As a second year epilepsy fellow I will be traveling to the Foundation for African Medicine and Education (FAME) Clinic in Tanzania with my attending Dr. Kulick-Soper to help implement a point-of-care EEG system (BrainCapture) in the inpatient setting and further optimize patient selection and use in the outpatient setting. BrainCapture is a full-montage EEG that can be applied by staff without specific EEG training and is read remotely by trained healthcare providers. Thus far it has been implemented in the FAME clinic in the outpatient setting in a limited capacity. Our goal would be to develop a protocol for inpatient administration of the device, for example in the ICU or emergency department. We intend to meet with clinic leadership as well as healthcare providers and patients to understand logistically how the BrainCapture EEG could be integrated into existing practices. We then intend to develop and implement a protocol for its use.
In addition to our inpatient goals, we also aim to optimize the outpatient use of the BrainCapture system. By reviewing the current selection criteria we intend to develop a more streamlined and precise process to potentially increase the diagnostic yield of the EEG and identify patients at higher risk of seizures and epilepsy who might benefit from initiation of an antiseizure medication.
In the inpatient (ICU/ED) context, this project would be of benefit to encephalopathic or comatose patients in whom the etiology of their altered mental status is unclear and could be secondary to non-convulsive status epilepticus (NCSE). Several studies have identified prevalence of NCSE in 8-10% of comatose ICU patients and this prevalence has been observed as high as 20% of comatose patients specifically in neurointensive care units. Using EEG to reveal NCSE within the inpatient setting at FAME could identify a population of patients with a potentially reversible cause for their encephalopathy that could be managed with antiseizure medications. This is a particularly important population as there are numerous other etiologies of altered mentation that are less directly treatable/reversible.
As noted above, we also aim to address the need of patients with seizure disorders/epilepsy in the outpatient setting who have had difficulties arriving at a clear diagnosis. Seizures reflect a paroxysmal disturbance of the central nervous system, lasting several seconds to minutes at a time and may occur days, weeks, and months apart. Seizures often occur when an individual is alone and as patients are often amnestic to the event, it can be very challenging to obtain an accurate description of it. Certain features on EEG, such as interictal epileptiform discharges (IEDs) significantly increase the likelihood of a patient having epilepsy. By identifying patients with features that put them at higher risk of having epilepsy and IEDs, we could increase the yield of using EEG to capture a limited sample of time.
The University of Pennsylvania has an established connection with the FAME Clinic in Tanzania, through the efforts of Dr. Michael Rubenstein. Dr. Rubenstein has maintained regular trips to FAME with neurology residents and faculty to provide neurological care and teaching/training services to the community. Given this existing framework, my project aimed at implementation of point-of-care EEG would prove relatively easy to sustain as there will be ongoing trips with neurological providers, even if epilepsy trained physicians do not return.
Even in the absence of the neurological care and training provided to FAME by Penn, this project would be relatively easy to sustain due to the ease of applicability of the BrainCapture device (not requiring trained EEG technologists to apply) and the ability for remote review of the data (allowing EEG readers to review from distant sites).
