According to the World Health Organization, an estimated 50 million people worldwide are living with epilepsy, making it one of the most prevalent neurological disorders globally.
Nearly 80% of these individuals reside in low and middle-income countries, underscoring the urgent need for improved diagnosis, treatment, and access to care in these regions. Brain Capture, a Danish company and a TechPeople[1] client, is trying to address the problem with new smart technology.
Originally the idea that ended up as BrainCapture was to just build a system with off-the-shelf modules and code an app so you could see your brain waves spinning around on the phone. And the whole thing started as a research project in 2014 at DTU (The Danish Technical University) with the name: “The Smartphone Brain Scanner: A Portable Real-Time Neuroimaging System”, with Tue Lehn-Schiøler as the project manager.
Tue Lehn-Schiøler and the research team travelled the world demonstrating the brain scanner at conferences around the world, and at one of them they met the American doctor, Farrah Mateen. She believed that the scanner could be used to diagnose epilepsy in 3rd world countries, where one typically does not have measuring equipment to measure EEG signals. She asked the DTU researchers to build several prototypes for her, which she subsequently tested, among other things, in Guinea and Bhutan.
In the spring of 2018, Mateen went back to Tue and his team at DTU. The original idea and equipment were now four years old, and about to be worn out. Also, the original research project had expired. Believing in their technology and its potential Tue and the research team quit their jobs at the university and started BrainCapture.
First thing on the agenda was to update the hardware and make it future ready. Tue Lehn-Schiøler and his colleagues had to build some new scanners, then travel to Guinea in August to meet Farah Mateen and perform scans on local patients with suspected epilepsy.
We called TechPeople to ask if they could help us revive the old technology, says Tue Lehn-Schiøler. We had some old boxes lying around that needed to be disassembled and modified to fit the system. In addition, the old software had to be updated and installed on some new devices. We did that pretty quickly with Akkodis over the summer. In Guinea, we then conducted a large number of scans, and everything went as it should.
BrainCapture’s project manager Tue Lehn-Schiøler and Harvard researcher Farrah J. Mateen were welcomed with open arms when they travelled to Guinea’s capital Conacry in 2018 to test their epilepsy scanner at the local Ignace Deen hospital. The BrainCapture system is affordable and mobile, unlike the stationary, advanced and expensive EEG scanners that only a few low- and middle-income countries can afford. In many countries there is at most one, in others there are none. Therefore, the WHO estimates that 2 million new cases of epilepsy annually are not diagnosed.
In Conacry, the researchers scanned 400 patients in two weeks, to test five BrainCapture prototypes, and to present the system to local neurologists. Tue Lehn-Schiøler and his colleagues confirmed that the need for a low-cost EEG solution is enormous: in sub-Saharan Africa alone, there is a need for around 1 million scans, annual.
Now BrainCapture has developed a new version of its mobile scanning equipment. The system consists of a “bathing cap” with sensors, a recorder the size of a matchbox, a smartphone app and cloud-based diagnostic software. Instead of the patients having to travel to a remote neuro-clinic, the BrainCapture system can perform scans at the local health center. After the scan, data is sent to the experts, who can make a diagnosis at a distance. Typically, one in three scans shows a positive result.
For the BrainCapture solution to work it needed to be both cheap and robust, and rare combination. Also, since the solution is defined as “medtech” it must meet strict standards and regulations. Any software or hardware failures stops the process of getting certified, which is a necessity in order to reach a commercial stage.
When we got home, we decided to make ourselves independent of the off-the-shelf modules we had used until then. For the system to work in the long run, we needed a cheaper and better version, with some hardware that we could control ourselves. Here we again asked Akkodis to help us, explains Tue. TechPeople helped us early on to develop electronic architecture that would allow a low-cost amplifier that still delivered really high quality, adds Paul Loomis, Chief Commercial Officer in BrainCapture.
TechPeople provided expertise that enabled cheap, but reliable electronics for controlling the measuring circuits and some measuring amplifiers that boost the signal from the electrodes. Which in turns ends up as measurement data sent to a smartphone or tablet, and from there on to a server that enables the machine learning functionality.
One of BrainCapture’s clever moves is to use the smart phone as key component in their product. Smartphones, with their widespread availability and diverse capabilities, have the potential to revolutionize healthcare delivery in impoverished nations. Firstly, health-related applications can facilitate remote consultations, enabling patients in remote areas to connect with healthcare providers without the need for expensive and time-consuming travel.
Secondly, smartphones can serve as educational tools, providing access to videos, infographics, and interactive apps that help individuals learn about various health conditions, including epilepsy. By dispelling myths and reducing stigma, these resources contribute to greater awareness and understanding. Additionally, smartphones can aid in medication management, allowing users to set reminders for regular intake, log side effects or seizure episodes, and share this information with healthcare providers to optimize treatment.
Finally, in regions where access to specialists is limited, smartphones can support telemedicine. Healthcare workers in rural settings can capture and transmit data to specialists who can then provide expert guidance on diagnosis and treatment.
In addition to BrainCapture’s own app other mobile applications have the potential to transform epilepsy diagnostics, particularly in impoverished regions where traditional healthcare resources are limited. Firstly, seizure tracking apps can enable users to record seizure episodes, their frequency, duration, and associated symptoms. This data can then be shared with healthcare professionals, aiding in diagnosing the type of epilepsy.
Mobile apps can use machine learning algorithms to analyze real-time data, such as video or sensor input, to detect seizures. For example, there are apps capable of analyzing video feed to detect unusual movement patterns or changes in facial expressions indicative of a seizure. These data can be invaluable in establishing a diagnosis, particularly in the absence of a healthcare professional.
Additionally, some apps can use wearable sensor data, like heartbeat or sweat gland activity, to detect possible seizure events. Mobile apps may also facilitate genetic testing for epilepsy, where users can order home testing kits and receive results via the app, further aiding in diagnosis and the selection of appropriate treatments.
Securing a proper diagnosis for individuals with epilepsy in impoverished nations is not just important, but crucial for several compelling reasons. Firstly, an accurate diagnosis lays the foundation for appropriate treatment, reducing the risk of debilitating seizures and potentially fatal consequences. Without the correct diagnosis, effective management becomes unattainable.
Secondly, it plays a pivotal role in diminishing the social stigma associated with epilepsy, which is unfortunately prevalent in such societies. By highlighting that epilepsy is a medical condition and not a supernatural affliction or a sign of mental impairment, a correct diagnosis helps dispel misconceptions and foster understanding. Lastly, a proper diagnosis can enhance access to support services, improving the overall quality of life for affected individuals.
Accessing treatment for epilepsy in less affluent countries can pose significant challenges. The scarcity of medical resources, including trained healthcare professionals and essential antiepileptic drugs, creates formidable obstacles. Furthermore, the high cost of medical care and travel to healthcare facilities, often located in urban centers, may be prohibitive for many. Consequently, the treatment gap in these regions remains substantial, with numerous affected individuals unable to access the necessary care.
The availability of healthcare workers specialized in epilepsy in impoverished nations is extremely limited. The scarcity of qualified neurologists and other healthcare professionals specializing in epilepsy presents a critical issue that significantly contributes to the treatment gap. In many low and middle-income countries, the neurologist-to-population ratio is alarmingly low, with some regions having as few as one neurologist for every one million people.
Furthermore, these professionals are often concentrated in urban areas, leaving rural populations underserved. Training programs for healthcare workers in epilepsy care are scarce, and the lack of standardized and culturally appropriate training materials further exacerbates the issue. This shortage of specialized healthcare providers underscores the urgent need for enhanced training and resource allocation to improve epilepsy care in these regions.
There is still some way to go before the BrainCapture system can be produced on a large scale. Before then, the new BrainCapture equipment must be tested at epilepsy hospitals in Denmark and the USA to document that they provide reliable data. In addition, the system must go through a series of medical approval procedures.
But the potential is great. According to Tue Lehn-Schiøler, the new version of the system will help to spread effective epilepsy diagnostics to a huge population group who currently do not have the opportunity to have their disease treated.
The primary market remains low- and middle-income countries. But in the long run, BrainCapture also anticipates use in the industrialized world where e.g. 24-hour measurements on children or the disabled are necessary, but more appropriate to monitor at home than in the hospital. Needless to say, the technology has the potential help anyone suffering from epilepsy, regardless of where they live.
[1] TechPeople is Data Respons subsidiary based in Kopenhagen, Denmark
Managing Director