key: cord-0891330-gqwovsmx
authors: Puteikis, Kristijonas; Mameniškienė, Rūta
title: Epilepsy care and COVID‐19: A cross‐sectional online survey from Lithuania
date: 2021-03-16
journal: Acta Neurol Scand
DOI: 10.1111/ane.13409
sha: 40ca07bdc5ed36a9cc2144063eee90a86f7ca0fe
doc_id: 891330
cord_uid: gqwovsmx

BACKGROUND: Changes in epilepsy care during the COVID‐19 pandemic required to reassess the patient‐specialist interaction in the context of telehealth and future vaccination campaigns. AIMS OF THE STUDY: The aims were to outline changes in neurologists' experience when providing care for patients with epilepsy (PWE) and to investigate how neurologists perceive telehealth and vaccination. METHODS: We conducted an anonymous cross‐sectional online survey among members of the Lithuanian Association of Neurology. RESULTS: We received 104 completed forms by adult (74, 71.15%) and pediatric neurologists (30, 28.85%). A decrease in epilepsy consultations was noted by 76 (73.1%) specialists, and up to 26 (25.0%) could not provide diagnostic tests at a usual rate. Most respondents (99, 95.2%) would recommend the COVID‐19 vaccine for patients at risk. Telehealth was valued as a useful tool in epilepsy care, especially if combined with timely diagnostic and treatment options (Kruskal‐Wallis chi‐square = 10.392, p = .034 and F[4,99] = 3.125, p = .018, respectively). According to 85 (81.7%) respondents, video calls could substitute in‐person visits in at least half of all consultations. CONCLUSIONS: Despite disrupted epilepsy care, neurologists may benefit from telehealth when providing services for PWE and become vaccination advocates to mitigate the spread of preventable infections.

The shift toward telehealth during the COVID-19 pandemic was relevant in epilepsy care as remote consultations are often sufficient to address many of the patients' issues (eg, prescription renewal, referral for future testing). 1 Telehealth will probably be widely used in future practice and improve access to health care by being either a substitute or an add-on service for in-person visits. 2, 3 While studies indicate that both persons with epilepsy (PWE) and epilepsy specialists are content with remote consultations, additional research is needed to determine its main benefits for the diagnostic and treatment process. [3] [4] [5] We investigated factors that will be relevant for a seamless transition to a post-pandemic world and may represent innovations of the patient-specialist interaction in epilepsy care.

We report a nationwide cross-sectional online survey with focus on epilepsy care among members of the Lithuanian Association of Neurology. The aims of our study were to outline the experience of neurology specialists when providing services for PWE during the global COVID-19 pandemic, determine neurologists' views on vaccination against COVID-19 and telehealth. This question was included in the topic's scale. c The results of this question were inverted in the topic's scale.

Data for this study were collected by sending a questionnaire (Google Forms, Google Inc.) to members of the Lithuanian Association of Neurology (closed mailing list, 300 recipients). The survey was open from 8 December 2020 to 24 December 2020. All data were completely anonymous. Because of such design, no informed consent forms or formal approval from the local Bioethics Committee was required, according to local regulations. The questionnaire (its translation is provided as Appendix S1) revolved around different aspects of epilepsy care during the pandemic (eg, potential causes for health deterioration among PWE, the participants' outlook on vaccination, and experience with telehealth). Therefore, questions within these separate topics were tested for internal consistency and were treated as scales (summarized topic's scores) if Cronbach's α > .7.

The study sample consisted of 104 respondents (response rate 34.7%). The participants' characteristics and reported work experience during the COVID-19 pandemic are presented in Table 1 . More detailed results of this and subsequent sections are presented in Neurologists viewed telehealth as a frequent substitute for inperson services: 82 (78.8%) respondents could use telehealth to renew prescriptions, 62 (59.6%)-to collect initial patient information in more than half of all cases. The mean score of telehealth usefulness was high, regardless of missed clinical data during remote consultations (F[4,99] = 0.884, p = .477, Figure 1 ). However, the scores were higher among respondents who did not witness worsening patient status because of delayed diagnostic tests or treatment 

The first wave of COVID-19 and a national lockdown in Lithuania took place from 16 March to 16 June 2020. It was followed by a summer with low infection rates and a large second wave and national lockdown from November 7 (cases peaked at the time of the survey with 3.0% of the population infected when closing the online form). 6 In-person visits were restricted during the first three-month-long lockdown and impeded during the study period in late 2020 because the healthcare system became overwhelmed with new COVID-19 cases. The direct disruption of accessible services and changes in help-seeking behavior (eg, fear of being infected with COVID-19 at an epilepsy clinic) may explain the reported decrease in patient consultations and urgencies. 7 The unavailability or delay of EEG or neuroimaging translated into worse patient outcomes, as perceived by a third of respondents. This phenomenon was less frequent among pediatric neurologists (speculatively because of lower patient flow and less fear of COVID-19 infections among children). A decrease in access to diagnostic tools (eg, EEG) has been noted across European reference centers and in the United States-it should therefore be advised to restore or even expand these services as the pandemic abates. 8, 9 Neurologists in Lithuania recognized that a lack of in-person consultations, socioeconomic harm, and strict national lockdowns were the most damaging consequences of the pandemic. Socioeconomic strain and mental health issues were highly prevalent during the pandemic-the latter may be even more relevant than seizure exacerbation. 10, 11 Accordingly, more respondents in our study saw anxiety rather than increased seizure frequency as an emerging complaint. The results of this question were inverted in the topic's scale. and were unwilling to prematurely conclude that the vaccine is safe.

Further, the approved vaccine was not evaluated in the pediatric population, explaining the neutral position of pediatric neurologists. 13 Neurologists also remained neutral when asked about the priority for PWE to get the vaccine-this may reflect a view that PWE are not at a higher risk of COVID-19 complications. 14 Vaccine rollout in Lithuania began on 27 December 2020 and first targeted medical personnel and patients at risk (mass availability is sought around mid-2021). 6 Even those respondents who reportedly missed clinical data because of remote consultations endorsed telehealth. However, delays of diagnostic tests or treatment and unavailable EEG were associated with poorer outlook on telehealth. This probably reveals that telehealth is useful only if combined with timely diagnostics and smooth medication prescription and renewal. 1 Telehealth may therefore be reserved for cases when no extensive investigation is required. Alternatively, the emergence of virtual clinics might replace most of face-to-face follow-up visits (including EEG testing, which might be done at local clinics) as this lowers healthcare costs and journeys for PWE. 15 In Lithuania, almost everyone is covered by healthcare insurance and may receive free teleconsultations through selected software or by phone call.

In summary, we report difficulties providing epilepsy care to the routine extent during the COVID-19 pandemic. However, telehealth is appreciated whenever diagnostic tests and appropriate treatment options are available. Further, neurologists might have a beneficial role when providing information about vaccines for PWE. This survey has limited generalizability because of its cross-sectional and single-country design and may be influenced by non-response bias.

We thank all neurology specialists for dedicating their time and effort to answer to our survey.

The authors declare no conflict of interest.

Ethical review and approval were not required due to anonymous design of the online survey (according to local bioethics regulations).

Raw study data are available from the authors upon reasonable request.

Rūta Mameniškienė https://orcid.org/0000-0001-5719-8175

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