According to the National MS Society nearly 1 million people are living with Multiple Sclerosis (MS) in the United States. MS is a disease of the central nervous system where the body triggers an immune response that causes inflammation that damages myelin – the fatty substance surrounding and insulating nerve fibers. Demyelination interrupts or stops the normal functioning of the central nervous system resulting in a variety of neurological symptoms such as numbness, tingling, fatigue, memory loss, and even paralysis.
Once a patient is diagnosed, treatment typically includes the administration of DMTs (disease modifying therapies) and monitoring of patient symptoms for disease progression. This involves regular communication and visits with a neurologist much of which can be conducted using telehealth visits.
Neurologists can use sessions to help patients adhere to a specific medication program, conduct neurological exams, review results from blood work or imaging tests, as well as consult with patients on lifestyle situations and changes to help manage their neurological condition.
Using Telehealth to Ensure Medication Adherence
The successful management of Multiple Sclerosis starts with the adherence to DMT treatments. Therapy options include infusions, injections, or oral therapies. In all cases, making sure that medication is taken or administered on a regular cadence is essential to disease management. Disruptions of any kind can cause an increase in symptoms and trigger relapses.
Neurologists can schedule regular telemedicine visits to check on the effectiveness of your patient’s therapy and address any concerns. Use the telehealth appointment to review disease history, current or new symptoms, ask about changes in medical history or medications, as well as discuss how the patient is doing with treatment.
These types of wellness checks have been particularly important during the pandemic where patients are more hesitant to seek treatments due to fear of exposure. Telehealth allows you to maintain the care continuum leading to better patient outcomes.
Using Telehealth for Neurological Testing & Exams
While not appropriate for every type of neurological test or exam, telemedicine can be used for many aspects including:
- General appearance assessment
- Vital signs (if patient has home equipment)
- Mental status
- Speech
- Cranial exam including eyes, face, hearing, tongue, and shoulders
- Motor exam of the arms and legs
- Sensory exam
- Cerebellar exam
- Reflexes
The key is preparing your patient for the visit. Pre-visit instructions should be sent to your patient with all the information they need to prepare for the neurological exam. For example, if you are doing a strength test, make sure your patient has a weight or canned good to assist with the exam. If you are doing a gait test, the patient should have a well-lit area for the exam so you can easily observe. Some elements of the exam may require the camera angle to be adjusted for proper viewing. Make sure your patient has the capability to adjust their camera.
The American Academy of Neurology has published a tips and tricks document for planning quality telehealth visits for patients with MS.
Using Telehealth to Review Test Results
Multiple Sclerosis patients have a variety of tests they need to take on a regular basis. Initial diagnosis requires extensive blood tests that are used to rule out MS “mimics” – conditions that present like MS. Ongoing blood tests, or maintenance tests, are required to monitor blood counts, lymphocytes, liver function, and to check for the presence of JC virus.
In addition to bloodwork, MS patients have regular imaging appointments to check and monitor disease progression. MRIs are routinely conducted to check for new lesions in the brain and spine. Lesions indicate areas where demyelination has occurred, and a scar has formed. DMTs are used to slow the progression of these lesions.
Telemedicine visits to review results can be a tremendous convenience to you and your patients. Instead of having your patient trek to the office, they can connect with you from the convenience of their home. For your practice, it saves the cost of maintaining and turning over an exam room.
Providers can share imaging results through the telehealth platform comparing new and past images. Similarly, they can share the blood work results and review what the numbers mean.
One caveat, if the results are bad or indicate significant disease progression, those discussions may be better served with an in-person visit.
Leverage Telehealth for Mental Health Checks for Multiple Sclerosis Patients
Depression is one of the most common side effects of Multiple Sclerosis. The uncertainty and unpredictability of the disease can lead to increased anxiety, distress, anger, and frustration for your patients. Additionally, the disease itself might cause depression by disrupting nerves that affect mood. Some DMTs are also known to cause depression as a side effect of the therapy. This makes regular depression screening a critical part of patient treatment.
Mental health screenings are one of the most popular diagnosis codes for telehealth use in 2020. Telehealth is an excellent mechanism for conducting regular assessments as much of the assessment involves listening and observing your patient with Multiple Sclerosis.
The Patient Health Questionnaire (PHQ) is the most used tool for depression screening. Most practices will start with PHQ-2 and if needed will conduct the full PHQ-9 if further evaluation is required.
- Over the past month, have you felt down, depressed, or hopeless?
- Over the past month, have you felt little interest or pleasure in doing things?
Providers can send the PHQ to patients in advance of the telemedicine session to self-complete and review the results during the session. Alternatively, providers may prefer to wait and ask the questions during the appointment to monitor patient behavior during responses. In either case, telehealth offers a great tool to evaluate and treat mental health conditions for your MS patients.
Telehealth: A Convenient and Effective Solution to Treating Neurological Conditions
Telehealth is an effective and convenient option for treating patients with a variety of neurological conditions, not just patients with MS. Epilepsy, Parkinson’s, and Neuropathy are conditions that can also be effectively treated by incorporating telehealth visits.
For patients with neurological impairments, frequent trips to the doctor’s office can be daunting. Telemedicine options will help your practice improve patient satisfaction and increase patient engagement. When patient engagement is high, compliance with treatment increases, and this leads to a better quality of life for your neurology patients.
