Digital and technological opportunities in epilepsy: Toward a digital ecosystem for enhanced epilepsy management

Shegog, Ross; Braverman, Lana; Hixson, John D.

doi:10.1016/j.yebeh.2019.106663

Cited by 24 publications

(18 citation statements)

References 41 publications

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“…However, while these might be better utilised in the future to improve quality of patient care and reduce service costs [ 49 ], a number of barriers to the widespread uptake of digital solutions have been identified. This includes lack of efficacy data, patient non-adherence and confidentiality concerns [ 50 ]. One specific concern regarding the use of wearable technology is the risk of false positives in seizure detection, which can reduce reported benefits [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study

McKinlay

Morgan

Noble

et al. 2020

Seizure

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Highlights We interviewed highly informed people with epilepsy and their carers Participants usually preferred to avoid emergency services after a typical seizure They developed strategies to manage themselves without emergency services Improved communication between existing services will facilitate appropriate care Two alternative pathways were not viewed as replacements for emergency care

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Section: Discussionmentioning

confidence: 99%

Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study

McKinlay

Morgan

Noble

et al. 2020

Seizure

View full text Add to dashboard Cite

show abstract

“…(A) Examples of diverse self-care practices delivered by digital health technologies aiming to improve therapy outcomes and lifestyle modifications. Such digital interventions can be offered via digital health ecosystems (Shegog et al, 2020), or combined with pharmacotherapies (drug+digital combination therapies) (Sverdlov et al, 2018). Integration of digital therapeutics (mobile medical apps) with prescription medications is enabled using the regulatory pathway for drug-device combination products (in this case medical device is a mobile medical app, "software as medical device") (Bulaj, 2014).…”

Section: Precision Digital Interventions For Epilepsy Pain Depression and Cancermentioning

confidence: 99%

“…Currently, content of mobile apps for people with epilepsy, pain, depression, and cancer is designed for specific indications [e.g., self-management for epilepsy (Si et al, 2020), CBT for depression (Mantani et al, 2017), mindfulness meditation, selfmanagement, physical exercise, education for cancer (Jongerius et al, 2019), a combination of physical therapy, CBT and education for chronic low back pain (Shebib et al, 2019)]. Creating disease-specific digital health ecosystems (Shegog et al, 2020) could expand a repertoire of available self-care modalities for each indication, further supporting more personalized digital interventions.…”

Section: Examples Of Clinical Benefitsmentioning

confidence: 99%

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

et al. 2021

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To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

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“…The use of digital solutions in epilepsy care is not new but is primarily used for epilepsy care guideline implementation (63%), while web-based resources and technology for clinical decision making are used less widely at just 26 and 12%, respectively. 16 Digital solutions have great potential to help those with epilepsy manage their daily lives, especially as they move through the transition process. As adolescents with epilepsy begin to play a more independent and proactive role in their care, they may struggle with self-management, mental and neurocog-nitive health, and more informed 1:1 communication with their clinical team.…”

Section: Applications In Epilepsy Care Transitionmentioning

confidence: 99%

“…11 Furthermore, these programs have been shown to reduce costly negative health events due to epilepsy. 16 The addition of active and passive monitoring devices can help ease the day-to-day tracking and management of epilepsy. Active monitoring devices such as electronic diaries allow for more efficient seizure tracking, including seizure and symptom reporting, medication reminders, and side effect entry (►Table 1).…”

Section: Digital Technologies For Self-managementmentioning

confidence: 99%

An Overview of Digital Health in the Transition of Pediatric to Adult Epilepsy Care

Bernard-Willis

Oliveira

Lakhan

2020

Journal of Pediatric Epilepsy

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Children with epilepsy often have impairments in cognitive and behavioral functioning which may hinder socio-occupational well-being as they reach adulthood. Adolescents with epilepsy have the added worry of health problems while starting the transition from family-centered pediatric care into largely autonomous adult care. If this transition is not appropriately planned and resourced, it may result in medical mistrust, nonadherence, and worsening biopsychosocial health as an adult. In recent years, there has been increased availability of digital health solutions that may be used during this stark change in care and treating teams. The digital health landscape includes a wide variety of technologies meant to address challenges faced by patients, caregivers, medical professionals, and health care systems. These technologies include mobile health products and wearable devices (e.g., seizure monitors and trackers, smartphone passive data collection), digital therapeutics (e.g., cognitive/behavioral health management; digital speech–language therapy), telehealth services (e.g., teleneurology visits), and health information technology (e.g., electronic medical records with patient portals). Such digital health solutions may empower patients in their journey toward optimal brain health during the vulnerable period of pediatric to adult care transition. Further research is needed to validate and measure their impact on clinical outcomes, health economics, and quality of life.

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Digital and technological opportunities in epilepsy: Toward a digital ecosystem for enhanced epilepsy management

Cited by 24 publications

References 41 publications

Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study

Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

An Overview of Digital Health in the Transition of Pediatric to Adult Epilepsy Care

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