Teleneurology is defined as consultation with a neurological doctor at a distance, making use of technologies such as the internet or phone. Teleneurology covers teleconsultation, teleconferencing and tele-education. This section of telemedicine is being used for conditions such as headache, epilepsy, stroke, multiple sclerosis and dementia. The number of patients using teleneurology has multiplied mainly due to the internet. Teleneurology has taken out the division between time and space and made quality healthcare more cost-effective.

Teleneurology can be classified into 2 types, namely, patient-initiated and clinician-initiated.

History of Telemedicine

Time periodEvent
1970s & 1980sStarting era of telecommunication; relied on broadcast & television technology
Late 1980s & furtherTelecommunication digitized & advancement in computers; limited bandwidth carried both telecommunication & computer processing

Internet era coming of age & putting the digital communication era behind

World Stroke Day is observed on 29th October every year

There are three main problems in adopting teleneurology:

1. Dealing with technology- Limited use of e-mails by doctors in hospitals. Also, videoconferencing might not be cost-effective for some doctors as digital lines are needed for the process. But with the broadband connection, this problem might get solved to some extent.

2. Many neurologists require examining a patient directly before giving their opinion. Teleneurology changes this trend and gives the patients many more advantages than the neurologists.

3. Medico-legal issues- Teleneurologists have to make sure that they also have a license to practice in the same hospital or country where the patient is situated.

The advantages of teleneurology are:

1. It reduces the burden of patients on-call.

2. Stops interruption of office work because of emergency calls.

3. Quick real-time medical consultation in case of emergencies, in remote areas.

Current Applications

For Stroke:

Stroke causes the most number of disabilities, even in a country such as the US. A miniscule percentage of patients who have suffered a stroke receive the tissue plasminogen activator therapy (tPA) which greatly reduces the morbidity. The paucity of neurologists in emergency care makes it hard & unaffordable to provide round-the-clock advice for stroke patients.

Teleneurology offers a timely option for the stroke patients to consult the neurologist and get expert medical advice (even when the specialist is not present in person, with the patient).

For Multiple Sclerosis:

Multiple Sclerosis is a disease of the Central Nervous System that affects the eyes and muscles. Such patients are managed with lifelong medicines and rehabilitation measures. To improve the quality of life of patients, physical exercise is a step in the positive direction. To increase the rate of patients complying with rehabilitation, interactive systems of telemanagement play a huge role.

For Encephalopathy:

It is very important to know the history of a patient, to diagnose one with encephalopathy. The neurological check-up of such a patient is normal- the required set up for optimizing the use of teleneurology.

• Spinal cord injury & epilepsy are also taken care of, in teleneurology.

Military Teleneurology:

The pioneers in military telemedicine were the United States Army Medical Command (AMEDD), enabling teleconsultation to their respective sites from Somalia in 1992. Patient identifying information is not disbursed; hence it is in line with HIPAA and the Privacy Act. The difficulties at present include limitations on the email file size, restrictions by the Department of Defense in uploading images from digital cameras & the unforeseen email problems between different domain accounts. The group of neurology teleconsultation has given answers to more than 390 questions mainly related to traumatic brain injury, neuro-ophthalmology, internal medicine, child neurology, clinical neurophysiology and movement disorders. Amongst the prominent achievements of the program have been the dissemination of the stratified headache protocol to the primary care level and generation of an early management protocol for mild TBI & post-traumatic headache.

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