Catching and counting seizures for patients with Epilepsy using an automated telemedicine platform – EpxEpilepsy
Chen RY 1*, Zhang S 2*, Javaherian K 1, Groenedyk JW 1, Pan M 2, Maccotta L 3
- * Authors contributed equally to this work
- 1 Washington University School of Medicine
- 2 St. Louis University School of Medicine
- 3 Department of Neurology, Washington University School of Medicine
Epilepsy management continues to be a major difficulty in the clinic due to long wait periods between clinic visits and inaccurate seizure monitoring. Current methodology revolves around self-recorded seizure diaries, which can be inaccurate and incomplete, and accurate monitoring is difficult without invasive implants. Accurately tracking seizures with high temporal resolution is critical for medication titration, which is key to reducing the time to seizure freedom. In this study, we undertook the design and implementation of a novel, pro-active telecommunication tool, EpxEpilepsy, to more accurately and frequently track seizures, thereby improving the management and care of epilepsy patients.
EpxEpilepsy is an automated communication service that uses SMS (text message) and phone communications – free of charge to the patient – to ask patients about seizure events every week. Patient responses are tracked and summarized for the provider both in text and graphical formats. Furthermore, smart alerts notify the provider of high-risk individuals, with recommendations for intervention such as medication titration. EpxEpilepsy was designed by a series of interviews with community and academic physicians and patients.
In this report, we demonstrate the design and pilot testing of EpxEpilepsy at the Washington University Epilepsy Center. 9 patients with a diagnosis of epilepsy were enrolled in the EpxEpilepsy system. Patients received one text message every week for 4 weeks. After the 4 week pilot, patients were called and interviewed to better understand their experience using the EpxEpilepsy platform. The goal of the pilot was to track response rates, message fatigue, and the number of seizures that could be detected by the system.
We find that with our initial pilot performance testing in 9 patients, we achieved an 86.1% response rate and detected 84 seizures during the 4 week pilot.
Our study demonstrates that weekly messages asking about seizure frequency are both well tolerated and effective at tracking seizures in patients with epilepsy. During the 4 week period, we observed no message fatigue, and were able to track more than 84 seizures, with new seizure data reaching the provider each week on a patient-by-patient basis. While the study suffers from a small sample size and a non-randomized uncontrolled design, our data suggest that EpxEpilepsy provides a promising platform for proactive seizure tracking in epilepsy patients that warrants further investigation in larger studies. As such, a randomized case-control trial with a larger sample size examining EpxEpilepsy’s effect on time to seizure freedom is ongoing. Here, we present a comprehensive trial protocol to test the capability of EpxEpilepsy to aid in the management of epilepsy. Finally, we present a cost-benefit analysis that demonstrates the capability of EpxEpilepsy to enable new revenue generation for providers under recent fee-for-service codes.
EpxEpilepsy is a proactive system to help patients track seizure frequency on a weekly basis. Seizure frequency of individual patients can be accessed easily at any time through this portal, with patients triaged through an algorithm that takes into account individualized seizure frequency baselines so that more critical patients are prioritized.