{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:41:05Z","timestamp":1793673665269,"version":"4.5.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric epilepsy care is often constrained by follow-up bottlenecks\u2014travel burden, caregiver time loss, and limited pediatric neurology capacity\u2014leading to fragmented management and preventable utilization. Methods: We conducted a narrative mini-review of studies and practice statements (2019\u20132025) identified in PubMed and Scopus, prioritizing pediatric populations and major guidelines relevant to tele-follow-up, adherence and refills, unplanned care, equity, privacy, data governance, and implementation; no meta-analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence indicates that, for established patients, video or telephone visits can safely support medication titration, adverse-effect checks, seizure-diary review, counseling, and care coordination, with performance broadly comparable to clinic visits for these tasks when used judiciously. Tele-follow-up is inappropriate for new diagnoses, acute neurologic change, or other red flags requiring examination and electroencephalography. Effective implementation relies on risk-stratified schedules, predefined escalation thresholds and time-to-action, nurse-led triage, and measured substitution rather than wholesale replacement of in-person care. Equity risks persist for families with low connectivity, low income, language barriers, or disability; mitigations include device and data subsidies, school-linked access points, multilingual materials, and privacy-by-design with developmentally appropriate consent and auditable safeguards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tele-follow-up is a feasible complement to clinic care that can reduce burden while maintaining quality when paired with transparent oversight. We propose a practical oversight approach using key performance indicators with equity stratifiers to monitor completion, adherence, and unplanned care, and outline research priorities on longer-term outcomes in under-connected populations, privacy impact evaluations, interoperability, and pragmatic trials with equity endpoints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1727725","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:27:16Z","timestamp":1764916036000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Remote follow-up for pediatric epilepsy: effective care with equity-focused oversight"],"prefix":"10.3389","volume":"13","author":[{"given":"Tiantian","family":"Zhong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref1","volume-title":"Epilepsies in children, young people and adults (NG217)","year":"2022"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/WCO.0000000000001350","article-title":"Epilepsy in low- to middle-income countries","volume":"38","author":"Sen","year":"2025","journal-title":"Curr Opin Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/S1474-4422(24)00079-6","article-title":"Improving epilepsy diagnosis across the lifespan: approaches and innovations","volume":"23","author":"Pellinen","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1001\/jamaneurol.2024.1187","article-title":"Early access to first-seizure clinics, subsequent outcomes, and factors associated with attendance","volume":"81","author":"Li","year":"2024","journal-title":"JAMA Neurol"},{"key":"ref5","volume-title":"Telehealth position statement","year":"2020"},{"key":"ref6","volume-title":"Telemedicine in people with epilepsy","year":"2020"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.seizure.2023.02.005","article-title":"Telemedicine for individuals with epilepsy: recommendations from the international league against epilepsy telemedicine task force","volume":"106","author":"Samia","year":"2023","journal-title":"Seizure"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2651","DOI":"10.1212\/WNL.0000000000204653","article-title":"Unleashing the potential of telemedicine in epilepsy: effectiveness and patient preferences (P10-1.003)","volume":"102","author":"Vasireddy","year":"2024","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1177\/08830738221099730","article-title":"A multicenter study of adherence to best practices and application of epilepsy quality metrics in a pediatric telemedicine encounter","volume":"37","author":"Joshi","year":"2022","journal-title":"J Child Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e1257","DOI":"10.1212\/WNL.0000000000010010","article-title":"Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic","volume":"95","author":"Rametta","year":"2020","journal-title":"Neurology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1111\/dmcn.15406","article-title":"Child neurology telemedicine: analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic","volume":"65","author":"Kaufman","year":"2023","journal-title":"Dev Med Child Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e14549","DOI":"10.1111\/cns.14549","article-title":"Telemedicine during the COVID-19 epidemic improves outcomes in children with tuberous sclerosis complex: a 1206 visits retrospective cohort study","volume":"30","author":"Wang","year":"2024","journal-title":"CNS Neurosci Ther"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"703","DOI":"10.15585\/mmwr.mm7121a2","article-title":"Seizure- or epilepsy-related emergency department visits before and during the COVID-19 pandemic - United States, 2019-2021","volume":"71","author":"Sapkota","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"642381","DOI":"10.3389\/fped.2021.642381","article-title":"Telehealth for children with epilepsy is effective and reduces anxiety independent of healthcare setting","volume":"9","author":"Klotz","year":"2021","journal-title":"Front Pediatr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e208087","DOI":"10.1212\/WNL.0000000000208087","article-title":"Guidelines for specialized epilepsy centers: executive summary of the report of the National Association of epilepsy centers guideline panel","volume":"102","author":"Lado","year":"2024","journal-title":"Neurology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1056\/NEJMp2003539","article-title":"Virtually perfect? Telemedicine for Covid-19","volume":"382","author":"Hollander","year":"2020","journal-title":"N Engl J Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"109232","DOI":"10.1016\/j.yebeh.2023.109232","article-title":"Self-management education for children with epilepsy and their caregivers. A scoping review","volume":"144","author":"Leviton","year":"2023","journal-title":"Epilepsy Behav"},{"key":"ref18","volume-title":"WHO guideline: recommendations on digital interventions for health system strengthening","year":"2019"},{"key":"ref19","volume-title":"Guidelines for industry on child online protection","year":"2020"},{"key":"ref20","volume-title":"Recommendation of the council on health data governance (OECD-LEGAL-0433)","year":"2016"},{"key":"ref21","volume-title":"OECD recommendation of the council on children in the digital environment (OECD-LEGAL-0389)","year":""},{"key":"ref22","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1111\/jrh.12759","article-title":"Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities","volume":"39","author":"Ko","year":"2023","journal-title":"J Rural Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e2347686","DOI":"10.1001\/jamanetworkopen.2023.47686","article-title":"Telehealth expansion, internet speed, and primary care access before and during COVID-19","volume":"7","author":"Tilhou","year":"2024","journal-title":"JAMA Netw Open"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e231864","DOI":"10.1001\/jamanetworkopen.2023.1864","article-title":"Rates of primary care and integrated mental health telemedicine visits between rural and urban veterans affairs beneficiaries before and after the onset of the COVID-19 pandemic","volume":"6","author":"Leung","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref25","volume-title":"Global report on assistive technology","year":"2022"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/S0140-6736(20)30424-4","article-title":"Telemedicine 2020 and the next decade","volume":"395","author":"Dorsey","year":"2020","journal-title":"Lancet"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3697","DOI":"10.3390\/ijerph19063697","article-title":"Summary measures of health inequality: a review of existing measures and their application","volume":"19","author":"Schlotheuber","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e126","DOI":"10.1017\/cts.2021.789","article-title":"Understanding and applying the RE-AIM framework: clarifications and resources","volume":"5","author":"Holtrop","year":"2021","journal-title":"J Clin Transl Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e83","DOI":"10.1542\/hpeds.2023-007296","article-title":"A practical guide to QI data analysis: run and statistical process control charts","volume":"14","author":"Winckler","year":"2024","journal-title":"Hosp Pediatr"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions","volume":"21","author":"Schaffer","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1097\/EDE.0000000000001755","article-title":"Advances in difference-in-differences methods for policy evaluation research","volume":"35","author":"Wang","year":"2024","journal-title":"Epidemiology"},{"key":"ref33","article-title":"Toolkit for using the AHRQ quality indicators","year":"2025"},{"key":"ref34","volume-title":"Global strategy on digital health 2020\u20132025","year":"2021"},{"key":"ref35","first-page":"167","article-title":"Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and policy changes and fiscal year 2025 rates (final rule)","volume":"89","year":"2024","journal-title":"Fed Regist"},{"key":"ref36","volume-title":"Innovative provider payment models for promoting value-based health systems","year":"2023"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1727725\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:27:18Z","timestamp":1764916038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1727725\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2025.1727725"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1727725","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]},"article-number":"1727725"}}