Remote follow-up for pediatric epilepsy: effective care with equity-focused oversight

Pediatric epilepsy care is often constrained by follow-up bottlenecks-travel burden, caregiver time loss, and limited pediatric neurology capacity-leading to fragmented management and preventable utilization. Methods: We conducted a narrative mini-review of studies and practice statements (2019-2025) 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.

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.

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.