Hold the Smartphone! Tele-epilepsy in a Post–COVID-19 World

Epilepsy is the third leading contributor to global burden of disease for neurologic disorders, affecting 65 million people worldwide.1Ngugi A.K. Bottomley C. Kleinschmidt I. Sander J.W. Newton C.R. Estimation active and life-time epilepsy: a meta-analytic approach.Epilepsia. 2010; 51: 883-890Crossref PubMed Scopus (897) Google Scholar Besides direct impact seizures, with epilepsy (PWE) face problems including disruption work education, psychological stress, social stigma. PWE also require regular outpatient visits optimization antiseizure medication (ASM) therapy, management epilepsy-related problems, counseling on family planning. Unfortunately, often have restricted driving privileges that can hinder traveling these visits. The containment measures established coronavirus 2019 (COVID-19) pandemic further compounded this problem.2Fesler J.R. Stanton S. Merner K. et al.Bridging gap in care: single-center experience 3700 tele-epilepsy visits.Epilepsia. 2020; ([Online ahead print])Crossref (15) Luckily, rapid emergence telemedicine, catalyzed by COVID-19 pandemic, using smartphone applications (apps) offers unique opportunities address these.3Lopez-Jimenez F. Attia Z. Arruda-Olson A.M. al.Artificial intelligence cardiology: present future.Mayo Clin Proc. 95: 1015-1039Abstract Full Text PDF (83) integration telemedicine health care systems has been accelerated increase users, latest figures estimating more than 3.5 billion users worldwide.4StatistaNumber worldwide from 2016 2021.https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide/Date accessed: October 21, 2020Google In issue Mayo Clinic Proceedings, Tatum Acton5Tatum W.O. Acton E.K. Smartphones new age Aquarius.Mayo 2021; 96: 29-31Abstract (1) discuss clinical utility smartphones post–COVID-19 world. authors highlighted massive potential smartphone-based telehealth care, diagnostic value videos (Figure). technology facilitate remote adverse consequences recurrent seizures PWE. Besides, seizure diaries other apps help track document frequency, ASM use, nondrug therapy administration. Furthermore, smartphone-accessible online communities be used improve patient literacy, widen support networks An increasing number patients seeking shortage neurologists limited access care. This especially true which significant specialists exists. become even larger because self-isolation strict lockdowns.2Fesler Fortunately, high-speed Internet now ubiquitous both developed many developing countries.3Lopez-Jimenez These advances made “new normal.” Ample evidence supports successful use diagnosis follow-up PWE.6Hatcher-Martin J.M. Adams J.L. Anderson E.R. al.Telemedicine neurology: Telemedicine Work Group American Academy Neurology update.Neurology. 94: 30-38Crossref (177) A initial visit diagnose living areas centers expertise. It early identification referral an surgery evaluation. Follow-up focus control, adherence, effects, easily performed platform. enables communication community providers allows stay their local while improving consultation higher level when it needed.6Hatcher-Martin Differentiating epileptic psychogenic nonepileptic (PNES) remains art, one supported video encephalography (EEG). wide availability incorporating camera makes possible obtain recording ictal event. Examining accuracy PNES, motor signs are present. recent multicenter trial found physician review high-quality resulted PNES >95% time.7Tatum Hirsch L.J. Gelfand M.A. al.Assessment predictive seizures.JAMA Neurol. 77: 593-600Crossref (73) Clinicians had confidence included video. ability identify without just reviewing could realign resources whom need highest.7Tatum During peak COVID-19, most medical closed monitoring units either free beds or as part temporarily stopping elective procedures. certainly eliminate unnecessary unit admissions Current methods assessing treatment outcomes reducing activity; however, self-reported occurrence unreliable. along prevent seizure-related injuries fostered development wearable devices, paired smartphones, detect real-time continuously.8Bruno E. Viana P.F. Sperling M.R. Richardson M.P. Seizure detection at home: do devices market match needs caregivers?.Epilepsia. (55) single modalities combinations EEG, video, accelerometry, electromyography, electrocardiography, photoplethysmography, electrodermal activity.8Bruno Almost all built-in positioning system receivers, sensing capabilities, motion detectors accelerometers, enabling clinicians “close loop” timely detecting seizures. alarms safety particularly crucial those ASM-resistant who risk prolonged convulsive seizures; left unattended, lead sudden unexpected death epilepsy. Along same lines, smartphone-compatible electrode caps opportunity complete EEG (“tele-EEG”) portable user-friendly.9McKenzie E.D. Lim A.S. Leung E.C. al.Validation among prospective study.Sci Rep. 2017; 7: 45567Crossref (32) Continuous tele-EEG spikes typically precede alert advance (ie, forecasting). Tele-EEG services resource-limited settings.9McKenzie Certainly, there capabilities manage change dynamics self-management. For example, interactions remind take time.10Afra P. Bruggers C.S. Sweney M. al.Mobile Software device (SaMD) digital therapeutics comprising behavioral music-based interventions neurological disorders.Front Hum Neurosci. 2018; 12: 171Crossref (28) latter increases compliance, issues On hand, diary allow record information may give insight into patient’s triggers.10Afra Information form tailor plan. self-management programs such Internet-based psychosocial integrated apps. apps, music therapeutic games, incorporate nonpharmacologic interventions.10Afra addition, provide self-learning providing relevant educational content expand acknowledged although possibilities smartphone-assisted endless, ethical legal remain concern. When begins resolve, due diligence required ensure privacy addressed appropriately. Gaps access, confidentiality, errors, malpractice attention. Smartphone share sensitive data advertisers parties ways not anticipated users. sensors designed collect household’s activities wishes keep private. From standpoint, capture entire period only postictal period, potentially misguiding correct diagnosis.7Tatum Importantly, wide-reaching, cannot replace face-to-face (“doctor’s touch”) some circumstances. technology, combined artificial intelligence, advancing rapidly.3Lopez-Jimenez Integrating will underserved rural improves comanagement between providers. era costs, reduce costs. continuous inform decisions. Smartphone-assisted opened avenues undoubtedly populations. Practical tools, indeed normal” PWE’s long-term However, platform requires regulation standardization consistency quality its application safeguard pertaining security. Epilepsy: New Age AquariusMayo ProceedingsVol. 96Issue 1PreviewOvernight, forced clinics hospitals over world transition mobile units.1 Now, catapulted action molecule ribonucleic acid, delivery way we practice medicine changed forever, making standard operating procedures clinic-based obsolete. staple society gradually incorporated infrastructure professions, Full-Text