Prakash Agarwal’s life is currently balanced on a knife-edge. The 14-year-old from Nagpur has experienced two grand mal seizures over the past six months. Doctors suspect epilepsy and advised him to undergo Video-EEG or electroencephalogram test to chart his brain’s electrical activity. A year has passed since an appointment for the test was made. In the meantime, all he can do is hope that he doesn’t suffer another seizure.
Prakash’s situation is hardly unique; wait times for Video-EEG (VEEG) diagnosis in India currently range anywhere between eight months and a year-and-a-half. While medication, treatment, and management of epilepsy have come a long way, becoming affordable and easily available, barriers to timely diagnosis continue to exist. This is primarily because Video-EEG, the gold standard tool for diagnosing epilepsy, is costly and not easily accessible.
The procedure itself requires a few days of in-patient monitoring and is only effective if a seizure occurs while the patient is under medical observation. Since the environment during monitoring is relatively stress-free, seizure-inducing triggers may not be present and often the patient does not experience symptoms at all. Without this crucial information, doctors cannot make a diagnosis. The patient needs to be admitted again, which means another round of agonising wait, stretching into months.
The vast gulf between diagnostics and treatment comes into stark relief when one looks at the numbers. According to a five-year old study published in the Annals of Indian Academy of Neurology, there are 50 million people living with epilepsy worldwide, with most of them residing in developing countries. India is home to about 12 million suffering from this sort of brain disorder. The actual numbers in India could be much higher since the lack of diagnostic facilities leaves a sizeable number outside the purview of treatment. When one considers the rural-urban divide, the issue takes on even more worrisome proportions.
The situation isn’t much better abroad, regardless of a country’s economic status. In the US, video-EEG monitoring for epilepsy can cost patients anywhere between $3,000-$9,000 depending upon how long they must stay to be monitored. The wait time too can last for months.
360EVS, a product designed by the award-winning startup Mocxa Health, founded by Ankita Kumar and Aditya Kadambi, is aimed at addressing these concerns. It is a fully automated smartphone-based device that can be integrated with commercial EEG machines to offer cost-effective Video-EEG testing anywhere, including at home.
The patient is outfitted with EEG electrodes, which continuously transmit EEG data to the smartphone wirelessly. At the same time, the phone camera is capturing audio and video data round the clock while constantly tracking the patient’s movements.
Since the device is portable, patients do not need hospitalisation; they can be monitored in their regular environment. The data collected is much more accurate, giving doctors a better insight into the problem. It also cuts down on costs related to infrastructure and human resources for hospitals while drastically reducing the wait time for patients and saving them the costs of long hospital stays.
Mocxa’s other product, 360DID, enables patient confidentiality after the diagnosis process is complete. 360DID intelligently and automatically anonymises the face of the patient in the diagnosis video by morphing facial features while retaining the diagnostic elements such as expressions, tics and grimaces on the patient’s face. “For the first time, video-based medical evidence can be shared for research and development of better anti-epileptic drugs and for educating patient and caregiver communities without compromising on patient privacy,” says Aditya who oversees the technical aspects of the innovation.
Aditya has over 15 years of experience at the intersection of healthcare and video technologies. He holds a Master of Science in Computer Engineering from the University of Florida, Gainesville, USA, and an undergraduate degree in Industrial Engineering from NIT Surat, India.
He has always been interested in problems in healthcare that can be solved through consumer technologies. While talking to neurologists and hospitals, he was struck by the lacuna surrounding epilepsy care management. “As diagnostic procedures are not readily available, doctors administer a range of drugs to patients as part of a trial and error process. If long waiting periods at hospitals are reduced, an overwhelming majority of patients who received the right diagnosis can easily manage or treat their condition,” he says.
The limitations of the video EEG method stoked his intellectual curiosity and compassion and paved the way for the concept of the device between 2017 and 18. BIRAC’s Biotechnology Ignition Grant (BIG) scheme of Rs 50 lakh in 2018 provided the impetus to build and test the prototype in a hospital setting. “In January 2019, we finished the first prototype validation study at Amrita Hospital in Kochi” says Ankita, the brains behind Mocxa’s business and strategy development. She has over 16 years of experience in business unit management, strategy and operations. Ankita holds an MBA from Ross School of Business, University of Michigan, Ann Arbor, US, and Master of Management Studies from BITS Pilani, India.
Founded on September 7, 2018, Mocxa has just completed two years. The company’s roadmap includes a second round of study at the St John’s Institute, Bengaluru, in a few months. It is also planning a study with an international consortium of neurologists in the coming months.
The pandemic has worked in the company’s favour. “The value of our two-tiered solutions is evident to doctors who are now amenable to remote monitoring. Hospitals too have come around as home-based diagnoses allow them to marshal their resources to fight the virus,” says Aditya.
Why are we investing in Mocxa
VEEG is currently offered at very few facilities in India and is strenuous for both the patients and their caregivers. Mocxa’s product reduces the cost of seizure diagnosis by 70-80% and can potentially provide timely, affordable and accessible treatment to millions of patients across the globe. Mocxa’s choice to operate in this very niche market and to focus on solving an extremely big pain point for patients was one of the first reasons why Social Alpha was drawn towards the startup.
Mocxa’s products are highly innovative and are a significant leap from the current offerings in the market. Social Alpha was particularly impressed by 360EVS’s “Follow-me” capability coupled with the 360DID software that retains valuable facial data.
Although the market is dominated by traditional EEG manufacturers, most options are very expensive and often miss out on capturing key features required for correct diagnosis. Mocxa’s patent-pending solutions make seizure diagnosis more accurate, automated, accessible and affordable through their advancements in video, image processing, computer vision and machine learning.