Tablet-based EEG diagnostics for epilepsy patients in the West African Republic of Guinea.

BACKGROUND: Epilepsy is most common in lower income settings where access to EEG is generally poor. A low-cost tablet-based electroencephalography (EEG) device may be valuable, but the quality and reproducibility of the EEG output are not established. METHODS: A tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEGs twice, separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology on data quality and clinical utility. RESULTS: There were 149 participants (41% female, median age 17.9 years; 66.6% ≤21 years; mean seizures per month 5.7+/-standard deviation 15.5). The mean duration of EEG1 was 53 minutes+/-12.3 and EEG2 was 29.6+/-12.8. The mean quality scores of EEG1 and EEG2 were 6.4 (range 1(low)-10(high); both medians 7.0). Forty-four (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.7%) at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. Thirty-nine (26.1%) were recommended for neuroimaging after EEG1 and 22 (14.7%) after EEG2. Of participants without EDs at EEG1 (n=53, 55.8%), 7 (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n=23, 24.2%), 12 (52.1%) did not have EDs at EEG2. CONCLUSIONS: The tablet-based EEG has a reproducible quality level on repeat testing and is useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.