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