A EUROPEAN NEUROLOGICAL NETWORK USING TELEMATICS

T. Penzel, R. Conradt, C. Guilleminault^*, K. Kesper, T. Paiva^**, J.H. Peter
Medizinische Poliklinik of Philipps-University, Baldingerstrasse, D-35033 Marburg
^* Hospital Santa Maria, P-1600 Lisboa, Portugal
^** Stanford sleep disorders center, Palo Alto, Calif. USA

INTRODUCTION Sleep disorders and headache are common symptoms caused often by chronic disorders. A diagnosis of these chronic disorders requires well equipped laboratories and trained physicians. Epilepsy is less prevalent but diagnostics need special training in Neurophysiology. Today differential diagnosis and a problem oriented therapy of these disorders is possible. The main problem is the limited availability of diagnostic systems and of appropriate medical knowledge. Telemedicine can help by setting up a network of diagnostic laboratories linked with general practitioners to achieve an early diagnosis and thereby an adequate therapy throughout cities and rural areas.

METHODS A central server accessible by 34 expert centres was installed in Marburg using existing Internet connections. Expert systems to support medical decisions are developed on the basis of the database. The communication network is extended to connect remote locations such as the Azores. Remote monitoring devices which can be connected to telephone lines are used by general practitioners for diagnostic long-term recording of sleep disorders and EEG. Tutorial material is developed with TOOLBOOK software tools to train physicians in the diagnosis of these chronic disorders.

RESULTS The database server installed at the university Marburg (ppsl01.hrz.uni-marburg.de) is connected with the internal hospital network via a firewall computer. As selected polygraphic recordings and the tutorial software is collected there, the tutorial system can be accessed on-line by centres with reasonable network transmission speed. The tutorial system supports interactive training. It is built on an underlying knowledgebase and database collected by the centres working in the network. The database contains case reports with diagnoses, therapies and questionnaires concerning symptoms as well as biosignals and video clips recorded in sleep- and EEG laboratories. The database forms the basis for a new digital atlas of polysomnographic recordings. A first atlas was distributed on CD-ROM and is available through WWW. Typical biosignal patterns of sleep disorders are kept there. As we use a standard format for biosignals the exchange of signal data is as easy as the exchange of digital text, graphics and video.

CONCLUSION The European neurological network is used to create interactive educational material for sleep disorders, headache and epilepsy. A common database of biosignals and case reports is built. The network enhances the exchange of multimedia patient records among specialised centres and interested physicians. Centres can use X25 and ATM connections whereas general practitioners can use ISDN connections.

Supported by the European Commission DG XIII, grant no. HC1014