What is Teleneurology?

Teleneuroloy allows neurologists to quickly evaluate a patient in an accurate and effective manner using remote technology, explains Dr. Salman Azhar, Northwell Health’s Director of TeleStroke. “The pandemic has made us use it more, but there was already a push toward delivering specialty care using telehealth,” he says.

Dr. Azhar says that an exam using teleneurology isn’t all that different from in-person consultations. It can also serve to aid in both life-saving emergency stroke treatment, as well as help diagnose and treat a wide variety of neurological disorders.

At its most basic level, teleneurology requires a neurologist and a patient to be connected via video conferencing software. Dr. Azhar explains that advanced portals, like the one used by Northwell physicians, also gives the doctors access to patient records like bloodwork, imaging results, and other diagnostic tests.

Once connected, the virtual visit is conducted in much the same way as it would happen in person. “We can see them, evaluate them, have them walk around the house,” says Dr. Azhar. It’s especially helpful if there is a caregiver present who can assist with positioning the device and help the patient follow the doctor’s instructions.

Home teleneurology visits work especially well for patients who need ongoing treatment and regular appointments with their neurologists, but even first-time consultations can be done using telemedicine.

Teleneurology is also an integral tool when it comes to some patient rehabilitation, says Dr. Azhar. Neurologists can regularly check in from afar as part of a rehab team to see what their patients are working on, and their progress.

While Dr. Azhar notes that there are certain examinations that cannot be done because they are not physically present, such as checking a person’s reflexes. However, if the patient is in a healthcare setting, the neurologist can rely on other care providers such as nurses to act as their hands.

Almost anything neurological can be evaluated with telehealth, says Dr. Azhar, but one case use in particular has shown to be very effective: diagnosing strokes. “It’s pretty common to have a stroke neurologist log into a computer and examine a patient remotely,” he says. Because not every hospital or medical center may have a neurologist onsite or on standby to make a diagnosis, teleneurology plays a vital role by bringing in a specialist instantly who can then make a life-saving decision.

“Time is Brain” is a well known phrase in the world of neurology and neurosurgery,” says Salvo-Wendt. Best case outcomes are reduced when there’s a delay in diagnosis of stroke or other life-threatening neurological conditions “The ability for rural and underserved populations to receive timely neurological diagnosis and treatment from a specialist is important to closing the gaps in healthcare access.”

For example, a teleneurology visit can confirm a stroke in just a few moments, prompting the specialist to recommend administering an emergency clot-busting (and life-saving) medicine called tPA.

Another disorder that can be treated via teleneurology is Parkinson’s disease. “Parkinson’s care is highly specialized when you get beyond a certain level, but the number of Parkinson’s specialists is not overwhelming,” says Dr. Azhar. Teleneurology allows these specialists to be virtually present right in the patient’s home, even if they are hundreds of miles away. Specialists might be better able to recognize changing patterns of movement, and can recommend if the patient needs specialized rehab or other treatment options.

Multiple Sclerosis is another emerging area of teleneurology. “Since patients tend to be younger and can access technology, we can examine them well,” says Dr. Azhar. That said, even patients with dementia who live with a caregiver, or older, less tech-savvy people in nursing homes can benefit from having a teleneurology visit.

Just like other areas of telemedicine, teleneurology provides open access to specialized, expert care directly to patients, as well as to any hospital or medical setting that may not have expert care on site. This can be especially important to rural or underserved areas that might have fewer medical centers nearby.

Some of its other benefits include:

Patient privacy is protected. Dr. Azhar notes that teleneurology is also a safe way to deliver care for patients into their homes in a way that remains compliant with HIPAA as well as internet security protocols. “It’s not just through a Zoom call,” he says. Telemedicine software is designed to deliver high level expertise to patients in the safest possible manner.

It’s safe during pandemic times. During COVID-19, patients have been afraid to go to emergency rooms and conduct in-person doctor visits. Teleneurology allows for a safe evaluation for vulnerable populations or anyone who is nervous about venturing out in public. In fact, Dr. Azhar says that teleneurology is a great solution for COVID-positive patients who had to go into long term care facilities. “Still debilitated, I was able to log on and evaluate [patients] with the help from a nurse in the home. They would not have been able to see a COVID neuro specialist otherwise,” says Dr. Azhar.

It gives patients a way to continue therapy at home. “I’m able to send out exercise programs to our patients through Northwell ExerciseRx,” says Dr. Azhar. Again, this is especially useful during the pandemic as many avoid the gym or rehab centers. By being able to push out customized programs to patients, and then modify them as needed, patients have been able to stay on track.

As health technology innovations continue, Dr. Azhar predicts that wearable devices may become helpful tools for monitoring patient health. Even current wearables that count steps can help neurologists understand their patients’ activity level, and manage their exercise, which is a key component of neurological treatment, he says.

What’s more, devices that can share real-time blood pressure and EKG readings with physicians, as well as recognize if a patient is falling could play a bigger role down the line. “It’s just a matter of creating connections,” says Dr. Azhar.

In the meantime, teleneurology will continue to advance and open up accessibility to patients as more and more neurologists add telehealth options to their practice.

Dr. Salman Azhar, Northwell Health director of TeleStroke
Susy Salvo-Wendt, Summit Healthcare Regional Medical Center telehealth specialist

• American Academy of Neurology – Telehealth and Remote Care
• National Library of Medicine – Teleneurology in patients with multiple sclerosis
• Elsevier Public Health Emergency Collection – Teleneurology during the COVID-19 pandemic