title: Experiences from an international tele-epilepsy collaboration.
abstract: OBJECTIVE
  Our main objective was to use videoconferencing as a primary means to: a) assist in launching an epilepsy surgery program in Pakistan; 2) participate in case conferences on complex epilepsy patients in each country.
  
  
  METHODS
  Extensive testing using both point to point and bridged integrated service digital network (ISDN) and internet protocol (IP) connections was carried out using bandwidths of 384-768 kilobits per second (kbps). Videoconferences between sites were arranged two to three weeks in advance and connections were tested a day prior to the scheduled conference. Sharing of PowerPoint presentations, neuroimaging and video-EEG was available to all sites. Discussions centered on patients with medically refractory epilepsy.
  
  
  RESULTS
  Between July 2006 and June 2008, 17 sessions were booked. Five of these conferences bridged in specialists from West Virginia University. Most successful connections occurred using IP point to point calls or a bridge connecting end points through IP at 512 kbps. We conducted three surgeries for medically refractory temporal lobe epilepsy in Pakistan. At follow-up in January 2009, two patients have been seizure free and one had two breakthrough seizures after sudden unsupervised discontinuation of Levetiracetam.
  
  
  CONCLUSIONS
  Our international tele-epilepsy collaboration has proven feasible and valuable to all participants. Our experience suggests considerable thought and preparation are needed before a teleconference to ensure its success. We provide a recipe to set-up similar telemedicine collaborations. Considerations include time zone differences, equipment type, interoperability between endpoints, connection capabilities, bandwidth availability, and backup plans for unsuccessful connections. Telemedicine can facilitate epilepsy care around the world, identifying with the concept of a "Global Health Village".
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: S Nizam
authors.initials: SN
authors.lastname: Ahmed
authors.forename: Carly
authors.initials: C
authors.lastname: Mann
authors.forename: Fowzia
authors.initials: F
authors.lastname: Siddiqui
authors.forename: Mughis
authors.initials: M
authors.lastname: Sheerani
authors.forename: Nadir Ali
authors.initials: NA
authors.lastname: Syed
authors.forename: Thomas
authors.initials: T
authors.lastname: Snyder
authors.forename: S Ather
authors.initials: SA
authors.lastname: Enam
authors.forename: Warren
authors.initials: W
authors.lastname: Boling
mesh_terms: D000328:Adult; D003194:Computer-Assisted Instruction; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D049269:Videoconferencing / Q000295:instrumentation; D055815:Young Adult