Telemedicine — the perfect tool
to overcome the challenges of stroke treatment
November 2018 Dallas Medical Journal 13
When every minute
of untreated
ischemic stroke
leads to the
irreversible death
of 1.9 million
neurons, every minute truly counts.
Acute stroke treatments including
intravenous thrombolytics and
mechanical embolectomy dramatically
improve outcomes, and the magnitude
of benefit is directly associated with
time to treat. With expanding treatment
windows, evolving eligibility criteria
and advancing imaging techniques,
rapid treatment requires stroke
expertise literally on a moment’s notice.
Enter onto the scene — telemedicine,
the tool perfectly suited to overcome
these challenges in the treatment of
stroke. I feel humbled and honored
as a vascular neurologist to practice
teleneurology and provide care to
patients across the state.
PATIENT’S RESPONSE TO TREATMENT
CHANGES MY PLANS
I still remember the exact moment
almost 20 years ago that inspired me to
pursue vascular neurology. As a young
intern, I responded to a stroke alert in
the crowded Emergency Department
to find a patient suffering from a
complete aphasia and hemiparesis.
It was a devastating deficit. As the
transcranial doppler demonstrated
total occlusion of the left middle
cerebral artery, the stroke attending
neurologist arrived and ordered IV
tPA. I watched with wide eyes as the
clot dissolved on doppler 15 minutes
after the bolus was given, and then the
patient miraculously began to speak
and move her right side. I had never
witnessed such an amazing and lifealtering
response to any treatment. In
that instant, I decided I wanted to have
such an impact in people’s lives and
later completed a vascular neurology
fellowship.
During my stroke fellowship,
the concept of telestroke care was
in its infancy. It was an intriguing
concept, yet I had doubts about its
practicality. Could the patient be
examined well enough to detect subtle
deficits? Would imaging provide
the resolution necessary to detect
early ischemic changes? How could
stroke docs, already swamped at busy
stroke centers, possibly add to their
call burden? Would the distant site
technology be portable enough for
the teleneurologist to be mobile? How
would patients and families respond?
I initially decided to pursue the more
traditional path as a neurohospitalist
in large hospital systems in the DFW
area, which I did for 13 years. As stroke
program medical director, I led the
development and certification of the
first two Advanced Primary Stroke
Centers in the Metroplex — Baylor
University Medical Center and Medical
City Dallas Hospital. During my time
at Medical City Dallas, the stroke
program became one of the first 10
state-designated stroke centers in
Texas and received certification as a
Comprehensive Stroke Center.
TELESTROKE CARE
EXPANDS THERAPIES
Having deployed successful stroke
programs within metropolitan
hospitals, I still felt an intense desire
to expand the revolutionary stroke
therapies to patients who did not
have access to such care. From my
time serving on the governor’s
EMS & Trauma Committee Stroke
Subcommittee, charged with
implementation of the Texas stroke
legislation, I was familiar with the
challenges facing rural Texans. I was
haunted by the fact that so many
communities did not have neurology
coverage to assist local medical
teams with complex decisions. I also
recognized that since my fellowship,
many technological advancements
had occurred and much research
performed on the feasibility and
safety of telemedicine. My passion
to increase access to specialty care
drove my transition to the practice
of teleneurology. This allowed me to
apply my experience in clinical stroke
care and administrative systems of care
development on a much broader scale.
In 2016, I joined Questcare
Telehealth as full-time teleneurology
medical director and stroke
neurologist. Our team of boardcertified
and fellowship-trained
vascular neurologists provides
neurology consultations to patients
across Texas, in rural and urban
regions ranging from Abilene to Lake
Granbury to Conroe and Corpus
Christi. Our program is committed
to monitoring quality outcomes
and facilitating stroke program
certification. The goal is to provide real
value to the patient and the hospital.
Although telestroke was one of the
earliest telemedicine pilot programs,
teleneurology is suited to both acute
Lise A. Labiche, MD | Medical Director, Questcare Telehealth
Telemedicine allows patients
rapid access to highly specialized care
even in the most remote areas.