Smartphone EEG and remote online interpretation for children with epilepsy in the Republic of Guinea: Quality, characteristics, and practice implications

Abstract

Children with epilepsy in low-income countries often go undiagnosed and untreated. We examine a portable, low-cost smartphone-based EEG technology in a heterogeneous pediatric epilepsy cohort in the West African Republic of Guinea. Methods: : Children with epilepsy were recruited at the Ignace Deen Hospital in Conakry, 2017. Participants underwent sequential EEG recordings with an app-based EEG, the Smartphone Brain Scanner-2 (SBS2) and a standard Xltek EEG. Raw EEG data were transmitted via Bluetooth ™ connection to an Android ™ tablet and uploaded for remote EEG specialist review and reporting via a new, secure web-based reading platform, crowdEEG. The results were compared to same-visit Xltek 10-20 EEG recordings for identification of epileptiform and nonepileptiform abnormalities. Results: : 97 children meeting the International League Against Epilepsy's definition of epilepsy (49 male; mean age 10.3 years, 29 untreated with an antiepileptic drug; 0 with a prior EEG) were enrolled. Epileptiform discharges were detected on 21 (25.3%) SBS2 and 31 (37.3%) standard EEG recordings. The SBS2 had a sensitivity of 51.6% (95%CI 32.4%, 70.8%) and a specificity of 90.4% (95%CI 81.4%, 94.4%) for all types of epileptiform discharges, with positive and negative predictive values of 76.2% and 75.8% respectively. For generalized discharges, the SBS2 had a sensitivity of 43.5% with a specificity of 96.2%. Conclusions: : The SBS2 has a moderate sensitivity and high specificity for the detection of epileptiform abnormalities in children with epilepsy in this low-income setting. Use of the SBS2+crowdEEG platform permits specialist input for patients with previously poor access to clinical neurophysiology expertise.

COVID-19 response in low- and middle-income countries: Don’t overlook the role of mobile phone communication

“… Epilepsy Use of a valuable diagnostic test that was previously unavailable in a particular setting creates the possibility for appropriate treatment alteration. Williams et al (2019) Vula Mobile: a free app that connects, for example, primary healthcare workers who work in rural areas directly with medical specialists in urban centres across South Africa. N/A Better health care for patients in under-resourced areas and stronger links between different levels of South Africa’s health services.…”

Tablet‐based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea

“…The high specificity and reduced sensitivity of this system were demonstrated by our group previously. The specificity for EDs is similar to that of Xltek ® (Natus Medical Inc., Pleasanton, CA, USA) standard EEG technology [6,7]. Handheld devices hold promise because they enable low‐cost capture, processing and transmission of EEG data in regions where a standard EEG machine would be financially inaccessible.…”

“…Quality scores were assigned by individual readers with a range from 1 (worst quality, uninterpretable) to 10 (best quality, easily readable without artifact) [6]. Readers were able to enter notes further explaining their interpretation.…”

“…Data interpretation was possible via a secure web‐based reading platform (crowdEEG; http://crowdeeg.ca) [6,7]. The crowdEEG platform provides a centralized portal for remote EEG interpretation by neurophysiologists, ensuring consistent montage and filter options as well as a fully integrated and customizable input template.…”

“…Compared with standard EEG technology, this is emerging as a lower‐cost, portable and user‐friendly option. Previous work by our group demonstrated that a mobile software app with an off‐the‐shelf headset called the Smartphone Brain Scanner‐2 (SBS2) has a moderate sensitivity and high specificity for the detection of epileptiform abnormalities and that the use of this platform enables patients who otherwise would not have access to specialist input, access to expert clinical epilepsy or EEG support [6,7]. Here we report a new longitudinal cohort of PWE in the West African Republic of Guinea across all ages.…”