14 - Ganapathy

2/12/2021 Telemedicine and Neurological Practice in the COVID-19 Era :<b>Krishnan Ganapathy</b>, Neurololy India
Home
REVIEW ARTICLE
Year : 2020 | Volume : 68 | Issue : 3 | Page : 555--559
Telemedicine and Neurological Practice in the COVID-19 Era

Krishnan Ganapathy
Department of Telemedicine, Apollo Telemedicine Networking Foundation, Chennai, Tamil Nadu, India
Correspondence Address:
Dr. Krishnan Ganapathy
Apollo Telemedicine Networking Foundation, C/O, Apollo Main Hospital, No. 21, Greams Lane, Off Greams Road, Chennai - 600 006, Tamil Nadu
India
Abstract
Background: The COVID-19 pandemic has within months turned the world upside down. With personal distancing
and shortage of personal protective equipment, face-to-face health care encounters are increasingly becoming
problematic. Neurological manifestations are also being observed in clinical presentations. Objective: Worldwide
most countries, the World Health Organization (WHO) and Centre for Disease Control (USA) have recommended use
of Telemedicine during the current pandemic.With acute shortage of neurologists and neurosurgeons and their
lopsided distribution, it becomes more difficult to provide neurological care to those who need it the most, particularly
with travel restrictions. The author has since 2002 been advocating use of Telemedicine in Neurosciences. Materials
and Methods: This article reviews the increasing deployment of Telemedicine in neurological practice in the last few
years, particularly the radical exponential use in the last few months due to COVID-19. Conclusions: With possible
reduction in face-to-face consultations, remote evaluation may become mainstream. Webinars will play an increasing
role. CME's and resident training will become more and more digital. The world will never be the same again. It is
imperative that we accept and start deploying the “New Normal”.
How to cite this article:

Ganapathy K. Telemedicine and Neurological Practice in the COVID-19 Era.Neurol India 2020;68:555-559
How to cite this URL:

Ganapathy K. Telemedicine and Neurological Practice in the COVID-19 Era. Neurol India [serial online] 2020 [cited 2021 Feb 12
];68:555-559
Available from: https://www.neurologyindia.com/text.asp?2020/68/3/555/288994
Full Text
SRS COV 2 is making us look at how neurological services are being delivered now, and how mode of delivery needs
to radically change in the AC (After Corona) era. Telemedicine is an all-encompassing term, which includes the
deployment of customized hardware and software, peripheral medical devices and a wide spectrum of
telecommunication technologies. Using these, history can be taken, patients can be physically examined,
investigations reviewed, and a provisional or final diagnosis made with the consultant and the patient physically
separated. Distance has become meaningless. In fact, geography has become history! Synchronous real time
telephone or video consults or asynchronous store and forward digital services can be used. The latter includes text
messages, WhatsApp communication and email. Remote monitoring of patient data could include visualizing images,
neuro physiological parameters and even surgical mentoring in the operation theatre.[1],[2],[3],[4],[5],[6],[7],[8],
https://www.neurologyindia.com/printarticle.asp?issn=0028-3886;year=2020;volume=68;issue=3;spage=555;epage=559;aulast=Ganapathy 1/7
[9],[10]
The COVID-19 outbreak has necessitated an immediate digital revolution. As recently as 2019 in a Price Waterhouse
Cooper survey, 38% of chief executive officers of U.S. health care systems conceded that there was no digital
component in their strategy.[11] Telemedicine has existed for decades, but widespread implementation has not been
forthcoming. The rapid use of Telemedicine has been an inadvertent fall out of COVID-19. Within a eight week time
period, many institutions in the USA have adopted telemedicine due to dire necessity and relaxation of prior stringent
regulations. Telehealth Coverage Policies in the time of COVID-19 have been modified. Interim rules have been
issued.
A “telecommunications system” for telehealth services implies multimedia communications equipment. This includes,
audio and video equipment permitting two-way, real-time interactive communication between the patient and distant
site physician. A unique advantage of Telemedicine is that in the COVID-19 situation even quarantined doctors, whose
numbers are steadily increasing worldwide, can continue to provide teleconsultations. Licensure requirements have
been temporarily waived for Medicaid.[12] Resources and telemedicine references have been created by professional
societies like the American Academy of Neurology and American Association for Neuromuscular and Electrodiagnostic
Medicine. Neurologists and neurosurgeons are quickly acquiring new tools and skills required to practice Remote
Health Care. New clinical algorithms and robust telemedicine platforms and procedures will have to be developed for
continued patient care.[13]
The use of remote services has escalated from a slow rollout to a “need it now” priority. In the USA, the Centers for
Medicare & Medicaid Services [CMS], state Medicaid, and state health agencies have now ensured that doctors are
reimbursed for non–face-to-face services. In India, insurance companies are being requested to do likewise. The
American Academy of Neurology also has a Telemedicine and Remote Care resources page (aan.com/telehealth) and
a general resource center for all information related to COVID-19 (aan.com/COVID19.[14] In the USA, a centralized
licensing system has already been implemented.[15] The recently notified Telemedicine Practice Guidelines of the
Ministry of Health Govt. of India is causing an exponential increase in the use of Telemedicine in India.[16] The
author has personally given many webinars demystifying the Telemedicine Practice Guidelines. One of them was
attended by 12,842 physicians and cardiologists.[17] A webinar was also given to the members of the Neurological
Society of India.[18] During the last few weeks, the number of webinars in neurosciences originating from India itself
has been increasing.
Many small medical practices and community hospitals need to quickly establish telehealth services to obtain neuro
consults. Rising to the challenge, the American Telemedicine Association (ATA) is offering pro bono a Quick-Start
Guide to Telehealth. Topics covered include: a) Technology, b) Clinical, c) Financial, d) Communication, e) Metrics
after the COVID-19 Pandemic.[19] Cardinale, while reviewing the current state of telemedicine in neurological
healthcare, highlights evidence-based research and use cases for digital services.[20] It has even been suggested
that in-person visits should become an option! However, no telemedicine program can be created overnight. Existing
telemedicine units can leverage them for response to Covid-19. Telemedicine can provide rapid access to
subspecialists normally not available. Jefferson Health, Cleveland Clinic, and the University of Pittsburgh are examples
of institutions providing virtual emergency neurologic care at other hospitals. The Mount Sinai system uses specialists
at 8 hospitals to provide tele emergency consultations to 300 sites. Difficulties in implementing these programs are
largely related to credentialing, staffing of specialists and payment. Attention to regulations, licensing, credentialing
across hospitals, and program implementation take time.[21] The author in 2016 reported on the operational
challenges of setting up a multi-speciality telemedicine network in the Himalayas at a height of 14,000 feet in
temperatures of -25C.[22] In the last 5 years, 143 teleconsultations in Neurology and Neurosurgery have been given
in these mountainous areas, including emergencies.[23]
Teleneurology is a powerful and innovative way to provide neurology in deprived areas. Challenges in deploying
teleneurology include cost, insufficient expertise to implement necessary technology, compliance and adherence with
regulatory issues and fear of litigations.[24] Tele neurology has demonstrated high patient satisfaction and even cost
savings. Virtual neurological expertise can now be made available to rural areas reducing travel costs.[25] In the USA
billing is based on face-to-face video or phone interaction time with the patient.
Training for Teleneurology
Govindarajan et al. stress that comprehensive training in clinical bedside neurology is necessary to safely practice
teleneurology. The American Academy of Neurology Telemedicine Work Group has developed a model curriculum
including evaluation tools.[26] Neurology residents normally receive little to no formal training in telemedicine.
Afshari et al. showed that a formal didactic and clinic-based teleneurology curriculum was useful. Statistically
significant improvement in knowledge and perspectives, about the promise and limitations of teleneurology practice
was demonstrated.[27] Telemedicine requires close interaction between doctor and patient, body language
communication strategies, appropriate documentation and time management. Some consultants may be more
comfortable with direct physical interaction.[28] Laws, regulations, payment policies and workflow are needed to
establish a telemedicine unit. Staff needs to support scheduling. IT needs to integrate electronic medical records with
telehealth applications Doctors and patients need to connect with each another seamlessly using the telehealth
platform. Billing, prior authorizations, managerial supervision and e prescribing modalities need to be addressed.
Student and resident education needs to be reconfigured. Stakeholders in the eco system particularly doctors,
administrators, hospitals, and networks need to benefit by developing economically viable telehealth models.
Illustrations of specialised teleneurology units
Telemedicine use is expanding across a wide variety of neurologic disorders.[29]Tele stroke: Maximum work and
publications is in the area of tele stroke.[30],[31],[32],[33] Legal and regulatory barriers impeding Telestroke
adoption or delivery are being identified. It has been established that Telestroke is providing an effective solution for
small and under resourced hospitals. With the onset of COVID-19, telestroke services are being further expanded to
reduce or avoid physical visits. Lack of stroke specialists, has resulted in many European rural areas remaining
underserved. There is increasing use of evidence-based therapy enabling coverage of large areas of low population
density. Telemedicine in stroke care has shown to be safe. Quality improvement is being ensured by standardising
stroke treatment throughout a telestroke network. Intensive training and obtaining feedback and follow up is critical.
Outcomes after intravenous tissue plasminogen activator treatment via telemedicine are similar to those achieved
with in-person evaluations. Amyotrophic Lateral Sclerosis (ALS). Remote multidisciplinary care of ALS patients has
been reported as feasible and acceptable to patients and doctors. A trained telemedicine nurse makes a house visit
and performs and records a multidisciplinary assessment of the patient. Consultants review assessments and advise
through videoconferencing.[34]Movement Disorders – Remote clinical evaluation has been shown to be feasible in
hyperkinetic movement disorders. Cognitive testing, genetic counselling and other counselling-based therapeutic
interventions have also been used.[35]Polyneuropathy Tele-polyneuropathy clinics are operational. In this pilot,
Wilson et al. demonstrated that guideline concordant poly neuropathy care can be remotely provided with high levels
of satisfaction.[36]Tele rehabilitation using virtual reality has been used to reduce healthcare costs and encourage
continuity of care. Effectiveness of tele rehabilitation for the treatment of cognitive disorders following stroke have
been documented.[37]Head Injuries. The author has personally given teleconsultations for more than 2000 patients
in the last 20 years. More than 90% were follow-up or post-operative. Telemedicine has been successfully deployed in
the initial management of acute minor head trauma. Patients with head injury have been managed in non-
neurosurgical centres in Johor state using tele consults from neurosurgeons.[38]General Neurology - From India,
Gowda et al. demonstrated successful implementation of outpatient-based collaborative teleneurology consultation in
Karnataka in 189 patients, having various clinical conditions. The Tele-Medicine Centre at National Institute of Mental
Health and Neuro Sciences (NIMHANS), Bangalore has started providing teleneurology services from 2010 to all
district hospitals of Karnataka in collaboration with Department of Health and Family Welfare, Government of
Karnataka through Karnataka State Wide Area Network (KSWAN).[39]eNeuro Intensive Care: Electronic Intensive
Care Unit (e-ICU) monitoring programs, which allow nurses and physicians to remotely monitor the status of 60 to
100 patients in ICUs in multiple hospitals also involve neuro intensivists. eICU services for neurological patients have
been available in India from 2016 onwards. From Aug 2018 to Feb 2020, the Apollo eACCESS TeleICU has done 53
inpatient acute neurology and neurosurgery consultations out of a total 409 teleconsultations for acute issues in
patients in various ICU's distributed all over India. From 2016-2019 of the 3070 ICU patients seen 10.9% had a
diagnosis of stroke.[40]
Teleneurology services during COVID-19 lockdown
Patients with neurological diseases and those immunocompromised are at higher risk of complications when infected
by the Corona virus. To reduce risks due to physical contact, Telemedicine is particularly relevant. Many electronic
medical record systems have virtual encounter functions. They have traditionally been underutilized. The Medical
University of South Carolina employs virtual rounding. Medical record pre-rounding is completed remotely by all team
members. A rich medical education experience for trainees is maintained through virtual “table rounds” and academic
discussions using teleconferencing platforms. Only one team member will be “in-house” to move the workstation on
wheels and to perform neurological exams.[41]
Sun in an editorial from China points out that since the COVID-19 pandemic most pre and postoperative
neurosurgical visits were conducted virtually. According to “Neurosurgery News,” a national continuing education
platform for neurosurgeons, 40 national online outpatient question-and-answer sessions and 39 cloud seminars had
been hosted in just 4 weeks. 5G technology was used in a few. Virtual visits and online seminars attracted more than
280,000 patients and 1000 neurosurgical professionals.[42] Reports from Jordan revealed that patients with chronic
neurologic diseases were able to reach consultants and residents by telephone. Texting and chatting through
WhatsApp was also used. Physical visits to the Emergency Department was only if Telemedicine could not be
deployed. Patients with multiple sclerosis and myasthenia gravis on immunomodulatory medications, those on
warfarin and antiepileptics were advised telephonically. Consultants were available remotely to answer questions from
patients or from in-hospital staff, and to help with reading EEGs. WhatsApp was used to send material for residents to
read. E-learning apps like Zoom and Microsoft Teams were used by consultants to participate in lectures and
meetings. Private pharmacies in Jordan responded to online and phone ordering and a home delivery system,
approved by the government. However, a regular Telemedicine system was not available.[43]
As patients with suspected COVID-19 could present with acute stroke, a telestroke unit was initially established at
Utah USA, to enable remote evaluation. Training and access to technology platforms was provided. The telestroke
unit was subsequently expanded to include virtual evaluation of seizures, multiple sclerosis and other conditions. The
authors point out that institutions with telemedicine capabilities have started virtual “rounding” with no patient
contact. Rounding “styles” will continue to evolve. Solutions will be different for different hospital systems depending
on neurologic disease complexity and levels of COVID-19 prevalence. Remote evaluation could well be the new
normal during the pandemic with additional long-distance support.[44] American Academy of Neurology has
developed guidelines for clinicians and practices for implementing telemedicine services during the Public Health
Emergency. Potential HIPAA penalties are being waived for good faith use of telemedicine. FaceTime and Skype can
now be used though a HIPAA compliant platform is recommended to avoid complications after the emergency has
ended.[45],[46]
Many Multiple Sclerosis centres are utilising telemedicine to avoid non-essential hospital visits during the COVID-19
pandemic. High patient acceptability has been found.[47] Remote monitoring of infection risk, in people with multiple
sclerosis, especially those on immunosuppressant drugs, during COVID-19 pandemic is essential. A digital triage tool,
easily setup using Google Forms, was sent to patients to quickly identify people with high risk of COVID-19 infection.
Reducing physical visits to MS centres reduced risk of infection spreading.[48] A low-cost, in-home, telemedicine-
enabled assessment of disability in multiple sclerosis specially designed for the lockdown period has been used. The
American Academy of Neurology has made available a “Telemedicine and Remote Care Implementation Guide”, that
discusses most common forms of non–face-to-face care and coding elements necessary to provide these services.
[49] 30 patients with amyotrophic lateral sclerosis were called for a teleconsult in Italy, when the COVID-19 infection
was at its peak. For many, the video consult broke the isolation.[50] Kondziolka, in a recent communication, points
out that with the COVID-19 pandemic, most conferences of organized neurosurgical associations and societies
worldwide have been cancelled or postponed. International and national flights have been banned temporarily in most
countries. Self-isolation and social distancing has become the norm. This translates into a reduction in operative
experience and formal in-person resident training.[51]
Conclusion
After doing virtual visits for several weeks, a neurologist is said to have remarked, “Isn't this the way it always ought
to be?” This comment eloquently summarizes the possible future direction of neurological practice. The AC (After
Corona) era will never be the same again. The impact of telemedicine is unlikely to recede. Telemedicine capabilities
are likely to be embedded within normal operations, scalable, interoperable and built on a strong, reliable
infrastructure, so that it is useful even after the acute COVID-19 crisis resolves. The global pandemic will have a
lasting effect. As medical and surgical neurological specialists belonging to the cream of the cream of society, it is
imperative that we embrace and adopt cost effective, need based, appropriate technology to extend our now limited
reach. As a senior citizen trained in the BC (Before Computers – not Before Corona) era, I believe that technology is
only an enabler to achieve an end and not an end in itself. It is still possible to deliver TLC (tender, loving care)
virtually and empathize with the patient on a screen (small or big). We need to move with the times. To paraphrase
Charles Darwin, “It is not the strongest of the species that survives, not the most intelligent, but the one most
adaptable to change”. The writing is on the wall.
Acknowledgment
The author is thankful to Ms. Lakshmi for secretarial assistance.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1 Ganapathy K. Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of
telemedicine. Neurol India 2015;63:142-54.
2 Ganapathy K. Role of telemedicine in neurosciences. In: Latifi R, editor. Establishing Telemedicine in Developing
Countries: From Inception to Implementation. Studies in Health Technology and Informatics. Vol 104. IOS
Press; 2000. p. 116-24.
3 Ganapathy K. Telemedicine and neurosciences in developing countries: Surg Neurol 2002;58:388-94.
4 Ganapathy K. Role of Telemedicine in Neurosciences. In: Sharma BS, Mishra UK, editors. Progress in Clinical
Neurosciences. 17th ed. New Delhi Neurological Society of India; 2002. P. 1-10.
5 Ganapathy K. Telemedicine in the management of head trauma: An overview. Indian J Neurotraumatol
2004;1:1-7.
6 Ganapathy K. Telemedicine and neurosciences. J Clin Neurosci 2005;12:851-62.
7 Ganapathy K. Telemedicine in neurology. Neurol India 2005;53:242.
8 Ganapathy K, Aditi R. Telemedicine in neurosciences. In: Rifat L, editor. Current Principles and Practices of
Telemedicine. IOS Press; 2008. p. 149e-69.
9 Ganapathy K. Telemedicine and Neurosciences. Neurol India 2018;66:642-51.
10 Ganapathy K. Deployment of telemedicine in neurosciences: The good and the evil-A balanced approach. Neurol
India 2018;66:1852-3.
11 Keesara S, Jonas A, Schulman K. Covid-19 and health care's digital revolution. N Engl J Med. 2020;382:e82.
12 Center for Connected Health Policy. Telehealth Coverage Policies in the Time of COVID-19. Available from:
https://www.cchpca.org/resources/covid-19-telehealth-coverage-policies. [Last cited on 2020 Apr 06].
13 Guidon AC, Amato AA. COVID-19 and neuromuscular disorders. Neurology 2020;94:959-69.
14 Cohen, BH, Busis, NA, Ciccarelli, L. Coding in the world of COVID-19: Non–face-to-face evaluation and
management care. Continuum 2020;26:1-25.
15 Nath A. Neurologic complications of coronavirus infections. Neurology 2020;94:1-2.
16 Telemedicine Practice Guidelines. The Ministry of Health and Family Welfare, Govt of India. Available from:
https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last cited on 2020 Mar 25].
17 Ganapathy K. Webinar on Demystifying Telemedicine Guidelines and Role of Telehealth in the Management of
COVID-19 with Special Reference to Physicians organised in conjunction with Telemedicine Society of India.
Available from: https://www.youtube.com/watch?v=zy60nNZg-1I&feature=youtu.be. [Last cited on 2020 Apr 26].
18 Ganapathy K. Webinar on Demystifying Telemedicine Guidelines and Role of Telehealth in the Management of
COVID-19 with Special Reference to Neurosurgeons under the auspices of the Neurological Society of India and
Telemedicine Society of India. Available from: https://www.youtube.com/watch?v=yqiTqwuUbzo. [Last cited on 2020
Apr 25].
19 COVID-19 (Coronavirus) News, Information & Resources. American Telemedicine Association. Available from:
https://info.americantelemed.org/covid-19-resources-quickstart-guide-landing. [Last cited on 2020 Mar 24].
20 Cardinale AM. The opportunity for telehealth to support neurological healthcare. Telemed J E Health 2018. doi:
10.1089/tmj.2017.0290.
21 Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med 2020;382:1679-81.
22 Ganapathy K, Chawdhry V, Premanand S, Sarma A, Chandralekha J, Kumar KY, et al. Telemedicine in the
Himalayas: Operational challenges-a preliminary report. Telemed J E Health 2016;22:821-35.
23 Ganapathy K, Alagappan D, Rajakumar H, Dhanapal B, Subbu RG, Nukala L, et al. Tele-emergency services in
the Himalayas. Telemed J E Health 2019;25:380-90.
24 Patel UK, Malik P, DeMasi M, Lunagariya A, Jani VB. Multidisciplinary approach and outcomes of tele-neurology:
A review. Cureus 2019;11:4410.
25 Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015;72:349-54.
26 Govindarajan R, Anderson ER, Hesselbrock RR, Madhavan R, Moo LR, Mowzoon N, et al. Developing an outline
for teleneurology curriculum. Neurology 2017;89:951-9.
27 Afshari M, Witek NP, Galifianakis NB. Education research: An experiential outpatient teleneurology curriculum
for residents. Neurology 2019;93:170-5.
28 Brad Klein C, Neil Busis A. COVID-19 is catalyzing the adoption of teleneurology. Neurology 2020;94:903-4.
29 Hatcher-Martin JM, Adams JL, Anderson ER, Bove R, Burrus TM, Chehrenama M, et al. Telemedicine in
neurology: Telemedicine work group of the american academy of neurology update. Neurology 2020;94:30-8.
30 Schwamm LH, Chumbler N, Brown E, Fonarow GC, Berube D, Nystrom K, et al. Recommendations for the
implementation of telehealth in cardiovascular and stroke care: A policy statement from the American heart
association. Circulation 2017;135:2444.
31 What Neurologists Can Expect from COVID-19. Medscape. Available from:
https://www.medscape.com/viewarticle/927562. [Last cited on 2020 Mar 26].
32 Hubert GJ, Santo G, Vanhooren G, Zvan B, Tur Campos S, Alasheev A, et al. Recommendations on telestroke in
Europe. Eur Stroke J 2019;4:101-9.
33 Gabriel KMA, Jírů-Hillmann S, Kraft P, Selig U, Rücker V, Mühler J, et al. Two years' experience of implementing
a comprehensive telemedical stroke network comprising in mainly rural region: The Trans regional Network for
Stroke Intervention with Telemedicine (TRANSIT-Stroke). BMC Neurol 2020;20:104.
34 Paganoni S, Simmons Z. Telemedicine to innovate amyotrophic lateral sclerosis multidisciplinary care: The time
has come. Muscle Nerve 2018;59:3-5.
35 Srinivasan R, Ben-Pazi H, Dekker M, Cubo E, Bloem B, Moukheiber E, et al. Telemedicine for Hyperkinetic
movement disorders. Tremor Other Hyperkinet Mov (N Y) 2020;10. doi: 10.7916/tohm.v0.698.
36 Wilson AM, Jamal NI, Cheng EM, Inkelas M, Saliba D, Hanssen A, et al. Teleneurology clinics for
polyneuropathy: A pilot study. J Neurol 2020;267:479-90.
37 Torrisi M, Maresca G, De Cola MC, Cannavò A, Sciarrone F, Silvestri G, et al. Using telerehabilitation to improve
cognitive function in post-stroke survivors: Is this the time for the continuity of care? Int J Rehabil Res
2019;42:344-51.
38 Sidek MSM, Siregar JA, Ghani ARI, Idris Z. Teleneurosurgery: Outcome of mild head injury patients managed in
non-neurosurgical centre in the state of Johor. Malays J Med Sci 2018;25:95-104.
39 Gowda GS, Manjunatha N, Kulkarni K, Bagewadi VI, Shyam RPs, Basavaraju V, et al. A collaborative tele-
neurology outpatient consulation service in Karnataka: Seven years of experience from a tele-medicine center.
Neurol India 2020;68:358-63.
40 Haranath SP. Local intensive care enhanced by remote technology; saving lives, money and time. Proceedings
of the 9th International Conference on Transforming Healthcare with Information Technology; 2019 Sep 13-14;
Hyderabad, India. Available from: https://www.transformhealth-it.org/eposters/. [Last accessed on 2020 Mar 10].
41 Kasab SA, Almallouhi E, Holmstedt CA. Optimizing the use of teleneurology during the COVID-19 pandemic.
Telemed J E Health 2020. doi: 10.1089/tmj.2020.0109.
42 Sun Y, Mao Y. Editorial. Response to COVID-19 in Chinese neurosurgery and beyond. J Neurosurg 2020;1-2.
doi: 10.3171/2020.3.JNS20929.
43 Yassin A. Invited commentary: Neurology service during COVID-19 lockdown in Jordan: Challenges and
solutions. Neurology Blogs. Available from: https://blogs.neurology.org/global/invited-commentary-neurology-
service-during-covid-19-lock-down-in-jordan-challenges-and-solutions/.
44 Majersik JJ, Reddy VK. Acute neurology during the COVID-19 pandemic- Supporting the front line. Neurology
2020;10.1212/WNL.0000000000009564. doi: 10.1212/WNL.0000000000009564.
45 AAN Telemedicine and COVID-19 Implementation Guide. American Academy of Neurology. Available from:
https://www.aan.com/telehealth. [Last cited on 2020 Apr 10].
46 Procedure Coding for Telemedicine Visits. American Academy of Neurology. Available from:
https://www.aan.com/siteassets/home-page/tools-and-resources/practicing-neurologist—administrators/telemedicine-and-
remote-care/20-telemedicine-cpt-codes-and-descriptors.pdf. [Last cited on 2020 Mar 10].
47 Brownlee W, Bourdette D, Broadley S, Killestein J, Ciccarelli O. Treating multiple sclerosis and neuromyelitis
optica spectrum disorder during the COVID-19 pandemic. Neurology 2020;94:949-52.
48 Bonavita S, Tedeschi G, Atreja A, Lavorgna L. Digital triage for people with multiple sclerosis in the age of
COVID-19 pandemic infection. Neurol Sci 2020;41:1007-9.
49 Bove R, Bevan C, Crabtree E, Zhao C, Gomez R, Garcha P, et al. Toward a low-cost, in-home, telemedicine-
enabled assessment of disability in multiple sclerosis. Mult Scler 2019;25:1526-534.
50 COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurologic Conditions in Patients
with the Coronavirus. Neurology Today. Available from:
https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.aspx?PostID=920. [Last cited on 2020 Mar 27].
51 Kondziolka D, Couldwell WT, Rutka JT. Introduction. On pandemics: The impact of COVID-19 on the practice of
neurosurgery. J Neurosurg 2020;1-2. doi: 10.3171/2020.3.JNS201007.
Friday, February 12, 2021

Site Map | Home | Contact Us | Feedback | Copyright and Disclaimer

14 - Ganapathy

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

14 - Ganapathy

Uploaded by

Copyright:

Available Formats

2/12/2021 Telemedicine and Neurological Practice in the COVID-19 Era :<b>Krishnan Ganapathy</b>, Neurololy India

Telemedicine and Neurological Practice in the COVID-19 Era

How to cite this article:

How to cite this URL:

Training for Teleneurology

Illustrations of specialised teleneurology units

Teleneurology services during COVID-19 lockdown

The author is thankful to Ms. Lakshmi for secretarial assistance.

Financial support and sponsorship

There are no conflicts of interest.

Friday, February 12, 2021

You might also like