Neurology Care in the Time of COVID-19
Tracy Sax, M.D., neurologist, Providence Neurological Specialties-East
The practice of medicine has changed dramatically with the advent of the coronavirus pandemic. We have all learned to balance the concerns of patient safety, personal safety and delivery of care to our patients. Despite the many stressors caused by COVID-19, we have seen a few positive changes to our neurology practice at Providence. Policy changes during this pandemic have reduced barriers to telehealth access and have accelerated the practice of teleneurology in the outpatient setting.
There was a precedent to remote neurologic care via telehealth prior to COVID-19: acute stroke telemedicine has been established for many years and allows our Providence stroke providers to assess and treat acute stroke patients presenting to hospitals across Oregon. Prior to COVID-19, there were positive results from clinical trials assessing patient satisfaction and outcomes in the use of telehealth for Parkinson’s disease patients (Wilkinson et. al. 2016) and patients with other neurologic conditions (Hatcher-Martin et. al. 2020).
With expansion of teleneurology services at this time, we recognize the additional benefit to patients who previously experienced challenges coming to the office, including those with significant disabilities, patients who rely on caregivers for transportation and those who live in remote areas. We have been able to assess many neurologic issues via telehealth: dementia, movement disorders, epilepsy, migraine and multiple sclerosis. We hope that the option of telehealth post-pandemic will continue to allow us to expand our practice to patients who have difficulties accessing care. Our staff in all clinics across Providence Brain and Spine Institute have been trained to assist patients with telehealth access. It has been a learning curve for all, but many find it to be a positive experience.
We continue to offer in-person visits for procedures such as nerve testing and EMG, as well as Botox injections. In addition, we recognize some diagnoses such as ALS and other neuromuscular conditions require in-person assessment. Amidst the ongoing changes that COVID-19 has caused, we remain committed to serving patients and working with referring providers.
Telehealth Helps Care for our Most Vulnerable Patients
Julia Toub, M.D., epileptologist, Medical Director of Providence Epilepsy Center
As the COVID-19 pandemic continues to bring new challenges to many aspects of our lives, we understand that this time can be especially stressful for those with chronic health conditions, including our patients with seizure disorders (epilepsy). Although the pandemic has imposed many restrictions on our day-to-day activities, we at the Providence Epilepsy Center are proud to be able to continue to care for our patients with seizure disorders through telehealth.
Similar to an in-person visit, the virtual interface facilitates the same level of interaction patients would have in a face-to-face meeting; history-taking, test-ordering, medication refills are all the same, with the added benefit of keeping patients safe at home. For our patients with implantable devices such as vagal nerve stimulators (VNS) and responsive neurostimulators (RNS), our doctors will determine if in-person visits are necessary. For those who face mental health challenges, our Epilepsy Psychologist is also available for virtual appointments.
Patient safety is at the forefront of our care. Whether patients need an in-person office visit, outpatient electroencephalogram (EEG), 24 hour home EEG (ambulatory EEG), inpatient test in one of our Epilepsy Monitoring Units (EMUs) or even epilepsy surgery, we hope patients will feel more at ease knowing that we have taken extra precautions to ensure they are safe.
Wilkinson, JR et. al. (2016). High patient satisfaction with telehealth in Parkinson disease. Neurology Clinical Practice. 6(3), 241-251.
Hatcher-Martin, et. al. (2020). Telemedicine in Neurology. Neurology, 94(1), 30-38.