Validation of a phone app for epilepsy diagnosis in India and Nepal

Patterson, Victor; Singh, Mamta Bhushan; Rajbhandari, Hemav; Vishnubhatla, Sreenivas

doi:10.1016/j.seizure.2015.05.011

Cited by 38 publications

(37 citation statements)

References 11 publications

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“…Patterson et al 2015 56 In rural areas telemedicine programs started through non-medical health workers to reach out people who cannot access quality epilepsy care due to the shortage of skilled physicians Community health workers visited door-to-door in order to fill up the appbased questionnaire to identify people with Epilepsy. These data were later used to design comprehensive services.…”

Section: Videoconferencing and Teleconsultationmentioning

confidence: 99%

“…The current review identified 11 papers reporting the issue of shortage of healthcare service providers. 29,39,[42][43][44][45][46][47][53][54][55][56] 3 papers have highlighted the issue of inadequate health facilities. 29,41,54 These three papers discussed one common thing, which was the lack of skilled and specialized healthcare service providers outside of the mega cities of Nepal.…”

Section: Satellite Phone Patient Data Sharing Portable Computer Andmentioning

confidence: 99%

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<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

Siddiquee¹,

Poudyal²,

Pandey³

et al. 2020

SHTT

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The traditional model of health services imposes limitations, especially in resourcelimited countries like Nepal. Introduction to information technology can mitigate various challenges like geographic complexity, urban-rural disparity, poor accessibility, shortage of healthcare professionals, inadequate health facilities, higher cost, and time. Nepal is a resourcelimited country with diverse geographic features making it hard to have proper access to healthcare facilities. Telemedicine service has the potential to improve service quality and accessibility of the disadvantaged and underserved population by overcoming the existing challenges. The objective of this review was to explore the roles of telemedicine in vanquishing existing challenges. Seven data sources (namely CINAHL, PubMed, POPLINE, Web of Science, Scopus, DOAJ and Summon) were consulted using five keywords (telemedicine, telehealth, eHealth, mHealth and Nepal to find the literature using the Boolean operator AND) to obtain the relevant materials. The narrative synthesis method was used to review papers and to analyze the findings. This review selected 27 papers for further analysis by scrutinizing 1161 initial search results. The most common features of telemedicine services so far, implemented or piloted in Nepal, were addressing geographic remoteness (21%), a shortage of in healthcare service providers (11%), saving time (11%), addressing challenges of extreme conditions (10%), cost saving (9%), service quality (9%) and real-time services (8%). Some other features of telemedicine were communication, transportation, referral, collaboration, addressing challenges in proper diagnosis and the shortage of health professionals. In a nutshell, the review findings suggested improved service quality, increased collaboration and accessibility and decreased the disparity in comparison with traditional health service models. Although it cannot be said that telemedicine in Nepal has been mainstreamed, yet the appeal is increasing due to its positive impact, especially in rural and hard-to-reach areas where with a lack of healthcare set-up and professionals.

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Section: Videoconferencing and Teleconsultationmentioning

confidence: 99%

Section: Satellite Phone Patient Data Sharing Portable Computer Andmentioning

confidence: 99%

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

Siddiquee¹,

Poudyal²,

Pandey³

et al. 2020

SHTT

View full text Add to dashboard Cite

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“…This has been presented as a smartphone application [9] (app) which, in response to a series of questions, generates a probability score of the episodes being epileptic or not. The algorithm underlying the app uses a Bayesian approach and was developed in a Nepalese population [10] and validated in India and Nepal [11]. This app, presented on a tablet computer, can be used easily by computer-naïve NPHWs [12] and, when compared to the diagnosis of a neurologist, can generate similar agreement to that of local doctors studies [11,13]with specificities of 100% and 33%.…”

Section: Introductionmentioning

confidence: 99%

“…The algorithm underlying the app uses a Bayesian approach and was developed in a Nepalese population [10] and validated in India and Nepal [11]. This app, presented on a tablet computer, can be used easily by computer-naïve NPHWs [12] and, when compared to the diagnosis of a neurologist, can generate similar agreement to that of local doctors studies [11,13]with specificities of 100% and 33%. More importantly its misdiagnosis rate was 8% compared with 25% for the tool designed in South Asia by Anand et al [14].…”

Section: Introductionmentioning

confidence: 99%

Epilepsy field workers, a smartphone application and telephone telemedicine: Safe and effective epilepsy care in rural Nepal

Rajbhandari

Joshi

Malakar

et al. 2019

Seizure

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A B S T R A C TPurpose: Most people with epilepsy live in low-or middle-income countries (LMICs) where there are relatively few doctors. Over 50% of people with epilepsy in these countries are untreated so other models of care are needed. In this report we evaluate a novel model of care. Methods: We trained four residents of Myagdi, a rural district in Nepal as epilepsy field workers (EFWs). They provided epilepsy awareness to their communities. When they identified someone with possible epilepsy they used a smartphone application (app) to determine the probability score for an episode being epileptic and contacted an epilepsy specialist by phone. If the specialist thought treatment was indicated this was arranged by the EFW. We recorded mortality, change of diagnosis at face-to-face consultation and drug-related events as measures of safety. Seizure frequency and general wellbeing were also recorded, and a questionnaire was devised to measure satisfaction. Results: 112 patients with app scores suggesting epileptic seizures were identified and managed in 18 months, of whom 15 had provoked seizures. Forty-three percent of epilepsy patients were untreated. At follow-up one had died of a cause other than epilepsy. Diagnostic agreement at face-to-face assessment was 93%. Overall 5% had side-effects of medication. Seizures were stopped in 33% and reduced in 57%. Ninety-six percent of patients preferred this service to travelling to other doctors. Conclusion: This novel service met all criteria of safety and was effective in reducing frequency of seizures. Patients preferred it to conventional services. It should be transferable to other LMICs. [13]. The sensitivity of this app was 92% and 86% in two previous https://doi.

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“…Dr Brunklaus raises excellent points regarding the potential for misdiagnosis of epilepsy in intellectual disability (ID) and the paucity of rigorously tested screening tools for epilepsy, particularly when it is comorbid with neurodevelopmental features such as ID and autism spectrum disorder. This is a major unmet need, particularly in resource‐poor health‐care settings where app‐based screening tools have been trialed to reduce the treatment gap . We did not propose that the ESQ could be used to diagnose epilepsy; our intention was to screen for signs and symptoms that might suggest a history of seizures.…”

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confidence: 99%

Response to letter to editor: “Knowing when and how to use epilepsy screening questionnaires”

et al. 2020

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Validation of a phone app for epilepsy diagnosis in India and Nepal

Abstract: A tool presented as a phone app can be used by non-medical health workers to identify episodes as epileptic or not with good accuracy. It needs to be evaluated more widely but has the potential to play a part in reducing the epilepsy treatment gap.

Cited by 38 publications

References 11 publications

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

Epilepsy field workers, a smartphone application and telephone telemedicine: Safe and effective epilepsy care in rural Nepal

Response to letter to editor: “Knowing when and how to use epilepsy screening questionnaires”

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