Epilepsy & Behavior 103 (2020) 106854

Contents lists available at ScienceDirect

Epilepsy & Behavior

journal homepage: www.elsevier.com/locate/yebeh

Special Communication

Telemedicine in epilepsy: How can we improve care, teaching,

and awareness?
Najib Kissani a,b,⁎, Yilédoma Thierry Modeste Lengané c, Victor Patterson d, Boulenouar Mesraoua e,f,
Eliashiv Dawn g, Cigdem Ozkara h, Graeme Shears i, Harmiena Riphagen j, Ali A. Asadi-Pooya k, Alicia Bogacz l,
Ismael El Aarrouni m, Pradeep Pankajakshan Nair n
a
Commission of Telemedicine of the University Teaching Hospital Mohammed VI, the University Cadi Ayyad of Marrakesh, Morocco
b
Medical Research Center & Neurology Department, University Teaching Hospital Mohammed VI, Marrakesh, Morocco
c
Department of Neurology, University Teaching Hospital Yalgado Ouédraogo, Ouagadougou, Burkina Faso
d
University College London, UK
e
Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
f
Weill Cornell Medical College, Qatar, Neurology Department, P.O. Box 3050, Doha, Qatar
g
UCLA Seizure Disorder Center, UCLA Department of Neurology, CA, USA
h
Istanbul University, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electrophysiology, Istanbul, Turkey
i
Epilepsy Foundation, Australia
j
Epilepsy Namibia (wo292), Namibia
k
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
l
Institute of Neurology, Epilepsy Surgical Program, Universidad de la República, Montevideo, Uruguay
m
University Teaching Hospital Mohammed VI, Marrakesh, Morocco
n
Department of Neurology, JIPMER, Pondicherry, India

a r t i c l e i n f o a b s t r a c t

Article history: Telemedicine (TM) is the use of telecommunications' technologies to provide medical information and services.
Received 1 September 2019 Telehealth (TH) permits broader and psychosocial support for patients and their families. We aimed to highlight
Revised 8 December 2019 the importance of the use of TH for all aspects of epilepsy, either for the scientific aspects (e.g., research, educa-
Accepted 11 December 2019
tion, care, management, etc.) or for the social matters (e.g., education, sensitization, association support, etc.).
Available online 6 January 2020
There is a deep gap in knowledge and use of TH in the developing and developed countries.
Keywords:
Epilepsy is a condition responsible for 1% of the global burden of disease. More than 50 million people have ep-
Telemedicine ilepsy, and barriers to care include shortage of human resources, medical facilities, and resources. Eighty (80) per-
Epilepsy cent of people with epilepsy (PWE) live in low- and middle-income countries. Telehealth has the potential of
Education addressing limited resources and improving access to PWE across the globe.
Scientific © 2019 Elsevier Inc. All rights reserved.
Social
Care

1. Introduction refers to a broader scope of remote healthcare services than TM. In

1.1. Telemedicine
Telehealth (TH) is the use of a technology-based virtual platform to
deliver various aspects of health information, prevention, monitoring,
and medical care. The fastest growing sector of healthcare, TH's largest
segment, is telemedicine (TM) [1]. Telemedicine is the use of telecom-
munications' technologies to provide medical and psychosocial infor-
mation and services [2]. Telehealth is different from TM in that it
⁎ Corresponding author at: Neurology Department, Razi Hospital, University Teaching
Hospital Mohammed VI, Marrakesh 40080, Morocco.
E-mail address: najibkis@gmail.com (N. Kissani).
USA, TM refers specifically to remote clinical services, while TH can
refer to remote nonclinical services.
As such, TM and TH encompass the whole range of medical activities
including diagnosis, treatment and prevention of disease, continuing
education of healthcare providers, teachers, support workers, and con-
sumers, and research and evaluation [3].
Telehealth episodes may be classified on the basis of the following:
✓ The interaction between the groups and either prerecorded (also
called store-and-forward or asynchronous) or real-time (also called
synchronous) and
✓ The type of information being transmitted, including data and text,
audio, still images, and video pictures.

https://doi.org/10.1016/j.yebeh.2019.106854
1525-5050/© 2019 Elsevier Inc. All rights reserved.
2 N. Kissani et al. / Epilepsy & Behavior 103 (2020) 106854
1.2. Telemedicine in epilepsy
Epilepsy is a disease of the brain defined by any of the following con-
ditions: (1) at least two unprovoked (or reflex) seizures occurring N24 h
apart, (2) one unprovoked (or reflex) seizure and a probability of fur-
ther seizures similar to the general recurrence risk (at least 60%) after
two unprovoked seizures, occurring over the next 10 years, and (3) di-
agnosis of an epilepsy syndrome [4].
Epilepsy is one of the most common neurological disorders with its
unique set of challenges. This already difficult situation can be exacer-
bated by many factors including poverty, lack of seizure control, trans-
portation issues due to long distances, and the stigma that still
surrounds epilepsy [5].
Telehealth has the potential to be utilized in patient management,
education of people with epilepsy (PWE) on epilepsy, and psychosocial
support groups and reduced through education stigmatization. It offers
the opportunity to mitigate the barriers caused by geography or lack of
mobility or resources, provided that an internet access exists. Unfortu-
nately, TH is underutilized.
2. Objectives
The objectives of this study were as follows:
✓ To emphasize the importance of the use of TM and TH in the epilepsy
field, the first one in scientific and the second in social aspects;
✓ To identify the gaps in the knowledge and the use of TH in epilepsy;
✓ To optimize the use of TH in the epilepsy field for developing coun-
tries; and
✓ To try to simplify the TM and TH procedures for all kind of users (ex-
perts in epilepsy, neurologists, general practitioners (GPs), PWE,
families).
3. Why to use TM and TH in epilepsy?
In the Mental Health Gap Action Programme (mhGAP) of the World
Health Organization (WHO), epilepsy is a priority [6]. Also, in the overall
policy and strategy for the attainment of health for all in the 21st cen-
tury, WHO recommends to integrate the appropriate use of health
telematics [7,8].
To overcome the shortage of human resources and medical facilities,
the long distances either in developed countries (e.g., Canada, Australia)
or developing countries, and the development of information technolo-
gies, TH offers an opportunity for caregivers, patients, and their families
to improve and disseminate knowledge and awareness about epilepsy.
Telehealth has the capacity to improve the quality of epilepsy man-
agement and increase patient and caregiver satisfaction. This is espe-
cially important for people who are far from medical facilities. People
with epilepsy even in developed countries due to their limitations of
driving privileges may be unable to come to their appointments or par-
ticipate in support groups' activities.
We emphasize that TM and TH address access to care, not only for
developing countries, but also for developed countries in remote areas
where health professionals and facilities are not readily available.
In addition to the improvement in care, TM can provide an econom-
ically viable response to many challenges [9,10].
4. Who can benefit from TM and TH in epilepsy?
Beneficiaries of TM include medical experts, neurologists of 1st, 2nd,
and 3rd levels of health systems, GPs, and also paramedical staff (nurses,
electroencephalogram [EEG] technicians). For TH, the most concerned
are patients, their families, and associations.
4.1. Professionals
Neurologists and other caregivers of first, second, and third level
health centers can be connected through TM. The experienced neu-
rologists or epileptologists of tertiary level centers can be contacted
through TM in case of diagnostic difficulties at the lower levels of
health centers.
Through TM, a network of communication can be set up between
physicians at three levels with experts within and outside countries. It
can consist of experts, epileptologists, general neurologists, neuroradi-
ologists, neurosurgeons, psychiatrists, neurogeneticists, GPs, psycholo-
gists, EEG technicians, and nurses involved in PWE care.
4.2. Persons with epilepsy and their families
People with epilepsy often experience transport barriers because of
withholding of driving privileges, low socioeconomic status, or fear of
having seizures in public.
Telemedicine and TH technologies offer the ability to receive equita-
ble access to medical, psychosocial, and educational services via
technology.
4.3. Psychosocial support
Associations of PWE both inside and outside the International Bu-
reau for Epilepsy (IBE) are benefiting from TH [11]. Telemedicine and
TH enable educational and training programs to be delivered to both in-
dividuals and their families and to staff in education, disability, work-
place, and care sectors. This education supports PWE and those
around them to understand an individual's condition and how best to
support them to reach their potential in life irrespective of where they
live, provided that they have internet access.
Many activities can be simultaneously carried on via audio or video
teleconferences. In addition, associations' websites, blogs or Facebook,
or any social media tool could help to increase the understanding of ep-
ilepsy in communities.
5. Scope of TM and TH sessions in epilepsy
Patient and caregiver education/support: Activities can be catered to the
specific needs of the target population (tele-education, tele-meeting,
tele-sensitization, etc.).
TM includes different varieties of activities such: tele-education,
tele-meeting, tele-sensitization, telediagnosis, tele-emergency,
tele-treatment, tele-follow-up of any adverse effects, tele-education,
tele-transmission (congresses and other meetings), teleconference,
tele-advice, tele-research, tele-teaching, tele-emergency (as for sta-
tus epilepticus), and finally telecast (sharing any conference or
meeting about any topic in epilepsy).
5.1. Between professionals
In developing countries or even in some underserved areas in devel-
oped countries (USA, Canada, and Australia), there are few or no neurol-
ogists, and their distribution is unequal. Telemedicine in epilepsy
facilitates rapid communication and exchange of information for educa-
tional purposes like lecturing on specific topics in epileptology, interac-
tive case discussions.
✓ It is feasible and cost-effective to give an informative lecture via TM
facilities as it gives opportunity to interact. The audience (neurolo-
gists, GPs, nurses, EEG technicians) may ask questions or make re-
marks by Short Message Service (SMS), email, etc.
✓ The same video-recorded lecture may be left on website to be
reached anytime by the professionals.
 N. Kissani et al. / Epilepsy & Behavior 103 (2020) 106854
In many states of the USA (around the state of New Mexico), project
ECHO® (Extension for Community Healthcare Outcomes) links expert
interdisciplinary specialists with primary care providers through
teleECHO™ clinics. It is a lifelong learning and guided practice model
that revolutionizes medical education and exponentially increases
workforce capacity to provide best practice specialty care and reduce
health disparities. It has been used by the American Academy of Pediat-
rics to support multiple epilepsy ECHOs like the following:
- quality improvement approach for healthcare professionals to learn
and improve access to quality healthcare for children and youth with
epilepsy [12] and
- managing students with seizures by bringing together healthcare
providers (school nurses) and subject matter experts using didactic
and case-based presentations, fostering an “All TEACH, ALL LEARN”
approach [13].
This project, ECHO, has been used in 38 countries, including resource
poor countries [14].
Telemedicine has the potential to increase audience size as to bridge
the gap in term of epilepsy education and training, especially in devel-
oping countries with limited resources (Africa, Latin America, and
South East Asia) that could benefit from e-learning [15].
The decision-making in drug-resistant epilepsy (DRE) that approxi-
mately concerns a third of PWE involves analysis of various clinical, ra-
diological, and EEG data by experts during patient consensus decision-
making meetings. These meetings could be planned in real-time, as
per tele-meeting, or it could be shared in different times by all con-
cerned specialists, as in dedicated forums or simply through email.
This will help in effective utilization of available meager resources par-
ticularly in developing countries. In addition, trainees in these centers
get chance to talk to the experts and further their understanding of
the decision-making process.
Radiology in epilepsy is a relatively specialized area, and second or
third opinion may be required to pick up lesions such as focal cortical
dysplasia, which can be obtained in real-time if we network different
centers through TM.
Using mobile phones, any physician can pick up an image and send it
to a colleague or an expert by email, or easily by Viber or Whatsapp, and
can have an opinion in few minutes and facilitate the decision taking for
a patient in another part of the country or the world.
For the research in epilepsy field, TM will help on the following
topics like those identified by the Epilepsy Foundation in Australia:
✓ Evaluation of innovative teaching strategies;
✓ Assessment of the format and frequency of educational and training
opportunities existing within epilepsy centers;
✓ Identification of knowledge gaps across health professions that re-
late to areas such as seizure recognition and classification, new treat-
ment options, sudden unexpected death in epilepsy (SUDEP), and
appropriate treatment modalities for specific subpopulations;
✓ Development and testing of educational interventions and incen-
tives; and
✓ Assessment of current attitudes and beliefs of health professionals
about epilepsy and the impact of these beliefs and attitudes on
stigma and on access to and quality of care [15].
In term of physician–nurse communication and exchange of infor-
mation, there is one use of TM to support nonphysicians to deal with ep-
ilepsy which involves escalating TM as follows: first, the nurse may deal
with the patient on his/her own; second, she/he may deal with him after
a phone call to a neurologist; and finally, the neurologist may need a
video call to the patient and the nurse together. This saves a lot of
physician's time [16].
3
5.2. Between professionals and PWE
Telemedicine in epilepsy will help professionals to provide informa-
tion related to various aspects of epilepsy either live or as prerecorded
sessions to people at different places at same time.
Telemedicine also provides the opportunity for patients to commu-
nicate with specialists, and this will help to reduce the problem of acces-
sibility to medical facilities for many PWE (for those with disability,
sequelae or handicap, lack of resources for travel costs). They can ex-
change information related to the evolution of the disease, drugs and
their side effects, or any other useful information (particular state as
pregnancy for example), or send files of EEG, magnetic resonance imag-
ing (MRI) images, videos of seizures, etc.
Telehealth could also be used to assist associations in starting their
activities, in preparing the legal documents for registration, and in any
assistance needed by patients and their families and associations'
members.
5.3. Between PWE
People with epilepsy already use blog, group Facebook, and many
other social media links to exchange data about their disease, treatment,
and all daily living problems.
Many patients use some free system of exchanging data, like audio,
images, and videos, using either WhatsApp or Viber, that helps some pa-
tients with complicated situations to overcome their affections.
We should highlight the possibility of connecting illiterate patients
between themselves, or with their physicians, using mobile phone
apps via audio recording. This is a good opportunity for patients to get
answers to any of their questions in rural areas.
5.4. Between associations
Telehealth can be used to exchange about activities and for social
events' preparation. It also improves the building of an educational pro-
gram for patient, parents, and general public.
In Australia, the research of the Epilepsy Foundation which has com-
bined a comprehensive review of published studies from the literature,
consultations of experts, and surveys identified some priorities in epi-
lepsy. Telemedicine can be used as a powerful tool for some of them:
- Improving public knowledge, awareness, and attitudes towards ep-
ilepsy (discrimination, disclosure);
- Improving patient and family education, information, expectations,
and communication (information needs);
- Employment (vocational rehabilitation programs) and access to ed-
ucation; and
- Quality of life issues (culture, resilience), mobility issues (inability to
drive), and sport (social participation).
The Epilepsy Foundation pointed out the need to break down the di-
vision between the community service organizations and the epilepsy
research community by building partnerships and working together
as a whole unit to improve information and education [15].
6. What system to use for video teleconferencing?
Video teleconferencing (VTC) is a technology that facilitates the
communication and interaction of two or more users through a combi-
nation of high-quality audio and video over Internet Protocol (IP)
networks.
We can choose a large range of solutions available.
The 2 major ones are as follows:
The first one is the use of phone network, and the 2nd one is the sat-
ellite transmission.
4 N. Kissani et al. / Epilepsy & Behavior 103 (2020) 106854
6.1. Internet solutions
The use of phone network (asymmetric digital subscriber line [ADSL]
connection) is a digital communication technique that uses phone net-
work to transmit data and connect to the Internet.
Within this category, we have the following different systems:
Webex (CISCO), Zoom, Skype, Live class, “go-to-meeting”, “high-five”
and “go-to-webinar”…, etc.
These software offers flexible audio and video conferencing solu-
tions available in various plans. Each plan offers a specific capacity of
work space and meeting space. They can host webinars, teach online
courses, and conduct online training, video demonstrations, virtual
meetings, and video conference via internet.
The basic forms are often offered as a free service for three groups.
For more, the monthly cost varies from 5.00$ (8 groups) to 49$ (200
groups) [17–19].
6.2. Satellite connection
This system of connection uses satellite transmission to connect to
the latter. It is used in isolated locations where coverage of other types
of networks is nonexistent. Please note that both means of communica-
tion allow connection to the internet. Only the process differs.
In this perspective, TM intervenes to provide support to doctors and
citizens for remote diagnosis and treatment through the satellite
connection.
The satellite connection advantages are as follows:
• Low cost,
• Fair connection speed,
• Almost total geographic availability,
• Secured, and
• Easy implementation.
6.3. Backbone of digital service provided to the end user (T-1 system)
This is the backbone of digital service provided to the end user (typ-
ically business) in USA today which transmits voice and data digitally at
1.554 megabits per second (Mbps), connecting centers and hospitals for
short distances (around 30 km), widely used also in India. It can be used
to carry analog and digital voice, data, and video signal [20].
7. Practical aspects of TM sessions
To start TM, there is a need to get the following:
• Video materials which need good connection (bandwidth of more
than 100 kbits/s) and sophisticated equipment
• And nonvideo materials which need less equipment but with limited
possibilities.
7.1. For the nonvideo materials
Telemedicine is possible when good connection is not available by
the use of mails, SMS and voice calls, emails, and other text applications.
Some authors already proposed in 1993 some solutions for patients
living in remote areas or in situations making it difficult to have regular
meetings with the neurologist like “consultation epistulae” or “consul-
tation telephonis”. This would consist in the follow-up of patients
with epilepsy through exchange of letters or a conversation by tele-
phone [21].
For telephone review, some following tips have been proposed and
entitled “tips for effective telephone consultations”:
• Setting up: telephone consultation is qualitatively identical to a face-
to-face consultation; the clinician should be seated at the clinic
desk; the patient's notes are on hand; the computer is on, with access
to relevant results and scans, etc., …; and the phone is on loudspeaker
to maintain hands free and so other people in the room can hear; and
• Preparatory contact: Patients receive a courtesy call beforehand, e.g.,
from a secretary, to be reassured that the consultation will happen
(even if late). This also reassures the clinician that the patient's correct
and preferred phone number is to hand.
✓ The opening statement: After introducing other people in the room
(students, etc.), the carer could ask and record in the notes who else
is listening in at the patient's end;
✓ The consultation itself: the style of consultation differs to that when
a face-to-face, for example, prolonged silences need some filling (‘uh
huh’, ‘yes’);
✓ Patients worry if the call is late, so clinicians can phone early;
✓ Take each patient in turn: patients for telephone consultation must
have equal priority on the list;
✓ Difficult to provide written information (patients who need pre-
scription changes require urgent letters (or email) to their GPs);
✓ Ending the call (patients can misinterpret the mindset of a clinician
who ends a consultation too abruptly; it seems better for the patient
to hang up first. Some clinicians advise patients to hang up when
they are ready; however, it seems sufficient just to wait a few
extra seconds at the end before ending the call); and
✓ Not picking up: sometimes, if a patient's failing to answer a planned
phone call, it equates to ‘Did Not Attend’ [22].
The use of smartphones can help for a better communication and ex-
change of information between patients, their families, and carers.
Many phone applications exist, and the most used ones are Viber,
WhatsApp, Twitter, and Facebook.
We can use exchanges via forums of websites.
7.2. For VTC sessions
a. To agree for TM session,
A TM session may involve patients and/or caregivers. The TM coordi-
nator of the proposing group or person makes the request of a sched-
uled session to all parties involved.
b. To ask the party who will host the session,
This is usually the TM coordinator of the organization if it is inside an
entity. But in the case of many groups session, all the parties will chose
the host following their own criteria.
c. To send invitations,
Some software proposes options for the invitations, but it is often
done through emails from the TM coordinator of the host site. Many ap-
plications, like Zoom, Webex, …, etc., could offer more than 2 invita-
tions, allowing more groups to be connected in same time.
d. To be on time,
All the parties must be connected before the beginning of the session
as it is required in real life.
e. To check in advance all needed tools (computer, camera, audio, and
internet connection),
f. To make a test in advance to avoid any unexpected technical prob-
lems,
 N. Kissani et al. / Epilepsy & Behavior 103 (2020) 106854
g. To respect time (starting and closing of the session), and
h. To pay attention to all ethical aspects if the session is with patients.
A TM session involving patients and/or personal health information
may be recorded with some following conditions: the request, accep-
tance by written consent between the healthcare and the patient; the
integration of the recording to the patient's health record at the site;
and the secure storage of recordings/photos if they were not generated
to provide for and/or support patient care.
We can also exchange EEGs, photos, videos, and side effects by
smartphone applications.
Research Ethics Committees/Boards require specific consent forms
that are drawn up/approved and completed where research involving
patients (human subjects) is being undertaken. Always consult and ad-
here to your organizations' policy and procedure with respect to any re-
cordings involving patients and/or personal health information [20].
TM's Legislation is already available in some countries as USA, Aus-
tralia, or Switzerland), for Morocco a new law (article 101 of law 131-
13 approved in its final version by the Moroccan government in May
2018) [23].
8. Special situations
Blind people as well as illiterate people may benefit only from audio
sessions.
In many developing countries, like in Morocco and many sub-Saha-
ran African countries, patients who had never been in school could be
taught how to click on an audio recording. Via WhatsApp, or Viber, or
any other similar phone communication applications, the patient
sends an audio message to his physician; the profile's photo could facil-
itate recognizing his correspondent (neurologist, pediatrician, or GP).
The physician has to respond by the same format the patient is receiving
as to address questions.
The same application procedures could be adapted on websites as
tutorials.
9. Cost
Cost and reimbursement issues provide challenges to TM and TH.
Some advocate that TM and TH should be free for patients, while others
propose to expand reimbursement for this model of care. We know that
funding had been an important barrier to TM programs in the USA when
Medicare did not provide reimbursement for most of TM care [24].
Nowadays in the US, Medicare reimbursement for TH has been updated
and covers more services (e.g., neurobehavioral status exam, depression
screening) [25].
Despite expansion of Medicare reimbursement for TH, it is unclear
whether and to what extent US physicians are using this capacity to
treat PWE (e.g., advance care planning, family psychotherapy,
prolonged service in the office—all reimbursable for Medicare patients
—or something to this effect.). So, the system is improving each year
with more services offered and clear conditions given for its use.
The use of TM in epilepsy must be cost-effective if we expect sustain-
able programs [2]. Ideally, the national healthcare system should find
ways of compensation for the healthcare professionals delivering the
TM to the patients.
In Switzerland TM activities, citizens pay health insurance compa-
nies. If citizens are unable to pay, they are subsidized by their canton
which pays this contribution directly to the health insurance companies.
General practitioner and specialist care are covered by insurance, but
cantons provide a substantial share of hospital funding [26].
In some countries like USA and Switzerland, insurance costs includ-
ing TM can be charged by credit card. In France, the system is available
only in some health centers with various payment systems.
5
Other issues, such as limited physician acceptance, social acceptance,
and technical knowledge of public, have to be overcome.
10. Keys to optimize the use of TM and TH in developing countries
In low- and middle-income countries (LMIC) and even in some re-
mote areas of developed countries, it is more difficult to get dedicated
video transmissions to work. Telephone, SMS, email, and apps are
more feasible. In Morocco, we have had good experiences with
WhatsApp and Viber to share information between physicians and pa-
tients to monitor medications and their side effects and address urgent
questions from rural physicians. We still hold the position that these ap-
plications' use does not replace face-to-face consultation.
Some phone apps are developed to help nonspecialist healthcare
provider in LMIC to diagnose generalized epilepsy at first-level care [27].
A tool to enable nondoctors to diagnose episodes of altered con-
sciousness as epileptic or nonepileptic was developed in Nepal. It was
based on an analysis of the sort of questions that comprise routine his-
tory taking in this situation [27]. The tool showed initial promise in a
small population of 14 patients, and its validity had been tested in a
larger series of patients from India and Nepal [28].
Even SMS can be useful. In Namibia, SMS is hugely important. They
have 24/7 helpline, and most contacts are by SMS. Short Message Ser-
vice is cheap, and for those who want to avoid stigma, they answer
name withheld SMS.
Anecdotally, Namibia reports that they had a lingering problem con-
vincing PWE to use a seizure diary to make communication with medi-
cal personnel effective. Complaints were that printed diaries were
expensive, a problem of illiteracy, and old-fashioned to write. In desper-
ation to find a solution, they tried the EpiDiary App. Although they did
this on an experimental basis, they found that more people were willing
to enter data on their phones rather than on paper. The illiteracy argu-
ments disappeared, and using the App instead of a paper diary was doc-
umented as “it is cool”.
Websites of the IBE, its chapters, and active associations permit ex-
changes between patient, associations, IBE, and chapters.
11. Collaboration
For all the aspects of collaboration to fight against the social conse-
quences of epilepsy, TM will be a great support.
11.1. Scientific
Staffs, meetings, and tele-transmission of epilepsy conferences will
gather many professions as to make them be more aware of advances
in epilepsy.
Teaching course via TM, research, and expertise mentors for young
and less experimented health professionals.
11.2. Social
A huge field of education of PWE is available through websites, reg-
ular sessions of TM with association for assistance and counseling.
For the creation of new chapters and associations, IBE can use TH for
assisting and advising the initiators.
12. Conclusion
Telemedicine and TH provide the best opportunity to mitigate the
barriers caused by geography or lack of mobility or resources in deliver-
ing the required care to patients with epilepsy. With TM and TH, care,
education, and support can be provided to any group, no matter
where they live, provided that they have internet access or at least mo-
bile phone or late on access to internet. To successfully establish a TM or
TH program, the minimum requirements with regard to the
6 N. Kissani et al. / Epilepsy & Behavior 103 (2020) 106854
technologies should be wiliness, availability, and minimum of expertise
in the field of epilepsy. On the other hand, it needs a well-designed
agenda and plan, and there should be a plan to compensate for the
time of providers to have a sustainable program.
Declaration of competing interest
None.
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