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Mobile PDAs and smartphones render possible new approaches to monitor and train patients over long time-periods with minimal interference with the patients' daily life. However, programming of the devices is sophisticated and requires professional developing skills which is expensive and time-consuming.

We developed a method enabling non-experts to program mobile devices in order to create custom dialogs for data capturing, monitoring, and patient training. An easy to understand desktop program or internet web-site is used to build an interactive dialog. After cable- or web-based synchronization with the mobile device, the dialog may be run by the patient or the study subject as often as required. The entered data is collected either after the study is completed in the case of Palm® PDAs or transmitted in real-time in the case of internet-connected smartphones. The responsible specialist is automatically notified if cognitive abilities do not match a range of desired values and may take appropriate actions. This could either be adaption of the level of difficulty for the neurological tests or contacting the patient or his/her family doctor concerning therapeutic interventions.

Basic dialog modules comprise display of messages, questions, pictures, text input, date-time selection, check- and assessment lists. Depending on the entered data, branches may be used to follow different routes through the dialog. A drawing module enables to capture the signature of the patient in order to verify the identify of the user.

In close collaboration with the Epilepsy Center Freiburg, Germany, four neuropsychological test modules have been developed comprising a 16-fields test, GoNogo, Number sequences and Two-back. These modules allow to determine the short term memory, the ability to focus, and the reaction time of the patients.

 

Clinical application

The monitoring units have been used to evaluate behavioral side effects of antiepileptic drugs [1] and to prospectively determine whether epilepsy patients are able to predict upcoming seizures based on prodromal events [2].

[1] L. Frings, K. Wagner, T. Maiwald, A. Carius, A. Schinkel, C. Lehmann, A. Schulze-Bonhage, Early detection of behavioral side effects of antiepileptic treatment using handheld computers, Epilepsy & Behavior 2008, 13(2):402-6.

[2] T. Maiwald, J. Blumberg, J. Timmer, A. Schulze-Bonhage, Are prodromes preictal events? A prospective PDA-based study. Epilepsy & Behavior 2011, in press