Digital measures in epilepsy in low-resourced environments

ABSTRACT

Introduction

Digital measures and digital health-care delivery have been rarely implemented in lower-and-middle-income countries (LMICs), contributing to worsening global disparities and inequities. Sustainable ways to implement and use digital approaches will help to improve time to access, management, and quality of life in persons with epilepsy, goals that remain unreachable in under-resourced communities. As under-resourced environments differ in human and economic resources, no one approach will be appropriate to all LMICs.

Areas covered

Digital health and tools to monitor and measure digital endpoints and metrics of quality of life will need to be developed or adapted to the specific needs of under-resourced areas. Portable technologies may partially address the urban-rural divide. Careful delineation of stakeholders and their engagement and alignment in all efforts is critically important if these initiatives are to be successfully sustained. Privacy issues, neglected in many regions globally, must be purposefully addressed.

Expert opinion

Epilepsy care in under-resourced environments has been limited by the lack of relevant technologies for diagnosis and treatment. Digital biomarkers, and investigative technological advances, may finally make it feasible to sustainably improve care delivery and ultimately quality of life including personalized epilepsy care.

KEYWORDS:

• Digital health
• digital endpoints
• biomarkers
• low-resourced countries
• epilepsy
• equity
• wearables
• artificial intelligence

Article highlights

• About 80% of PWE live in low-resource environments, with limited access to healthcare

• Digital endpoints are objective measurements of health outcomes collected using digital devices, such as wearables and smartphones

• In PWE, digital endpoints can provide otherwise unavailable data on seizure frequency, seizure duration, and severity

• Digital readiness, the level of technological infrastructure and digital literacy, is a critical factor in being able to implement digital endpoints in healthcare

• One of the main challenges to deployment is the lack of interoperability between digital health solutions and mobile applications; reasons for this include reliance on legacy systems and a lack of standardization

• Novel digital endpoints, with AI, may help to minimize or mitigate risk by assisting in decision-making of clinical and administrative tasks, major burdens for the LMIC clinician

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.