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Table of Contents    
COMMENTARY
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 941-942

Advantages of telestroke in rural areas


1 Department of Neurology, Hospital Universitari Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia (Spain)
2 Department of Medical Library, Hospital Universitari Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia (Spain)

Date of Web Publication12-Sep-2016

Correspondence Address:
Adrià Arboix
Department of Neurology, Hospital Universitari Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia (Spain)

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.190251

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How to cite this article:
Arboix A, Sánchez MJ. Advantages of telestroke in rural areas. Neurol India 2016;64:941-2

How to cite this URL:
Arboix A, Sánchez MJ. Advantages of telestroke in rural areas. Neurol India [serial online] 2016 [cited 2019 Nov 18];64:941-2. Available from: http://www.neurologyindia.com/text.asp?2016/64/5/941/190251




Acute stroke remains a major public health concern and represents the leading cause of disability, the second cause of dementia, and one of the most prevalent causes of death in the world.[1]

Organized care provided in Stroke Units is the most effective intervention for patients with acute stroke. However, implementation of these units requires multidisciplinary stroke specialists, who are often not sufficiently available in many rural areas. A feasible approach is to establish Telestroke Unit networks, that is, Stroke Units in rural areas supported by stroke centers in terms of education, quality management, and teleconsultation.[2]

Telemedicine was first conceptualized in 1924 with the aim to overcome geographical barriers that have kept rural and remote areas isolated and without access to quality healthcare. Teleneurology is the application of telemedicine to the fields of neurology; telestroke is a subdivision of teleneurology involving telemedicine consultation for the treatment of neurovascular patients. Initially, it was performed by means of video consultation-based telestroke services. More recently, the use of mobile computers (laptops or tablets) and smartphone devices for teleconsultants' access may represent a much cheaper alternative and reduce costs.[3],[4]

At present, it is well established that telemedicine applied to cerebrovascular disease [3],[4],[5] can ease the administration of thrombolytic therapy within 4.5 hours of ischemic stroke onset, which is the therapeutic window for intravenous rtPA. A recent Italian study showed no statistically significant differences, either clinical or outcome related, between thrombolysis delivered using the telestroke model versus the conventional technique.[6] This study confirms the potential of inducting telestroke into clinical practice, and that thrombolysis, when given using the telestroke conference, is both safe and effective; in addition, unnecessary transfers of patients with travelling problems secondary to neurological condition can be avoided; and ultimately, it may bring neurological expertise to rural areas where there is limited availability of neurologists.

Another potential use would be the possibility of consultation with major centres regarding therapeutic management of patients with cerebral stroke of unusual etiology.[7] Furthermore, rural or regional hospitals may experience the advantages of specialization in the management of one of the most frequent and life-threatening diseases.

Therefore, telestroke, that is, the use of telemedicine for stroke, is now a part of mainstream clinical stroke practice in developed countries, both in the academic and community environments. Jagolino et al., proposed integrating formal telemedicine training in the Accreditation Council for Graduate Medical Education vascular neurology fellowship.[8]

Telestroke is useful for providing stroke management when a vascular neurologist is absent. In rural areas, it constitutes a useful, safe, and beneficial therapeutic alternative. For this reason, we would like to recommend this first telestroke model reported from India.

 
 » References Top

1.
Arboix A, García-Eroles L, Massons J, Oliveres M. Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction. Cerebrovasc Dis 1998;8:8-13.  Back to cited text no. 1
    
2.
Jiménez MC, Tur S, Legarda I, Vives B, Gorospe A, Torres MJ, et al. The application of telemedicine for stroke in the Balearic Islands: The Balearic Telestroke project. Rev Neurol 2012;54:31-40.  Back to cited text no. 2
    
3.
Mutgi SA, Zha AM, Behrouz R. Emerging subspecialties in neurology: Telestroke and teleneurology. Neurology 2015;84:22e191-3.  Back to cited text no. 3
    
4.
Ranta A, Whitehead M, Gunawardana C, Cariga P, Iniesta I, Watson I, et al. International telestroke: The first five cases. J Stroke Cerebrovasc Dis 2016;25:44-5.  Back to cited text no. 4
    
5.
Müller-Barna P, Hubert GJ, Boy S, Bogdahn U, Wiedmann S, Heuschmann PU, et al. TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke center. Stroke 2014;45:2739-44.  Back to cited text no. 5
    
6.
Nardetto L, Dario C, Tonello S, Brunelli MC, Lisiero M, Carraro MG, et al. A one-to-one telestroke network: The first Italian study of a web-based telemedicine system for thrombolysis delivery and patient monitoring. Neurol Sci 2016;37:725-30.  Back to cited text no. 6
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7.
Arboix A, Bechich S, Oliveres M, Garcia-Eroles L, Massons J, Targa C. Ischemic stroke of unusual cause: Clinical features, etiology and outcome. Eur J Neurol 2001;8:133-9.  Back to cited text no. 7
    
8.
Jagolino AL, Jia J, Gildersleeve K, Ankrom C, Cai C, Rahbar M, et al. A call for formal telemedicine training during stroke fellowship. Neurology 2016;86:1827-33.  Back to cited text no. 8
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