Although there are gaps in knowledge, investigators see potential in telemedicine for other neurologic disorders beyond stroke.
Amy Guzik, MD
Results from an assessment of studies examining the use of telemedicine in neurologic disorders show that telemedicine is noninferior to traditional, in-person evaluations in terms of patient and caregiver satisfaction. Additionally, the investigators found that telemedicine has benefits in expediting care, reducing cost, increasing access to care, and improving health outcomes and diagnostic accuracy.1
Neurologists from the American Academy of Neurology (AAN), the Department of Veteran Affairs (VA) representing major subspecialties of adult neurology defined teleneurology as “an evolving branch of telemedicine…defined as neurologic consultation at a distance, or not in person, using various technologies to achieve connectivity, including the telephone and the internet…encompassing teleconsultation, teleconferencing and tele-education.”
In February 2018, the investigators conducted a PubMed search and examined 753 references related to telemedicine and neurologic subspecialties such as concussion with traumatic brain injury (TBI), dementia, epilepsy, headache, movement disorders, multiple sclerosis (MS), neuromuscular disorders, and inpatient neurology. References reviewed for the study included those that assessed clinical feasibility of telemedicine, compared effectiveness of telemedicine and other measures, demonstrated the need for telemedicine, evaluated patient/physician acceptance/satisfaction with telemedicine, and evaluated the financial pros/cons of telemedicine versus standard care. Each subspecialty would be graded on all quality measures, using “++” to indicate randomized controlled trial or inferiority trial with direct measure, “+” if there was a small case series with indirect measurement, or “-“ indicating no study for that quality measure.
Overall, the analysis included data across various quality measures based on subspecialty. In concussion and TBI, data were available on diagnostic accuracy and improved outcomes; patient/physician satisfaction and diagnostic accuracy in dementia care; improved outcomes in epilepsy; patient/physician satisfaction, diagnostic accuracy, and improved outcomes in headache, movement disorders and MS; and patient/physician satisfaction in neuromuscular disorders.
Teleneurology Applications in Subspecialties
Concussion and TBI:
Inpatient general neurology
Most of the studies reviewed showed similarities in the use of teleneurology across subspecialties. Although there are clear benefits, the investigators understand that the knowledge gap is still wide and there is a need for more randomized clinical trials in the future.
“Telemedicine is not the future of health care; it is how we best deliver many aspects of neurologic care to our patients today,” Amy Guzik, MD, professor of neurology at Wake Forest University School of Medicine, and Jeffrey Switzer, DO, professor and chair of neurology at Augusta University, wrote in a related editorial “To use this mode of delivery more broadly, we need further investigation into implementation strategies.”2
1. Hatcher-Martin JM, Adams JL, Anderson ER, et al. Telemedicine in neurology: Telemedicine work group of the American Academy of Neurology update. Neurology. 2020;94:1-9. doi:10.12.12/WNL. 0000000000008708.
2. Guzik AK, Switzer JA. Teleneurology is neurology. Neurology. 2020;94:1-2. doi:10.1212/WNL.0000000000008693.