Moyamoya in a Patient with FIRES: A First Case Report.

Febrile infection-related epilepsy syndrome (FIRES) is a form of epileptic encephalopathy with severe refractory epilepsy that presents in previously healthy, school-aged children after significant febrile illness with concomitant rise in body temperature. Suspected causes include genetic or acquired channelopathies, as well as mitochondrial disturbances. In FIRES, the EEG shows diffuse slowing, generalized, and/or multifocal discharges. Seizures are present and resistant to treatment. Moyamoya angiopathy (MMA) is characterized by progressive stenosis of cerebral arteries and subsequent development of a network of collateral circulation that is prone to rupture. We present here a case of a 6-year-old patient with a postfebrile illness, acute and explosive bilateral independent seizure onset that was most consistent with FIRES, but also with imaging evidence of right-sided-only MMA. Our patient demonstrated two diseases not described together previously in the literature. It is unknown whether this patient's MMA is related to FIRES. In spite of successful corrective surgery (encephaloduroarteriosynangiosis), the patient continues to suffer from intractable seizures (mostly on the right) and apparent mild encephalopathy. The impact of our interventions (surgery, antiepileptic medication) is unclear. In this article, we describe a case of MMA and FIRES, and the history, physical, laboratory, imaging, and developmental elements of the 6-year-old patient with previously normal development.

Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants.

OBJECTIVE: The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. METHODS: The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. RESULTS: There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO2, 50 metric tons of CO, 3.7 metric tons of NOx, and 5.5 metric tons of volatile organic compounds. CONCLUSIONS: This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants.

Geospatial Information System Analysis of Healthcare Need and Telemedicine Delivery in California.

BACKGROUND: Geospatial Information Systems (GIS) superimpose data on geographical maps to provide visual representations of data by region. Few studies have used GIS data to investigate if telemedicine services are preferentially provided to communities of greatest need. INTRODUCTION: This study compared the healthcare needs of communities with and without telemedicine services from a university-based telemedicine program. METHODS: Originating sites for all telemedicine consultations between July 1996 and December 2013 were geocoded using ArcGIS software. ZIP Code Tabulation Areas (ZCTAs) were extracted from the 2010 U.S. Census Bureau's Topologically Integrated Geographic Encoding and Referencing file and assigned a community needs index (CNI) score to reflect the ZCTA community's healthcare needs based on evidence-based barriers to healthcare access. CNI scores were compared across communities with and without active telemedicine services. RESULTS: One hundred ninety-four originating telemedicine clinic sites in California were evaluated. The mean CNI score for ZCTAs with at least one telemedicine clinic was significantly higher (3.32 ± 0.84) than those without a telemedicine site (2.95 ± 0.99) and higher than the mean ZCTAs for all of California (2.99 ± 1.01). Of the 194 telemedicine clinics, 71.4% were located in communities with above average need and 33.2% were located in communities with very high needs. DISCUSSION: Originating sites receiving telemedicine services from a university-based telemedicine program were located in regions with significantly higher community healthcare needs. Leveraging a geospatial information system to understand community healthcare needs provides an opportunity for payers, hospitals, and patients to be strategic in the allocation of telemedicine services.