Marisa McGinley, DO

"[Telemedicine] is not going to completely take over our in-person visits—there are going to be times where exams are definitely still going to be important in neurology&mdash;but I think this is going to be a great supplement to how we practice and a great option for patients to get access to care in a different way."

Over the years, the frequency of telemedicine use has begun to increase, helping to address the holes that have left patients with neurologic conditions behind. While it has mostly been utilized for acute conditions on a more inpatient basis, its utilization in chronic diseases has increasingly become the subject of interest in research.

A few years ago, Cleveland Clinic began utilizing this to attempt to meet this challenge and fill in these gaps across subspecialties, and in particular, to evaluate the &shy;personal use of video-conferencing platforms in neurology. These at-home virtual visits could potentially build toward better patient access to neurological subspecialty care that would normally require them to travel to the closest center. That in itself can present an additional challenge due to the expense and disability.

2019 American Academy of Neurology (AAN) Annual Meeting

, May 4-10, in Philadelphia, Pennsylvania, Marisa McGinley, DO, staff neurologist, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, and colleagues spoke during a plenary session to share data from the last 4 years of the institution’s telemedicine program. All told, the data included 3958 patients and 5646 virtual visits in a number of subspecialties, including headache (21.4%), epilepsy (19.1%), spinal disorders (15.7%), movement disorders (10.8%), psychiatry (6.4%), autonomic disorders (5.7%), cerebrovascular conditions (4.8%), and cognitive disorders (3.6%).

 to discuss how the study demonstrates the feasibility of implementing subspecialty tele-neurology services and the high patient ratings for these services. As well, she noted that future efforts should focus on demonstrating value for patients and the health care system.

Ross L, Bena J, Bermel R, et al. Implementation and Patient Experience with Outpatient Subspecialty Teleneurology Visits at a Single Academic Institution Over Four Years. Presented at: 2019 American Academy of Neurology Annual Meeting. May 4-10, 2019; Philadelphia, PA.

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The staff neurologist at Cleveland Clinic’s Mellen Center for MS shared her insight into the use of telemedicine in an outpatient setting across a number of subspecialties in neurology and how it can supplement care going forward.

Marisa McGinley, DO: Advantages of Outpatient Telemedicine in Neurology Subspecialties

“It’s an interesting concept—we obviously want to be using quantitative MRI&mdash;but we’re not quite sure how to define meaningful changes in that.”

The idea of using quantitative magnetic resonance imaging (MRI) has begun to be floated around in the multiple sclerosis field as a possible improvement to measuring patient outcomes over time. The process is defined as when maps of meaningful physical or chemical variables that can be measured in physical units are obtained and compared between tissue regions and among subjects.

Marisa McGinley, DO, and her colleagues at Cleveland Clinic’s Mellen Center for MS have been exploring the use of quantitative MRI with their patients to determine how best to identify meaningful changes in measurements. To do so, they sought to determine “cut points” for individual patients to help in the interpreting of the data with regard to meaningful life situations.

At the Americas Committee for Treatment and Research in MS (ACTRIMS) Forum in Dallas, Texas, the staff neurologist at the Mellen Center shared her experiences thus far with the process. She detailed the findings from a poster the group presented of the cohort of patients that they evaluated quantitative MRI in.

To find out more about the group’s work, 

Pierpaoli C. Quantitative brain MRI. Top Magn Reson Imaging. 2010;21(2):63. doi: 10.1097/RMR.0b013e31821e56f8

The staff neurologist at the Mellen Center shared the findings from a poster the group presented from the cohort of patients in which they evaluated quantitative MRI.

Marisa McGinley, DO: Using Quantitative MRI in Multiple Sclerosis

“We’ve been very focused on those objective tests, which are wonderful and very helpful, but we also need to understand that this patient’s walk time is this—what does that mean they can actually do in their life? How is this impacting their quality of life?”

For physicians and medical professionals treating multiple sclerosis (MS), there are a number of objective measurements which are incredibly helpful in understanding a patient’s disease progression. Although these are useful, patient-reported outcomes have also become an important part of MS care as the field focuses efforts on individualizing care.

At the Americas Committee for Treatment and Research in MS (ACTRIMS) Forum in Dallas, Texas, Marisa McGinley, DO, and colleagues spoke about the importance of taking a new, more comprehensive approach toward treating MS. This includes re-examining patient-reported outcomes to better understand the quality of life of patients and how it can affect clinical care. Additionally, she spoke about the need for more universal quantitative MRI measurements to help improve the recognition of clinically significant changes.

To find out more about her and her group’s work, 

 spoke with the staff neurologist at Cleveland Clinic's Mellen Center in an interview.

The staff neurologist at Cleveland Clinic's Mellen Center spoke about re-examining patient-reported outcomes to better understand the quality of life of patients and how it can affect clinical care.

Marisa McGinley, DO: Improving Comprehensive MS Care

“We’re used to looking at patients in these little snippets—what’s their walk look like, how do they tell me their functioning at home, what’s their MRI&mdash;but how do we do this comprehensively on a consistent basis?”

At the Mellen Center for Multiple Sclerosis (MS) at Cleveland Clinic, physicians are leveraging technology to help them in tracking disease progression and disability measures for their patients.

One of the physicians using this comprehensive approach is Marisa McGinley, DO. She and her colleagues have a suite of iPad apps which they use to measure a variety of standardized outcomes in MS in their own way, from the 25-foot walk test to the 9-hole peg test, a processing speed test and more. Additionally, they’ve developed in-house quantitative magnetic resonance imaging (MRI) techniques developed by Kunio Nakamura, PhD, to help assess patients in a multi-modal fashion.

 at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2019 Forum in Dallas, Texas, to discuss how collecting this host of demographics and MRI measures has helped the Mellen Center physicians better predict future disability and progression in individual patients. MS, she explained, is a complex disease, and being able to capture and understand this in a more complete manner can help improve patient care.

The staff neurologist at Cleveland Clinic's Mellen Center spoke about the importance of a comprehensive approach to managing patients with multiple sclerosis.

Author | Marisa McGinley, DO

Articles

Marisa McGinley, DO: Advantages of Outpatient Telemedicine in Neurology Subspecialties

Marisa McGinley, DO: Using Quantitative MRI in Multiple Sclerosis

Marisa McGinley, DO: Improving Comprehensive MS Care

Marisa McGinley, DO: Taking a Comprehensive Approach to MS