Telephonic review as effective as visit based management in patients of stable epilepsy

In a prospective randomized parallel group study, Dr.Kunal Bahrania and associates assessed telephonic review of outpatients with stable epilepsy compared with conventional face-to-face clinic visit based management.

There are 13 million epilepsy patients in India and an epilepsy treatment gap of up to 90% is still reported from many parts of the country. As many as 70% of these epilepsy patients require just one or two correctly prescribed antiepileptic drugs along with information that lets them make an informed choice about continuing treatment for a few years. Most of these patients can be managed well by primary care providers and do not need a neurologist.

Dr.Mamta Bhushan Singh, Professor, Dept of Neurology, All India Institute of Medical Sciences co-researcher in the study said, As epilepsy requires chronic care for many years, the logistics including the cost of reviews become important. If patients coming from distant places can be offered the option of a telephonic review, many of them may remain in touch with their care providers and continue treatment for as long as it is needed.

Primary outcomes were the percentage of patients with breakthrough seizures and the total number of breakthrough seizures. We also compared cost, patient satisfaction and numbers defaulting.

Results: A total of 465 patients were randomized and 429 were included in the final analysis.It was found that there was no significant difference in breakthrough seizures between the two groups.

Meantime spent in the consultation was 10 min in the telephone group (FT) and 22 h in the face-to-face group (FC) and the cost was INR 865 more expensive on an average in the FC group. Satisfaction was over 90% in the FT group. Significantly more people in the FC group were lost to follow-up.

The authors concluded that this study provides Class I evidence that the number of stable epilepsy patients who have breakthrough seizures and the total number of breakthrough seizures remain the same irrespective of whether patients are reviewed telephonically or face-to-face in the clinic. Clinicians managing epilepsy patients should consider using telephonic review for selected patients. Telephonic reviews have the potential of effectively reducing the secondary treatment gap in millions of patients who do not have easy access to doctors.

Dr. Mamta Bhushan Singh

The author is MD, DM, FAAN (Neurology) and is Professor, Dept of Neurology, All India Institute of Medical Sciences. She is a member Editorial Board, Neurology at Specialty Medical Dialogues.