Madaan Priyanka, Sahu Jitendra Kumar, Wanigasinghe Jithangi, Fatema Kanij, Linn Kyaw, Lhamu Mynak Mimi, Garófalo Gómez Nicolás, Samia Pauline, Poudel Prakash, Chand Prem, Riikonen Raili
Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Paediatrics, University of Colombo, Sri Lanka.
Epilepsy Behav Rep. 2021;15:100423. doi: 10.1016/j.ebr.2020.100423. Epub 2020 Dec 31.
With telehealth services rescuing patients with chronic neurological disorders during the COVID-19 pandemic, there is a need for simplified teleneurology protocols for neurological disorders in children. Infantile spasms is an epileptic encephalopathy where treatment lag is a significant predictor of outcome. It is one such condition where telemedicine can make a remarkable difference when in-person consultations are delayed or are not possible. However, the adverse effect profile of the first-line therapeutic options, the need for frequent follow-up, underdeveloped telemedicine services, lack of a rational protocol, poor awareness about infantile spasms, a lesser level of parental understanding, and scarcity of pediatric neurologists are the major hurdles in developing countries. This paper provides a teleneurology based approach for the management of infantile spasms in developing countries during the COVID-19 pandemic. The cornerstones of this approach include the fundamental principles of management of infantile spasms, decentralization of patient care to local health providers, efforts for improving sensitivity and specificity of diagnosis, early initiation of first-line therapeutic options, and constant motivation of parents and local health providers to be vigilant for therapeutic response, adverse effects of therapy, and infections.
在新冠疫情期间远程医疗服务拯救了患有慢性神经疾病的患者，因此需要为儿童神经疾病制定简化的远程神经学方案。婴儿痉挛症是一种癫痫性脑病，治疗延迟是预后的重要预测指标。在面对面咨询延迟或无法进行时，远程医疗在这种疾病中能发挥显著作用。然而，一线治疗方案的不良反应、频繁随访的需求、欠发达的远程医疗服务、缺乏合理的方案、对婴儿痉挛症认识不足、家长理解程度较低以及儿科神经科医生短缺等，都是发展中国家面临的主要障碍。本文提供了一种基于远程神经学的方法，用于在新冠疫情期间管理发展中国家的婴儿痉挛症。该方法的基石包括婴儿痉挛症管理的基本原则、将患者护理分散到当地医疗服务提供者、提高诊断敏感性和特异性的努力、一线治疗方案的早期启动，以及持续激励家长和当地医疗服务提供者对治疗反应、治疗不良反应和感染保持警惕。
