Abstract Details

Title A Quantifiable Telemedicine Approach to the Myasthenia Gravis Neurological Exam

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-008

Objective

Here we assessed whether quantification of videotaped assessment of the MG-CE could be done using novel image processing techniques.

Background The Myasthenia Gravis (MG) Core Exam (MG-CE) was developed to assist neurologists during telemedicine examination for patients with MG and consists of eight core elements that can be performed over video conferencing. However, much like in-person exams, they remain subjective to the interpretation and experience of the examiner.

Design/Methods

We utilized video recordings of the ADAPT teleMG study (NINDS U54 NS115054) performed at George Washington University. Seven subjects underwent video examinations on two occasions 2-3 days apart and had a standardized examination recorded and videos analyzed using image-processing techniques.

Results We used a combination of artificial intelligence and signal processing algorithms to compute automatically the main geometric metrics: (i) eyelid drop, (ii) misalignment of eyes that can lead to double vision, (iii) cheek deformation in the cheek puff and tongue to cheek test, variation of extended arm position and sit to stand trajectory and velocity during the corresponding physical tests. These metrics provide reproductible and unbiased scores for each of the component of the MG-CE. We obtained in addition the time dependency of these muscle weakness metrics, which is a new outcome of the digitalization.

Conclusions With very promising results on eye tracking and pose detection, our method can provide objective and reproductible assessments. However, some exercises’ protocol are not fitting the robustness of our new metrics and should be revisited. As a matter of fact, the time dynamic component of muscle weakness seems an important factor in the evaluation of the symptoms. We envision that our telehealth approach can be applied to other neuromuscular diseases and will be providing quantitative metrics that goes beyond in an in-person visit.

Authors/Disclosures
Henry J. Kaminski, MD, FAAN (George Washington University) PRESENTER	Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Kaminski has received personal compensation in the range of $0-$499 for serving as a Consultant for Cabaletta Bio. The institution of Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Canopy Immunotherapeutics. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Curie.bio. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Samsung. Dr. Kaminski has received personal compensation in the range of $0-$499 for serving as a Consultant for Care Constitution. Dr. Kaminski has stock in mimivax. The institution of Dr. Kaminski has received research support from National Institutes of Health. Dr. Kaminski has received publishing royalties from a publication relating to health care.
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Sienna McNett	Ms. McNett has nothing to disclose.
Mohammad Abu-Rub, MD	Dr. Abu-Rub has nothing to disclose.

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