Jessica Fesler, MD, MEd

"The apps do quite a bit with self-management or helping patients take ownership of their disease. That’s probably where they’re the strongest. But still, there’s room to grow there in helping them have all the tools they need to live better day-to-day with seizures.”

There are several different functions of seizure apps that can assist with the daily responsibilities patients with epilepsy have, mainly by recording and tracking their seizures and helping alert them when to take medications. Seizure diaries, which are heavily used in clinical trials, are now available through these apps and can be accessed on smartphones and tablets. Despite the advantages these apps appear to have, some, including 

 Epilepsy Center, believes there is untapped potential for these apps in the care paradigm, including seizure detection—which is not an uncommon thought, considering there are already devices that are FDA-approved to do the same thing. At the 

2021 American Epilepsy Society (AES) annual meeting

, December 3-7, in Chicago, Illinois, Fesler delivered a talk that touched on the topic of seizure apps, where they fit in the management of the disease, and where their roles could expand.

® at AES 2021 to discuss her thoughts behind the reach of these seizure apps, the challenges that come with trying to expand into seizure detection, and the need to include more social support.

Videos

The staff epileptologist at Cleveland Clinic’s Epilepsy Center discussed new untapped ways seizure apps could help patients with epilepsy. [WATCH TIME: 2 minutes] 

Expanding the Use of Seizure Apps for Epilepsy: Jessica Fesler, MD, MEd

"Now that we’re doing virtual visits, if we could integrate all of that together and make them talk to each other. That would be a step in the right direction.”

Social isolation caused by the COVID-19 pandemic has increased the use of smartphone devices for hundreds of millions of people; however, if this increase is parallel for those with epilepsy who utilize seizure apps remains to be seen. There are several of these apps on the market, but there is no app that serves as a go-to or is used most often by the epilepsy community. Jessica Fesler, MD, MEd, staff epileptologist at 

 Comprehensive Epilepsy Center, and an expert on these applications, claimed that it’s safe to assume the use of them has gone up, but the lack of integration with the healthcare system as a whole is concerning.

American Epilepsy Society (AES) annual meeting

, December 3-7, in Chicago, Illinois, on potential these apps have along with the barriers that hold them back. She stated that while there have not been a lot of data specifically focusing on how the role of these apps have changed, the need to shift focus and create apps that communicate well with patients and providers is even more crucial. She sat down at AES 2021 to provide her thoughts on the usage of these apps during the pandemic and how companies should shift their attention as telehealth continues to grow.

The staff epileptologist at Cleveland Clinic’s Epilepsy Center gave her expert opinion on whether seizure app usage has increased during the COVID-19 pandemic and why there remains a need for further data collections. [WATCH TIME: 2 minutes]

Use of Seizure Apps During the Pandemic, Need for Data: Jessica Fesler, MD, MEd

"Seizure apps are not used widespread by a lot of people. One of the reviews out there that looked at the most commonly used apps in 2018 showed that they were downloaded by about 10,000 people, which sounds like a lot, but not when you think about the 50 million people with epilepsy."

Typically, patients with epilepsy are asked to manage their disorder themselves, and self-management is often encouraged. Mobile health applications, specifically seizure apps, have become a great tool for these patients to track seizures and adhere to treatment regimens. Although there has been a steady rise in the number of these services, there is still no single app considered the standard or that is widely used by the space.

Jessica Fesler, MD, MEd, staff epileptologist, 

 Epilepsy Center, has been an expert in the field at understanding how to get the most out of these apps, but also harping on the continual need to improve the technology available. At the recently concluded 

, held December 3-7, in Chicago, Illinois, she delivered a talk that addressed these apps and where they could be more useful.

® at the meeting to discuss the pros and cons of current seizure apps, from the high accessibility they provide to the low social capabilities between patients. Fesler also harped on how there is no comprehensive “one-stop shop” app that has all the functionalities needed.

The staff epileptologist at Cleveland Clinic’s Epilepsy Center detailed the benefits seizure apps provide for patients with epilepsy, as well as the barriers that limit them. [WATCH TIME: 3 minutes]

Capabilities and Limitations of Seizure Apps: Jessica Fesler, MD, MEd

“We’re doing [patients] a disservice if we don’t leverage technology to take better care of them. There are a lot of downsides to technology, but this is one upside that we can really leverage to help people.”

Jessica Fesler, MD, staff epileptologist, Cleveland Clinic Epilepsy Center, and colleagues presented a large, single-center dataset showing the success and feasibility of telemedicine in epilepsy at the 

 annual meeting of the American Epilepsy Society (AES)

, December 6-10, 2019, in Baltimore, Maryland.

Their data suggest that the practice not only offers a number of advantages to patients and providers, including cost savings, convenience, time savings, etc., but that it is a feasible one for widespread use in epilepsy.

 A number of other studies have suggested similar results across the breadth of neurology.

However, there are barriers that remain in bringing this to more physicians and hospital systems—most notably, reimbursement.

To find out more about what challenges this innovation in medicine is facing and how the physician community is overcoming it, at least in epilepsy care, 

 sat with Fesler to discuss her experience in using the program at Cleveland Clinic over the last several years.

1. Fesler JR, Stanton S, Merner K. Bridging the Gap in Epilepsy Care: A Single-Center Experience of More Than 1000 Tele-Epilepsy Visits. Presented at: AES 2019; December 6—10; Baltimore, Maryland. Abstract 2.36.

2. Hatcher-Martin JM, Adams JL, Anderson ER, et al. Telemedicine in neurology: Telemedicine work group of the American Academy of Neurology update. 

2020;94:1-9. doi:10.12.12/WNL. 0000000000008708.

3. Guzik AK, Switzer JA. Teleneurology is neurology. 

. 2020;94:1-2. doi:10.1212/WNL.0000000000008693.

Despite showing great promise to provide additional and supplementary care to patients with a number of conditions, including epilepsy, some barriers remain to bringing telemedicine to more providers and patients.

Jessica Fesler, MD: Barriers to Adopting Telemedicine

“I am excited, I think it’s the way of the future. It just works better, and as people become more comfortable with it and the technology, [it will be used more often]. Obviously, the great thing is the convenience…it reduces a lot of burden.”

, December 6-10, 2019, in Baltimore, Maryland, Jessica Fesler, MD, staff epileptologist, Cleveland Clinic Epilepsy Center, and colleagues presented a large, single-center dataset showing the success and feasibility of telemedicine in epilepsy.

Over the 35-month study period, 3698 visits were conducted with patients from 43 different states. On a 5-point scale, with 5 representing the best possible, patients rated their overall experience with the virtual visit a mean of 4.77 and rated their provider a 4.91. The visits were mostly completed with epilepsy physicians (74%; pediatric: 25%; adult: 49%), with the remaining conducted by advanced practice providers (22%), neuropsychologists (1%), and neurosurgeons (3%).

Based on their distance from the Cleveland Clinic Epilepsy Center, 26.7% (n = 571) of patients were local, defined as within 50 miles, while 30.5% (n = 652) were deemed near regional (within 51 to 150 miles), 20.1% (n = 431) considered far regional (within 151 to 270 miles), and 22.7% (n = 486) were considered remote, defined as further than 270 miles. Using those distances, roughly 928,696 miles of travel were saved for patients.

To find out more about what these data mean, and what the benefits are, for patients, 

 spoke with Fesler about her experience utilizing the technology.

Fesler JR, Stanton S, Merner K. Bridging the Gap in Epilepsy Care: A Single-Center Experience of More Than 1000 Tele-Epilepsy Visits. Presented at: AES 2019; December 6—10; Baltimore, Maryland. Abstract 2.36.

The staff epileptologist at Cleveland Clinic’s Epilepsy Center spoke to the benefits of telemedicine for patients with epilepsy, and how the practice can alleviate a number of burdens.

Jessica Fesler, MD: Alleviating Epilepsy Burden With Telemedicine

“One thing I wasn’t expecting was how you could see the patient in their environment. You learn more about them—not even so much from their medical comorbidities, but from the context of their disease.”

Telemedicine has grown in recent years into a more widely used method in the treatment of patients with a number of conditions, but at Cleveland Clinic, its expanse in epilepsy has been almost unmatched. For staff epileptologists such as Jessica Fesler, MD, it has become a regular practice in the management of patients.

The positives for patients are quite obvious from both convenience and cost-effective standpoints. With less time needed for the visit due to less travel, patients can avoid needing to take time off work, save on travel costs, and keep their physicians updated in light of inclement weather and other factors out of their control. However, clinicians can benefit from these alternative visits as well.

, December 6-10, 2019, in Baltimore, Maryland, Fesler shared her insight from her involvement with telemedicine in a conversation with 

, offering a unique perspective on some of the unexpected gains telemedicine provides clinicians.

The staff epileptologist at Cleveland Clinic’s Epilepsy Center spoke to her experience using telemedicine to manage patients with epilepsy and some of the unexpected perspectives it offers.

Jessica Fesler, MD, MEd

Articles

Expanding the Use of Seizure Apps for Epilepsy: Jessica Fesler, MD, MEd

Use of Seizure Apps During the Pandemic, Need for Data: Jessica Fesler, MD, MEd

Capabilities and Limitations of Seizure Apps: Jessica Fesler, MD, MEd

Jessica Fesler, MD: Barriers to Adopting Telemedicine

Jessica Fesler, MD: Alleviating Epilepsy Burden With Telemedicine

Jessica Fesler, MD: Experiences With Telemedicine In Epilepsy

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