To describe the technological, legal and clinical implementation of a Global Teleneurology Service (GTS) through case review of the first 12 patients at each diverse pilot site (Saipan, Burundi).

Nearly one sixth of the world’s population suffer from a neurological disorder, but access to neurological services is disproportionately scarce. As one approach to addressing unmet needs for neurological care in resource-limited settings, in late 2017 the UCSF Department of Neurology developed the GTS.

At no cost to partner sites, GTS established two parallel models to deliver synchronous teleneurology evaluations and consultations by UCSF neurologists. All sessions used Zoom. After each case, both the requesting and consulting clinician completed short surveys for quality improvement, and a case log of deidentified patient summaries was maintained (Qualtrics server). The first 12 cases at each site were then analyzed.

Approximately half of the 24 consults were aged <18 or >60 years. As expected, there was a slight preponderance of neurovascular presentations in Saipan and neuroinfectious presentations in Burundi, but clinicians requested consultations overwhelmingly for presentations unfamiliar to them (e.g. tardive dyskinesia, postpartum polyneuropathy, tetanus, muscular dystrophy, neurodevelopmental delay, disseminated Potts disease). Consultations were deemed “very” or “extremely” useful by 87.5% partner clinicians and 85% UCSF neurologists; 71% of consults resulted in a “major” change in care management. Finally, a series of seminars was planned to educate each site regarding specific unmet clinical needs identified (e.g. coma examination, Parkinson’s disease medications).

In this first look at a collaborative partnership between UCSF and global clinical partners to deliver regular access to neurological expertise, we describe institutional agreements that protect all parties involved, and demonstrate technological and logistical feasibility of a valuable connection between consulting neurologists and partner clinicians and patients. Next steps will include expansion to new sites, incorporation of additional technologies, and shoring up sustainability.