Objective: To describe the experience of a movement disorder practice in a rural setting, the role of telehealth and the conditions diagnosed and managed

Background: Kenya has less than 20 neurologists and much fewer movement disorder specialists. Most of these are based in the capital city, leaving regions with a population of more than 30 million without access to their care. Internists with interest in neurology manage the bulk of these patients. Telemedicine has been critical in helping bridge the gap between internists and neurologists. The use of patient videos, video-calls with neurologists, whatsapp messaging application and other platforms has been employed by some centres to a good effect.

Method: We reviewed all cases of movement disorders managed at Meru Teaching and Referral Hospital and an affiliated clinic, Oregon Health Services for the last two years (2020 and 2021). Use of telehealth platforms with specialized neurologists was also reviewed, as well how the final diagnoses were arrived. Data was obtained from patient files with strict confidentiality, and analysed using statistical package for social sciences (SPSS version 28.0), and presented in tables, graphs and charts.

Results: Over a period of 2 years, 108 patients were diagnosed with a movement disorder and enrolled in care and follow-up. Males comprised 65 (60.2%) of the patients, while the mean age of the patients was 62.4 years. The commonest condition diagnosed was Parkinson Disease with 42 patients (38.9%), while 33 (30.6%) had drug-induced movement disorders, 11.1% had dystonia, 11.1% had functional movement disorders. We found 3 cases of diabetic striatopathy, 8 cases of myoclonus and 2 cases of Sydenham’s chorea. The main diagnostic method was whatsapp messaging and videos shared with senior neurologists, video calls, direct phone calls. In a few cases, patients were required to make a diagnostic visit to the consulting neurologist and then report back for follow-up.

Conclusion: This practice demonstrates the positive impact of telehealth platforms in diagnosis, management and subsequent follow-up of patients. In a region with a population of over 3 million people and no consulting neurologist, this model helps reach out and help patients with movement disorders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorder-practice-in-a-rural-setting-challenges-and-opportunities-and-utility-of-telemedicine/