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• The use of telemedicine in epilepsy care has remained elevated even after the pandemic ended. • The percentage of using telemedicine for the first visit increased during the COVID-19 pandemic. • The reimbursement for telemedicine varied across the COVID-19 pandemic. • Half respondents reported remaining regulation flexibility after the pandemic ended. • Female health providers used telemedicine more often compared to the male. • Privacy was an issue while practicing telemedicine in epilepsy care. Telemedicine was widely adopted for epilepsy care during the COVID-19 pandemic. Its role extends beyond preventing disease transmission, offering an efficient and high-quality care alternative. To understand the global scenario, an international group conducted a survey comparing telemedicine practices in epilepsy care before, during, and after the pandemic. The survey included 26 questions on demographics, telemedicine use for epilepsy care, regulations, reimbursement mechanisms, and tools used. Responses were collected via an online survey platform from June to October 2023. Two hundred eighty-five respondents from 60 countries participated. The average telemedicine use in daily practice was 0 %, 0–10 % (median, IQR) before the pandemic, 65 %, 30–90 % during the pandemic, and 20 %,10–50 % after the COVID pandemic. Female respondents reported higher telemedicine use than males after the pandemic (25 %, 10–50 % vs 15 %, 5 %-30 %, p = 0.002). According to respondents' perceptions, post-pandemic telemedicine regulations flexibilities were reported as expanded by 36.8 %, restricted by 17.2 %, and unchanged by 46 %. Reimbursement for telemedicine increased during the pandemic but decreased afterward (Cochran's Q test, p < 0.001). Voice calls were the most used telemedicine platform (46.6 %). Privacy issues were reported by 49 respondents (18.3 %). Telemedicine use for epilepsy care increased during the pandemic and remained higher than pre-pandemic levels. However, improvements are needed in telemedicine applications, regulations, reimbursement, and patient privacy. International collaboration and experience sharing can enhance telemedicine's acceptance and practice globally. [ABSTRACT FROM AUTHOR]