Neurologists around the country—from migraine specialists to epileptologists—are overhauling the way they deliver their patient care during the COVID-19 outbreak, mostly transitioning from face-to-face visits to video or telephone visits. They also face decisions on which circumstances require an in-person visit with a physician, or a trip to the hospital, despite the infection risk from the novel coronavirus.

The sudden change has been prompted by recommendations—and now, in many states, outright orders—to maintain social distance. These mandates are more financially feasible for neurologists with the decision by the Centers for Medicare and Medicaid Services to make telemedicine visits reimbursable across the country, not just in designated rural areas with limited access to care.

Jacqueline A. French, MD, FAAN, professor of neurology at the NYU Langone Comprehensive Epilepsy Center, said that the vast majority of patient visits are now being done over the phone or with video.

Cautioning that the situation changes by the day, she said that, as of the last full week of March, a priority was to keep patients out of the emergency room as much as possible, sometimes even if they have a convulsive seizure. For example, previously, if a patient who’d been doing well for a year had a breakthrough seizure, they might be told to visit the emergency room largely for their own reassurance, because it is such a distressing, traumatic event.

“You would not send those patients anymore,” Dr. French said. Electroencephalograms that used to be easy to obtain in the ED are no longer easy to obtain, and it might be considerably easier to get labs at an outpatient lab center, she said.

As for routine follow-up visits, much of the examination and interaction can be accomplished with telemedicine, she said. On top of that, patients prefer not having to come in to an office where they might be exposed to an infection.

Still, there are times when an in-person visit is needed, she said. Someone with a new symptom who needs a more detailed neurologic exam to see whether there is a new problem might fit into that category, she said. A patient with a vagus nerve stimulator or responsive neurostimulator who needs an adjustment to the device previously would also have had to physically visit the clinic—but in many centers these are now put on hold until it is safer to return to clinics. These adjustments should only be done when they cannot wait, and this is rare, she said.

“We all do risk-benefit in our heads for everything all the time, so I think that in general we are not at this point feeling like we are giving inferior care to people,” Dr. French said. “So that’s reassuring.” Dr. Jacqueline A. French.


Source: Take from an article in Neurology Today