Abstracts

Rationale: Epilepsy is a paroxysmal disease and access to emergent care and follow up is often delayed. The WHO estimates that 80% of the 50 million people with epilepsy (PWE) worldwide live in low- and middle-income countries. Three-fourth of this population do not get the access to the care they need. Over the past few years, mobile health (mHealth) technologies have been shown to address the treatment gap and be cost effective, potentially addressing the health disparity in other chronic diseases. In India, physicians providing epilepsy care are concentrated to metropolitan cities and in some regions the treatment gap is 90%. However as of 2016, 88% of households in India have access to a mobile phone. Thus, mHealth technologies have immense potential to improve access to health care. The overall aim of this project was to demonstrate that SMS text messaging is a feasible and acceptable method to obtain urgent health care in patients with epilepsy in resource poor populations. Methods: This study was conducted in New Delhi, India. A total of 59 adult PWE, who had access to a mobile phone were recruited over a two-week period. A total of 39 patients were given access to the SMS helpline. 20 patients served as control. Those who had access to the seizure SMS help line were asked to send a text message for a seizure urgency (status epilepticus, breakthrough seizures, drug side effect, pregnancy in a PWE) via a numeric code. For patient safety, every SMS received a text notification to seek immediate medical care if the patient was having seizures and not recovering. Half of the patients who had access to the helpline were also given a call back within 6 hours of sending a notification. Demographics, seizure history and baseline quality of life metrics via QOLIE-10-P were collected. Results: During the recruitment, all except two patients expressed that an SMS helpline would be helpful. The patient’s average distance from a neurologist was greater than 150 km (> 5-hour travel time) in both cohorts. Excluding patients who were reported to be seizure free for >2 years, 19.4 % of the patients used the helpline in a 3-month period. While, 11% of patients in the test group had a prior history of status epilepticus, patients only used the helpline to report breakthrough seizures. Our preliminary results showed that pre-intervention overall quality of life measures were more positive than negative. This was a limitation as small improvements may not be discernable with small sample sizes. Conclusions: SMS text messages can be a practical and acceptable method to seek urgent help in patients with epilepsy who reside in regions with poor access to healthcare. Our preliminary data show that patients are most likely to use a SMS helpline to report breakthrough seizures than other seizure emergencies. The results of this study will pave the way for development of further largescale projects to evaluate parameters and develop protocols for providing safe and effective care to epilepsy patients via mobile health technologies. It will also be used to advocate for the need for increased access to care using novel means such as an SMS help line. Funding: No funding