Unlocking the Potential of Telemedicine in Epilepsy: Noninferiority Analysis of Efficacy and Identifying Patient Preferences.

Background and Objectives: This study was undertaken to compare the effectiveness of telemedicine visits with traditional in-person visits for epilepsy care and simultaneously attempts to identify patient demographics favoring telehealth. Methods: We retrospectively collected demographic and clinical data from all adult epilepsy clinic visits at the University of Kentucky between July 2021 and September 2022. A propensity model using inverse probability of treatment weighting was constructed to examine the association between these variables and the choice of telemedicine vs in-person visits. The study investigated the effect of visit type on 5 specific clinical outcomes, using stabilized weights derived from the propensity model to adjust for confounding. Noninferiority analyses were conducted to compare telemedicine and in-person visits, with a predefined noninferiority margin set at a difference in proportions of 0.10. Results: Among 442 encounters included in the final analysis, 155 (35.1%) were in-person, while 287 (64.9%) were virtual. Telemedicine was noninferior to in-person visits for making antiseizure medication (ASM) regimen changes, discussing epilepsy surgery, and in postvisit emergency department visits for breakthrough seizures. The incidence of postvisit seizures and abnormalities on neurologic examination between visit modalities differed but did not meet the criteria for noninferiority. A propensity model identified 3 key variables influencing the decision to choose telehealth-age, distance to the clinic, and presence of a significant other. The likelihood of preferring telehealth increased by 42% for every 10-year decrease in age. Similarly, with every 50 miles an individual had to drive, their preference for a telemedicine visit increased by 33%. Finally, individuals in a relationship were more likely to prefer telehealth visits. Discussion: Telemedicine proves to be an effective and noninferior alternative to in-person appointments, proving particularly beneficial in overcoming geographic barriers to access. A hybrid model of mixed visit types can help overcome the limitations of conducting a thorough neurologic examination. Younger individuals, those facing long travel distances, and patients with significant others prefer current telemedicine technology. This emphasizes the need for future advancements in more user-friendly and affordable technology tailored toward diverse demographic needs.