Feasibility, safety and preliminary effectiveness of an epilepsy treatment smartphone application in rural primary care: A two-arm prospective observational study from India.

BACKGROUND

The epilepsy treatment gap remains a major public health challenge in low- and middle-income countries, including India, where up to 90% of people with epilepsy in rural settings receive no treatment. Smartphone applications capable of guiding non-specialist doctors through diagnosis and individualized treatment have been proposed as a scalable solution. We evaluated the feasibility, safety, and preliminary effectiveness of a novel decision-support application -the Epilepsy Treatment Aid (ETA) in rural primary care settings in Chhattisgarh, India.

METHODS

We conducted a two-arm prospective observational study across two rural blocks in Chhattisgarh, India. Primary care doctors at both sites received structured epilepsy training; doctors at the intervention site (Nagri) additionally used the ETA to manage consecutively-presenting people with suspected epilepsy (PWSE). Specialist neurologist assessment at six months served as the reference standard for safety (treatment agreement) and preliminary effectiveness (seizure frequency change) outcomes.

RESULTS

Seventy-two PWSE were recruited at the intervention site and 41 at the control site, yielding evaluable samples of 33 and 29 respectively after exclusions and loss to follow-up at completion of study. The ETA was successfully deployed in all presenting PWSE. Diagnostic agreement with the specialist was 91% in the app group versus 86% in controls. Full treatment agreement was achieved in 71% of the app group versus 48% of controls. Seizure frequency improved in 68% of the app group versus 48% of controls. None of these differences reached statistical significance.

CONCLUSION

The ETA was feasible to deploy in routine rural primary care and was not associated with inferior diagnostic or treatment outcomes compared with epilepsy-trained care alone. These preliminary findings support further evaluation of the ETA as a tool to reduce the epilepsy treatment gap in resource-limited settings.