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

Seizure. 2019 Jan:64:54-58. doi: 10.1016/j.seizure.2018.12.005. Epub 2018 Dec 10.


Purpose: 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.

Keywords: Apps; Epilepsy; Epilepsy treatment gap; Health workers; LMICs; Smartphone applications; Telemedicine; Telephone.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Community Health Workers*
  • Epilepsy* / diagnosis
  • Epilepsy* / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mobile Applications*
  • Nepal
  • Outcome and Process Assessment, Health Care*
  • Rural Population*
  • Seizures* / diagnosis
  • Seizures* / therapy
  • Smartphone*
  • Telemedicine / instrumentation
  • Telemedicine / methods*
  • Telemedicine / standards
  • Telephone
  • Young Adult