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ResultsTS consultations were provided to 21 hospitals, 8 of them are also contracted to receive RUTN consults. A total of 1646 consults were done through TS (incidence rate 102.9) and 2011 through RUTN (incidence rate 251.4). The incidence rate difference between the two services was 148.5 (95% CI 138.1-158.9, pb0.0001). The proportion of video consults in telestroke was 27% and in RUTN 10% (pb0.0001). In a 5-point Likert scale, neurologist's satisfaction mean score was 4.67 in TS vs 4.69 in RUTN (p=0.39). ConclusionOut study suggests that there is a large demand for inpatient general teleneurology consultations through an academic-based teleneurology program. Use of video consults are more frequent in telestroke and the neurologist satisfaction with the TS and RUTN was similar. The combination of teleneurology and telestroke meet an important and ever-growing need of access to neurology specialty care.

Natalizumab (NTZ) as a high-cost long-term disease-modifying treatment indicated as a basic mono-therapy in patients with active relapsing-remitting multiple sclerosis (RRMS) has provided clinical efficiency. We evaluated clinical and radiological features and outcome of our NTZ MS patients. All RRMS patients defined by the 2010 McDonald criteria who received Natalizumab (NTZ) treatment any time since 2013. Variables analysed included age, gender, disease duration, MRI, Expanded Disability Status Scale (EDSS), previous treatment, relapse rate before and after receiving NTZ, adverse events, complications, and reasons of discontinuation. Of 16 patients in our study, the female-to-male ratio was 2:1. The mean age was 33 years, mean disease duration was 12 years with a range of (2-25). At the time of this analysis, 14 patients had received 1 year of NTZ. Approximately 80% of these patients were relapse-free after 1 year. The relapse rate after treatment was significantly lower (0,13 Vs 4,5). Fifteen patients haveN9 T2 lesions at the beginning of treatment with only 7 patients that had Gd-enhancing lesions on MRI, 87% had achieved radiological NEDA (No evidence disease activity). We didn't notice any opportunistic infections such as progressive multifocal leukoencephalopathy (PML), or any adverse events. However, treatment was discontinued in 2 cases because of pregnancy in 1 patient and high positive JC virus serology with a high risk of PML in the other. NTZ significantly reduces progression of disability, occurrence of clinical relapse and formation of new lesions at MRI in our MS patients. However, PML increasing risk require a longer-term follow-up.

The mean admission rate due to relapse was significantly reduced from 24.54 ± 7.48 to 2.92 ± 4.26, P b 0.004 after establishing the MS clinic. Most patients (61%) had escalated therapy (mean duration till escalation: 7.4 years). MS specialists prescribed second line DMT for 600 patients (50.1%). Escalation therapy was significantly higher in patients who were seen by an MS specialist versus those who were seen by a general neurologist (66.6% vs 33.4%, Pb0.0. Mean EDSS at latest visit to MS clinic was less than 3 in 1039 (83.3%), from 3-4 in 59 (4.7%) and more than 4 in in 148 (12.7%). ConclusionOptimal therapy decisions for MS patients via a specialised MS clinic are associated with a significant decrease in relapse rate, disability, and hence, the economic burden of multiple sclerosis.

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