No abstract

Background and Purpose: Describe an inpatient teleneurology consultation service novel to our hospital system, and capture feedback from patients, ordering providers, and consulting neurologists. Methods : A single cohort of teleneurology consult patients was surveyed via telephone. Ordering and consulting providers completed online surveys. Quantitative survey data was reported using descriptive statistics and free-response survey data was summarized. Patient demographics and consult data were gathered via retrospective chart review. Results : Telephone survey was obtained from 25 of 53 patients receiving teleneurology consults from June 1–September 30, 2020. Patient-reported benefits included better understanding of condition (72%) and ability to remain close to home. Online surveys were completed by 11 ordering providers and by consulting neurologists on 20 telemedicine encounters. Ordering providers reported they were likely to use the service again (98.7%), agreed it added value to patient care (91%) and was valued by patients (82%), with concern for missed diagnosis (46%) and potential patient transfer (36%) without the service. In contrast, fewer consulting neurologists predicted need for transfer (5%) or missed diagnosis (10%) in the absence of teleneurology, though 20% indicated that length of stay may increase without the service. Conclusion: We confirm feasibility of an inpatient teleneurology service run by an academic medical center. Satisfaction was high among all key stakeholders, with few transfers to a tertiary care center. This service is valuable to patients, ordering providers, and potentially the hospital network, as a community based care model of neurological care, centered on the needs of the patient and hospitalist.

New-onset refractory status epilepticus (NORSE) is a rare clinical diagnosis. Autoimmune encephalitis and paraneoplastic encephalitis are the most common identifiable etiologies of NORSE; of the known autoimmune encephalitides, <200 cases of GAD65-related epilepsy have been reported in the literature. We describe a case of a 24-year-old female who presented with confusion and myoclonus. Electroencephalogram revealed NORSE that evolved into super-refractory status epilepticus. Her CSF showed a mild lymphocytic pleocytosis, and her MRI demonstrated changes in the bilateral temporal lobes. She was ultimately diagnosed with GAD65 autoimmune encephalitis and treated with immune-modulating therapy. This case highlights the complex diagnostic workup of patients with NORSE and the utility of validated prediction models for diagnosis and prognosis. While maintaining a broad differential, the patient’s Antibody Prevalence in Epilepsy (APE) score was a helpful clinical tool to support the pursuit of an autoimmune etiology. We also underline the need to concomitantly treat patients quickly during diagnostic workup because earlier treatment increases the Response to Immunotherapy in Epilepsy (RITE) score, indicating a more favorable prognosis.