Autónoma de San Luis Potosí; Jonathan Reyes-Rivera, School of Medicine – Medical Student, Neurology, Universidad Autónoma de San Luis Potosí
Rationale:
Telemedicine is a real-time interactive communication method that enables providers to join with patients and consultants across challenging geographic distances in a cost-effective, accessible manner. Telemedicine has shown to be useful in the treatment of epilepsy and other neurological disorders. The aim of this work is to share the casuistry of the use of telemedicine in the management of patients with epilepsy, belonging to suburban communities, during the COVID-19 pandemic and its post-pandemic follow-up.
Methods:
We conducted a retrospective, descriptive, and analytical study. Only patients with an initial consultation in the confinement period (2020-2021) and at least one consultation in post-confinement period (2022-2023) were included. The number of consultations received, city of origin, treatment, etiology, type of epilepsy, comorbidities, treatment outcome was obtained in order to compare between the two periods. The statistical analyses were conducted with IBM SPSS Statistics V.25 for Mac.
Results:
A total of 98 patients with an initial consultation between the period of 2020 through 2021 were identified, discarding 41 due to loss of follow-up during post-confinement, resulting in N=57 cases for the analysis. A total of 31 (54.4%) were female and 26 (45.6%) were male. Media for age was 33.93 (13.788 SD). Group of age were as follow: < 20yo=19.3%; 20-29yo=24.6%; 30-39yo=19.3%; 40-49yo=19.3%; >50yo=12.3%). Communities were grouped by distance to Central Hospital, and the percentage of patients belonging to each group was as follow: 100-200 km= 43.9%; 201-200= 14%; >300 km= 42.1% (
see Figure 1.1). Epilepsy Type: focal epilepsy 41 (71.9%); generalized epilepsy 4 (7%); epilepsy with focal and generalized crisis 1 (1.8%); not classified 11 (19.3%). Etiology: autoimmune 2 (3.5%); structural 3 (22.8%); genetic 1 (1.8%); epileptic syndrome 2 (3.5%); unknown 39 (68.4%) (
see Figure 1.2). 57.9% patients counted with EEG, 28.1% had CT scan and only 17.5% had a brain MRI.
Psychiatric comorbidities: anxiety 4 (7%); depression 7 (12.3%); psychosis 3 (5.3%); intellectual disability 16 (28.1%); none 27 (47.4%). Functional crises were identified in two patients (3.5%). The median of consults during 2020-2021 was 1.81 VS 2.96 consults in the period of 2022-2023. During follow up, 28.1% improved in their control of crisis, 7% worsened and 64.9% remained stable. Regarding precipitants of crisis, 5.3% reported menses as a risk factor, 7% stress, 8.8% sleeplessness and 15.8% skipping doses. McNemar-Bowker test was applied to compare crisis control between confinement and post-confinement period. It was also applied for number of drugs required (See Tables 1.1 and 1.2, respectively).
Conclusions:
In our hospital, during the period of confinement by COVID-19, telemedicine represented the only viable option for the care of patients located in remote communities. It proved to be a very successful strategy in monitoring the evolution in epileptic patients in the short and midterm. The reduction in seizure frequency could be maintained in the midterm.
Funding:
This study has received no specific funding from any public, commercial, or non-profit organization.