A smartphone EEG to diagnose seizure disorders in Bhutan

The new screening app, a $300 device, could dramatically raise the global level of diagnosis and treatment of epilepsy, a problem that affects 1 in 100 people — 65 million worldwide, an estimated 80 to 90% of them in developing countries, of which at least 60% go untreated.  The high incidence of epilepsy in developing countries is attributed to higher rates of head injuries and certain infections, including cerebral malaria. University of Ottawa-based researchers will pioneer tests of the technology in Bhutan, a small South Asian kingdom at the rugged eastern end of the Himalayas, landlocked between India, Nepal and China.  While there are two psychiatrists, not a single neurologist practices full time in Bhutan, a nation of 900,000 people with an estimated 10,000 epilepsy cases, most of them undiagnosed, says project leader Farrah Mateen, a neurologist and faculty member of both the University of Ottawa and the Massachusetts General Hospital of Harvard Medical School.  And, she says, there is only one EEG machine, working intermittently at the Jigme Dorji Wangchuk National Referral Hospital, the tertiary care centre in Bhutan’s capital, Thimphu. “Epilepsy is characterized by recurrent, unprovoked seizures and, in many poor countries like Bhutan, sufferers are stigmatized and ostracized — often feared by the ill-informed to transmit the illness through saliva.” says Dr. Mateen.  “Such beliefs prevent epilepsy victims from getting the help they need during a seizure, which causes many serious injuries and death, often due to drowning or burns.”  An EEG detects tiny electrical impulses produced when brain cells communicate with each other.  Typically, a test involves placing electrodes on the scalp, connected by wires to a speaker and recording machine. The brain's electrical signals are turned into wave patterns viewed on a computer as the patient is asked to, for example, breathe quickly and deeply, or to look at a bright flashing light. Dr. Mateen and colleagues will gather the results of tests conducted with the EEG app, developed with the help of Danish Technical University using open-source software (offering the potential for rapid global scale-up), and compare them against those of more expensive stationary equipment. The new device connects 14 electrode leads on the scalp through the headphone jack of a tablet or smartphone to capture the brain’s electrical activity. The data can then be sent via cellular phone network to specialists for interpretation. The ultimate goal: to enable a community-level primary healthcare worker anywhere in the world to diagnose seizure disorders.  In the case of epilepsy, it can be treated with drugs that are both effective and inexpensive (as little as a few cents a day). Says Dr. Mateen:  ""We particularly look forward to introducing the device in settings where children suffering seizures and related disorders are subjected to discrimination, and to study whether better diagnosis reduces stigma and increases social integration.” She sees the tablet/smartphone EEG as an effective solution to the shortage of neurologists in low-income countries. “Data show that 12 African countries with a combined population of 26 million don’t have a single neurologist, and 23 other countries —  average population, 5 million —  have four or fewer neurologists. By comparison, the WHO in 2004 reported Western countries average one to 10 neurologists per 100,000 inhabitants.” “Populating the world with neurologists, which involves training of a decade or more, is impossible. But we can roll out technology that is cheap and simple to use.” “People in Asia and Africa will be able to get a diagnosis and hopefully treatment, instead of going their entire lives without knowing that what they suffer from is epilepsy.”"