LAUSR

I read with interest the article by Hatcher-Martin et al.1 I am a neurologist attached to an academic institution in South India. Telemedicine was introduced in this part of the country in the early 2000s to help physicians in far flung areas—especially the Andaman Islands and the mountainous northeast—in treating their patients. These areas did not have and still do not have specialists. Neurology was one specialty—cardiology was another—in which the physicians felt the need for expert guidance. Conditions other than stroke—including chronic headaches, epilepsy, dementias, and post traumatic sequelae—were some of the conditions that were dealt with then, to the satisfaction of the patients, their caregivers, and the physicians involved. This was evidenced by the fact that patients would follow up as per schedule. When requested, guidance was offered to treating physicians on acute neurologic inpatients with neurologic infections, stroke, and acute encephalopathies. The telemedicine link was also used to include these physicians in CME programs conducted at the tertiary hospital. My experience during my tenure at that hospital was therefore not limited to acute strokes alone. I agree with the authors in that the scope of application of telemedicine in neurology can certainly be expanded outside stroke to deliver cost-effective services. However, in this litigation-prone era, it is necessary to proceed with caution, and it would be prudent to include all stakeholders in discussions to establish guidelines and rules so that the use of teleneurology is optimized.