Hemav Rajbhandari

Bio: Hemav Rajbhandari is an academic researcher from Kathmandu. The author has contributed to research in topics: Epilepsy & Cross-sectional study. The author has an hindex of 3, co-authored 4 publications receiving 49 citations.

Validation of a phone app for epilepsy diagnosis in India and Nepal

Abstract: Purpose Untreated epilepsy is a major global public health problem with more than 20 million people not being treated for an easily treatable disease. In part this is due to a lack of trained doctors. There are many more non-medical health workers than doctors and they could have an important role in diagnosis and treatment of epilepsy if they had some tools. We have previously described such a tool to distinguish epileptic episodes from other causes of altered consciousness and here present its validation in three new populations. Methods The tool was presented as a phone app where the answers to 11 questions provided a probability score which indicated whether episodes might be due to epilepsy or not. It was applied either by non-medical volunteers, health workers, or inexperienced doctors to 132 patients in three separate populations in India and Nepal and compared with the "gold standard" diagnosis of a neurologist with expertise in epilepsy. Results There was good agreement between the app score and the neurologists' diagnoses (weighted kappa=75.3%). An app score of 90 or greater had a sensitivity of 88% and a specificity of 100% for diagnosing epilepsy. The app was easy to use with little training and took about 5min to administer. Conclusion A tool presented as a phone app can be used by non-medical health workers to identify episodes as epileptic or not with good accuracy. It needs to be evaluated more widely but has the potential to play a part in reducing the epilepsy treatment gap.

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

Abstract: 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.

A Phone App to Diagnose Epileptic Seizures: A Useful Tool to Reduce the Epilepsy Treatment Gap in Poorer Countries (I10-1.009)

Abstract: Objective To devise and test a phone app to enable non-doctors to diagnose epileptic seizures. Background If the epilepsy treatment gap in the developing world is to be closed then health professionals other than doctors must be involved with epilepsy management. To do this they will need some tools to help them. The diagnosis of episodes of altered consciousness as epileptic seizures is key to the management of epilepsy. Traditionally done by doctors and time-consuming, this relies on asking questions and analysing the replies. It should be possible to design a tool to do this using a Bayesian approach. This would enable the diagnosis to be made by non-doctors and so save precious medical time. Design/Methods Sixty-seven consecutive patients attending epilepsy clinics at Dhulikhel Hospital, Nepal and its outreach centres were asked a series of about 26 questions about their episodes. A diagnosis of “epileptic seizure (E)” or “not epileptic seizure (NE)” was reached clinically. Retrospectively, for each question the Likelihood Ratio (LR) of having E or NE was calculated and the most informative LRs identified. These were then used sequentially and incorporated into a mobile phone app. This was then validated in two different populations in Nepal and India and compared with the independent clinical diagnosis. Results Of the 67 patients originally seen, 51 had E giving a pre-test probability of 0.76. Eleven questions were identified with an LR>3 and incorporated into the app. The app was then validated in 132 patients from two different populations. Non-doctors were able to use it with minimal training. The app separated those with E and NE with near-complete reliability. Conclusion A phone app has been designed to diagnose epileptic seizures and works well in practice. It should be particular useful where medical input is scarce or non-existent. Disclosure: Dr. Patterson has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Rajbhandari has nothing to disclose.

Theoretical Advancements in mHealth: A Systematic Review of Mobile Apps.

Abstract: There are now few hundred thousand healthcare apps, yet there is a gap in our understanding of the theoretical mechanisms for which, and how, technological features translate into improved healthca...

Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country.

Abstract: Introduction The ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects. Methods Clinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time. Results A total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice. Conclusion Teleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.