A Quantifiable Telemedicine Approach to the Myasthenia Gravis Neurological Exam
Marc Garbey1, Guillaume Joerger3, Quentin Lesport1, Helen Girma2, Sienna McKnett2, Mohammad Abu-Rub2, Henry Kaminski4
1Departments of Surgery, George Washington University – School of Medicine & Health Sciences, 2George Washington University – School of Medicine & Health Sciences, 3ORintelligence LLC, 4George Washington University
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.