Telemedicine has been recommended as an alternative to traditional in-person clinic visits during the coronavirus disease 2019 (COVID-19) pandemic to help reduce the risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Naoto Kuroda, MD, of Wayne State University, in Detroit, Michigan, provided a checklist for clinicians about what they should ask and look out for in a telemedicine session with patients with epilepsy in a Letter to the Editor published in Epilepsy & Behavior.
For new patients with epilepsy, Dr Kuroda recommends clinicians first obtain general information about the patient, including details on clinical history, family history, medical history, and physical/neurological findings.
Clinicians who treat outpatients with epilepsy also require seizure information for both new and regular patients, including information about seizure features as well as seizure frequency. While seizure frequency can be reported via telemedicine, it can be more difficult to provide accurate descriptions of seizure features. Dr Kuroda suggests that caregivers obtain video of the seizures via a smartphone camera, as the playback of this video can help clinicians distinguish new types of seizure from original types.
Additionally, clinicians should ask patients about treatment compliance, daily routines, and the date and time of seizure onset at a telemedicine session. Some smartphone applications that allow a patient to enter this information and have it readily available for clinicians could be helpful. Clinicians should also confirm via telemedicine whether a patient has experienced any side effects associated with antiepileptic drugs during this time.
Nutrition is a potential adjunctive therapeutic approach to control seizures associated with epilepsy, but some patients may have limited access to healthy foods because of the difficulty in obtaining these resources during the pandemic. Telemedicine sessions should include an assessment of the patient’s compliance to diet therapy. In addition, clinicians should assess any devices a patient may use to manage their epilepsy.
While epilepsy may not be a risk factor for COVID-19, clinicians should still ask their patients with epilepsy whether or not they or other household members have experienced virus-related symptoms. Psychological stress should also be assessed during a telemedicine session, according to the checklist. Telemedicine should also be used to assess whether a patient with epilepsy needs to attend a medical institution in person, a decision that should be made on a case-by-case basis.
Dr Kuroda concluded that “[t]his checklist will be helpful for epileptologists introducing telemedicine to their practice.”
Kuroda N. What should we ask the patients with epilepsy on telemedicine during COVID-19 crisis? A checklist for the clinicians [published online May 25, 2020]. Letter to the Editor. Epilepsy Behav. doi:10.1016/j.yebeh.2020.107184