MS and COVID-19: The Pros and Cons of Telemedicine

In this video, Florian Thomas, MD, discusses the use of telemedicine among patients with multiple sclerosis during the ongoing pandemic, and what can and cannot be accomplished in a telemedicine visit (transcript below).

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Florian Thomas, MD, is the chair of the Department of Neurology, founder of the Multiple Sclerosis Center, and founder of the Hereditary Neuropathy Center at Hackensack University Medical Center in New Jersey.

Transcript:

Florian Thomas, MD: Good morning. I'm Dr. Florian Thomas. I'm the Chair of the Department of Neurology at Hackensack University Medical Center and Hackensack Meridian School of Medicine. I'm also the founder of the MS Center at Hackensack University Medical Center and of the Hereditary Neuropathy Center.

I would like to talk a little bit about what can and what cannot be accomplished through telehealth. The reason that many patients find it desirable to seek care in a center that is specialized in multiple sclerosis as opposed to a single private practitioner is that such centers often offer comprehensive care under one roof.

To organize that via telehealth is somewhat challenging. Just to give you an example, the patient that I saw yesterday has recurrent bladder infections. For that, I had referred her to a urologist in my institution. Obviously, having several bladder infections a year exposes the body to continued inflammation, and that's not good for multiple sclerosis.

Unfortunately, she has declined such a referral because right now in her own mind, there are more important things for her to focus on, such as physical isolation at home. To some degree, you can get around such limitations, but to another degree, you cannot. It is important to alert patients to the consequences of not seeking medical attention for issues.

Of course, we're all very concerned that during COVID, the number of patients who've come to emergency rooms with strokes and heart attacks seems to have diminished. We all wonder what is happening to these patients. That's something that one needs to discuss with one's patients.

In regards to telehealth itself, there are some concerns that if one doesn't have a patient in one's office, there's very little one can do to assess a patient. I would agree that there are situations where an in-person visit is important.

I would be uncomfortable about making a diagnosis of an MS relapse if I cannot examine a patient's fundus, if I cannot directly assess a person's strength and use a tuning fork to measure their vibration sense.

On the other hand, there are many things that I can do in a telehealth visit. I can evaluate a person's eye movements. I can observe their facial symmetry, and I can observe a person's ability to walk, to stand on their toes, to stand on their heels, to utilize what we call rapid alternating movements.

There is a protocol, for instance, to measure the 25-foot timed walk, which is often an essential part of assessing a person's ambulation capacity. There's a protocol that one can share with patients. I recently had a patient's measure 25 feet in their driveway and report the results to me.

There are many ways I could do pretty much the same components of a neurological evaluation that allow me to assess disease progression as what I would do in my private office.

Over the years–and I didn't start using telehealth with COVID but had offered it to patients in rural zip codes for over 10 years–I've become very comfortable with telehealth.

Of course, our patients in many ways prefer telehealth, not just during COVID, but also because they may have difficulty using public transportations because of disability, they may be uncomfortable driving in bad weather, or because of cognitive problems related to multiple sclerosis.

For all those reasons, telehealth expands what we can do for our patients, and it's a good thing.