Advances in telecommunications concerning epilepsy

Telemedicine is a rapidly expanding discipline. Looking back on a long trad ition of telemetric measurement and transmission of brain electrical data, one might ask how relevant telecommunication techniques have become for cli nical work in epileptology. In principle, communication can be either betwe en patient and doctor or between doctor and doctor. The former includes tel ephone reports on frequency and severity of seizures and on mental and phys ical state. Because of the special problems of patients with epilepsy, the need for traveling should be minimized. To maintain close contact, telemetr ic transmission of electroencephalograms (EEG), seizure videoregistration, and monitoring of anti-epileptic drug (AED) blood levels from home are desi rable, but the technical tools now available are not of sufficiently high p erformance for these applications. However, physicians and medical units ca n communicate using high-rate data transfer. There are major problems with this technology. Transfer rates using the internet are not fixed. Moreover, using six digital telephone lines simultaneously, good-quality transmissio n of a 3-min video may take more than 1 h, restricting interactivity. In co ntrast to imaging (e.g., magnetic resonance imaging), there is no generally accepted protocol for handling EEG/electrocorticography data. There are al so legal problems relating to the responsibility for failures and safety of personal or medical data. Nevertheless, the expenses of installation and u se of such equipment appear justified by the expected benefits, for the pat ients (avoiding travel and multiple investigations, checking diagnosis and therapy, amending quality of life), for the physician (sparing equipment an d manpower, accelerating and improving diagnosis), for the epilepsy center (increased database for expert systems, improved logistic and data storage) and, finally, for insurance providers (reduced overall costs). When the ne urosurgical procedure is remote from the place of presurgical evaluation, t elecommunication should be obligatory.