Authors :
Presenting Author: Morris Scantlebury, MBBS – University of Calgary
Sesh Gowrie-Sankar, MBBS – University of the West Indies; Bruce Lavin, MD,MPH – BioSerenity, Inc.; Vincent Mysliwiec, MD – BioSerenity, Inc.; David Corbin, MBBS – University of the West Indies; Avidesh Panday, MBBS – University of the West Indies
Rationale: There are significant disparities in epilepsy care between resource-limited (RL) and more affluent nations, particularly with time to diagnosis and treatment of people with epilepsy. This often leads to delayed or inappropriate treatment with anti-seizure medications (ASMs) and increased morbidity. RL areas are faced with challenges in implementing ambulatory EEG (ambEEG) monitoring. Barriers include the availability of skilled personnel and trained epilepsy specialists, and associated costs of acquiring and maintaining the necessary technology to perform the studies.
Methods: We describe an innovative approach for establishing remote Virtual EEG Clinics (rVEC) to overcome these obstacles in the Southern Caribbean region, utilizing
portable remote EEG recording devices (Neuronaute
®-Bioserenity) and disposable electrode net head devices (ICE Cap
®-Bioserenity) to provide ambEEG monitoring. Through Nyota Tano Diagnostics, the rVECs were established at three locations in the Caribbean: Barbados (BDOS), Trinidad and Tobago (TT), and Dominica (DOM). In BDOS, trained technologists conducted recordings, while in TT, neurology residents and nurses received training to perform ambEEG, and in DOM, nurses received training to perform ambEEG. Local clinic physician partnerships facilitated patient referrals for the ambEEG studies.
Results: From April 2022 through June 2023, 152 patients received EEGs in three Caribbean rVECs for the assessment of epilepsy. Patients were referred to rVECs with indications ranging from myoclonus to confirming non-convulsive status epilepticus. The EEGs were performed in 68, 73, and 11 patients at BDOS, TT, and DOM respectively. Adults (
>18 years) accounted for 102 patients (67%), while 50 (33%) were pediatric (neonate through 16 years). Of the EEG studies performed, a majority (108/152, 71%) were prolonged (≥ 24-hr) ambEEG studies and 44 (29%) were routine (≤ 60 minutes). Studies were performed in clinics (133, 88%), or in hospitals (17, 12%; with 13 in ICU, 4 in ward) and two studies were performed at the patients’ homes. The EEG data was transmitted via a secure HIPPA compliant cloud platform to a board-certified neurologist in Canada for interpretation. The final EEG report was transmitted to the referring physician and when appropriate, the neurologist provided virtual consultation to the local clinicians, ensuring effective management of the patients. Abnormal EEG findings were observed in 28% (43/152) allowing for timely and appropriate diagnosis and treatment of patients.
Conclusions: In regions where performing EEG are limited by lack of resources, virtual consultations and remote ambEEG can reduce the burden on healthcare systems and improve patient care, aligning with PAHO resolution CD55.R12 goal of improving health care access by leveraging technology. This novel approach represents a significant step towards improving epilepsy care and diagnosis in resource-limited settings.
The remote Virtual EEG Clinic model can serve as a template to enhance similar care in other resource limited areas.
Funding: None