Navigating the waves: A systematic review of telemedicine interventions and health service access challenges in epilepsy during COVID-19

Introduction

The COVID-19 pandemic has dramatically reshaped the landscape of healthcare delivery, prompting a surge in the adoption of telemedicine as a means to ensure continuity of care. During the pandemic, patients with epilepsy experienced difficulties accessing healthcare and obtaining necessary medications, with a substantial percentage facing obstacles in acquiring anti-seizure medication and reaching healthcare professionals. Disruptions in the supply and distribution of medication, due to COVID-19-related actions, further caused more problems for people with epilepsy and their caregivers like increasing seizure frequency. The pandemic has also accelerated the adoption of telemedicine, with evidence suggesting its potential benefits in various medical fields. In this systematic review and meta-analysis, we aim to investigate the challenges faced by patients with epilepsy during the COVID-19 pandemic, including healthcare access and medication acquisition, as well as evaluate changes in seizure frequency. Additionally, we will synthesize existing evidence on the use of telemedicine to address the healthcare needs of these patients, exploring its advantages and limitations.

Methods

This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using Joanna Briggs Institute (JBI). Following rigorous application of eligibility criteria, relevant data, covering both telemedicine-related and health service access information, were methodically extracted and organized using Microsoft Excel spreadsheets. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software.

Results

A total of 70 articles included in this review. Regarding difficulties in accessing healthcare, 34% of PWE and 41% of caregivers experienced cancelled, changed or postponed appointments. Following issues with obtaining medicine, 13% of patients and 16% of caregivers had difficulties in medicine availability and 11% of patients and 10% of caregivers in medicine accessibility. A very high rate of 90% satisfaction with telemedicine was reported by PWE. 17.6% of PWE experienced an escalation, 9% a decrease and 67% no changes in seizure frequency.

Conclusion

This review and meta-analysis revealed that telemedicine and virtual communications have been helpful but not sufficient for meeting healthcare needs for PWE during the COVID-19 pandemic. Additionally, there was a significant increase in seizure frequency among PWE who had difficulty obtaining medicine and access to healthcare.