Validation of an Epilepsy Management Smartphone Application in Pakistan

Background There is no single way to improve epilepsy care in low- and middle-income countries (LMICs). An epilepsy management aid application (app) has been described, which enables a non-physician health worker (NPHW) to communicate with an epilepsy specialist using a smartphone. In this study, we aimed to assess the validity and quality of this care system in building connections between NPHWs and specialists in Pakistan and the UK. Methods A NPHW in Pakistan used the app on a series of referrals and sent the app-generated summary by email to a neurologist in the UK, who replied and suggested possible management. Patients were later seen in a face-to-face (FF) manner by the UK neurologist and a local neurologist, and diagnostic accuracy and quality parameters were assessed. Results Over 10 months, 59 patients were recruited and 33 of them were available for FF assessment. The misdiagnosis rate of the app was 6% (2 cases). Treatment advice provided by the app was judged appropriate in 32 patients (97%). In addition, 46% of the referrals were completed within 2 h and 85% within 24 h. Conclusions Consistent with an earlier study, this system is a safe method to provide care for patients who cannot access neurological services in person. In addition, it has advantage of timeliness compared to FF assessment and requires less specialist time, both of which are especially important during the coronavirus disease 2019 pandemic. This system can be generalised easily, depending on the willingness of referrers and specialists to use it.