T elehealth or telemedicine, defined as "the use of communications technologies to provide and support health care at a distance," has become an important part of medical care during the coronavirus disease 2019 (COVID-19) pandemic. 1,2 In response to the emergent need to reduce the spread of COVID-19 by limiting physical contact, Medicare's 1135 Waiver lifted previous limits on patient location, range of providers, and the requirement for patients to reside in designated rural areas or for patients to have established provider relationships to receive medical services through telemedicine. Additionally, the Centers for Medicare and Medicaid Services increased reimbursement for telephone visits on par with video. 3 However, given limited telemedicine use pre-COVID-19, 4 data on clinician and patient attitudes outside of rural and research settings are lacking. We describe a real-world experience of patient-and clinician-rated acceptability of telephone and video outpatient visits during the initial 4 weeks of the emergency COVID-19 response at a large, diverse gastroenterology (GI)/hepatology practice in an academic health system.

Summary:Purpose: To identify factors that are associated with the emergence of nonepileptic seizures (NES) after resective epilepsy surgery.Methods: Twenty-two patients with medically refractory epilepsy in whom NESs were documented by EEG after resective surgery were compared with a larger series of epilepsy surgery patients on demographic, neurologic, and psychiatric variables.Results: NES tended to become apparent in the first few months after surgery. Patients who developed NESs did not differ from other epilepsy surgery patients in terms of age, IQ, or preoperative psychiatric diagnoses. However, surgical NES patients' neurologic problems and seizures began later in life, the NES group included a larger proportion of female subjects and patients with right hemisphere surgery, and NES patients were more likely to develop non-NES psychiatric problems after surgery.Conclusions: The heterogeneous collection of behaviors subsumed under the label NESs are determined by multiple factors.Several variables were found to be specifically associated with the development of NES after resective epilepsy surgery: A disproportionate number of postsurgical NES patients are female, they have primary neurologic dysfunction in the right hemisphere, and their epileptic seizures often began after adolescence. We propose that at least one group of patients with somatoform tendencies develop NESs as part of the psychiatric instability that occurs often in the few months after resective surgery. Key Words: Nonepileptic seizures-Temporal lobectomy.Nonepileptic seizures (NESs) may be defined as repeated paroxysmal behavioral events that are falsely interpreted to be epileptic seizures, either by the patient himself or herself or by others, but which are not accompanied by electrographic indicators of epilepsy on concurrent EEG. NESs are not infrequent among patients with well-documented chronic epilepsy (1-3). In several reported cases, NESs developed after resective surgery in patients with medically refractory epileptic seizures (4-7).It has been suggested that the prevalence of NES after epilepsy surgery is higher than generally recognized (3, although this problem has received relatively little attention and systematic study. This study examined a group of postsurgical epilepsy patients with EEG-documented NES to identify factors that might be associated with the development of NES after resective surgery. NES patients were compared with a larger group of unselected epilepsy surgery patients on various demographic, neurologic, and psychiatric variables.

Although process improvement expanded the number of patients who underwent epilepsy surgical evaluation, we experienced concurrent prolongation of the time from pathway initiation to completion. Ongoing improvement cycles will focus on newly identified residual sources of bottleneck and delay.

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