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Wearable seizure detection devices in refractory epilepsy

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Abstract

Epilepsy affects 50 million patients and their caregivers worldwide. Devices that facilitate the detection of seizures can have a large influence on a patient’s quality of life, therapeutic decisions and the conduct of clinical trials with anti-epileptic drugs. This article provides an up-to-date overview and comparison between wearable seizure detection devices (WSDDs), taking into account the newly proposed standards for testing and clinical validation of devices. 16 devices were included in our comparison. The F1-score, combining the device’s accurate recall and precision, was calculated for each of these devices and used to evaluate their performance. The devices were separated by development phase and ranked by F1-score from highest to lowest. We describe 16 WSDDs: 6 of which were accelerometry (ACM)-based, 3 surface electromyography-based, 1 was a wearable application of EEG, 4 had multimodal sensors and 2 other types of sensors. We observed a significant inconsistency in the description of performance measures. The devices in the most advanced development phase with the highest F1-scores incorporated ACM- and sEMG-based sensors to detect tonic–clonic seizures. This review highlights the importance of implementing standards for an optimal comparison and, therefore, improving the research and development of WSDDs. WSDDs can improve the patient’s care and quality of life, decrease seizure underreporting and they could potentially prevent sudden-unexpected-death in epilepsy. We discuss the central role of the neurologist in the use of WSDDs, and why a business to business to consumer model is better than the current business to consumer model of most WSDDs.

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References

  1. Abramovici S, Bagić A (2016) Epidemiology of epilepsy. Handb Clin Neurol 138(1):159–171. https://doi.org/10.1016/j.neurol.2015.11.003

    Article  CAS  PubMed  Google Scholar 

  2. Ryvlin P, Ciumas C, Wisniewski I, Beniczky S (2017) Wearable devices for sudden unexpected death in epilepsy prevention. Epilepsia 2018(59):61–66

    Google Scholar 

  3. Elger CE, Hoppe C (2018) Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection. Lancet Neurol 17(3):279–288. https://doi.org/10.1016/S1474-4422(18)30038-3

    Article  PubMed  Google Scholar 

  4. Beniczky S, Ryvlin P (2017) Standards for testing and clinical validation of seizure detection devices. Epilepsia 2018(59):9–13

    Google Scholar 

  5. Kurada AV, Srinivasan T, Hammond S, Ulate-Campos A, Bidwell J (2019) Seizure detection devices for use in antiseizure medication clinical trials: a systematic review. Seizure 66:61–69. https://doi.org/10.1016/j.seizure.2019.02.007

    Article  PubMed  Google Scholar 

  6. Patterson AL, Mudigoudar B, Fulton S, McGregor A, Van PK, Wheless MC et al (2015) SmartWatch by SmartMonitor: assessment of seizure detection efficacy for various seizure types in children, a large prospective single-center study. Pediatr Neurol 53(4):309–311. https://doi.org/10.1016/j.pediatrneurol.2015.07.002

    Article  PubMed  Google Scholar 

  7. Schulc E, Unterberger I, Saboor S, Hilbe J, Ertl M, Ammenwerth E et al (2011) Measurement and quantification of generalized tonic–clonic seizures in epilepsy patients by means of accelerometry—an explorative study. Epilepsy Res 95(1–2):173–183. https://doi.org/10.1016/j.eplepsyres.2011.02.010

    Article  PubMed  Google Scholar 

  8. Kusmakar S, Member S, Karmakar CK, Yan B, Brien TJO, Muthuganapathy R et al (2019) Automated detection of convulsive seizures using a wearable accelerometer device. IEEE Trans Biomed Eng 66(2):421–432

    Article  PubMed  Google Scholar 

  9. Johansson D, Ohlsson F, Krýsl D, Rydenhag B, Czarnecki M, Gustafsson N et al (2019) Tonic–clonic seizure detection using accelerometry-based wearable sensors: a prospective, video-EEG controlled study. Seizure 65:48–54. https://doi.org/10.1016/j.seizure.2018.12.024

    Article  PubMed  Google Scholar 

  10. Kramer U, Kipervasser S, Shlitner A, Kuzniecky R (2011) A novel portable seizure detection alarm system: preliminary results recording. Development 28(1):36–38

    Google Scholar 

  11. Beniczky S, Polster T, Kjaer TW, Hjalgrim H (2013) Detection of generalized tonic–clonic seizures by a wireless wrist accelerometer: a prospective, multicenter study. Epilepsia 54(4):58–61

    Article  Google Scholar 

  12. Meritam P, Ryvlin P, Beniczky S (2017) User-based evaluation of applicability and usability of a wearable accelerometer device for detecting bilateral tonic–clonic seizures: a field study. Epilepsia 2018(59):48–52

    Google Scholar 

  13. Borusiak P, Bast T, Kluger G, Weidenfeld A, Langer T, Jenke ACW et al (2016) A longitudinal, randomized, and prospective study of nocturnal monitoring in children and adolescents with epilepsy: effects on quality of life and sleep. Epilepsy Behav 61:192–198. https://doi.org/10.1016/j.yebeh.2016.05.035

    Article  PubMed  Google Scholar 

  14. Beniczky S, Conradsen I, Henning O, Fabricius M, Wolf P (2018) Automated real-time detection of tonic–clonic seizures using a wearable EMG device. Neurology 90(5):e428–e434

    Article  PubMed  PubMed Central  Google Scholar 

  15. Conradsen I, Beniczky S, Wolf P, Jennum P, Sorensen HBD (2012) Evaluation of novel algorithm embedded in a wearable sEMG device for seizure detection. Proc Annu Int Conf IEEE Eng Med Biol Soc EMBS 2012:2048–2051

    Google Scholar 

  16. Szabõ CÁ, Morgan LC, Karkar KM, Leary LD, Lie OV, Girouard M et al (2015) Electromyography-based seizure detector: preliminary results comparing a generalized tonic–clonic seizure detection algorithm to video-EEG recordings. Epilepsia 56(9):1432–1437

    Article  PubMed  Google Scholar 

  17. Halford JJ, Sperling MR, Nair DR, Dlugos DJ, Tatum WO, Harvey J et al (2017) Detection of generalized tonic–clonic seizures using surface electromyographic monitoring. Epilepsia 58(11):1861–1869

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ahmed A, Ahmad W, Khan MJ, Siddiqui SA, Cheema HM (2017) A wearable sensor based multi-criteria-decision-system for real-time seizure detection. Proc Annu Int Conf IEEE Eng Med Biol Soc EMBS 2017:2377–2380

    Google Scholar 

  19. Arends J, Thijs RD, Gutter T, Ungureanu C, Cluitmans P, Van Dijk J et al (2018) Multimodal nocturnal seizure detection in a residential care setting. Neurology 91(21):e2010–e2019

    Article  PubMed  PubMed Central  Google Scholar 

  20. Regalia G, Onorati F, Lai M, Caborni C, Picard RW (2019) Multimodal wrist-worn devices for seizure detection and advancing research: focus on the Empatica wristbands. Epilepsy Res 153:79–82. https://doi.org/10.1016/j.eplepsyres.2019.02.007

    Article  PubMed  Google Scholar 

  21. Poh MZ, Loddenkemper T, Reinsberger C, Swenson NC, Goyal S, Sabtala MC et al (2012) Convulsive seizure detection using a wrist-worn electrodermal activity and accelerometry biosensor. Epilepsia 53(5):93–97

    Article  Google Scholar 

  22. Mckenzie ED, Lim ASP, Leung ECW, Cole AJ, Lam AD, Eloyan A et al (2017) Validation of a smartphone-based EEG among people with epilepsy: a prospective study. Sci Rep 7:1–8. https://doi.org/10.1038/srep45567

    Article  CAS  Google Scholar 

  23. Jeppesen J, Beniczky S, Johansen P, Sidenius P, Fuglsang-Frederiksen A (2015) Exploring the capability of wireless near infrared spectroscopy as a portable seizure detection device for epilepsy patients. Seizure 26:43–48

    Article  PubMed  Google Scholar 

  24. De Cooman T, Varon C, Hunyadi B, Van Paesschen W, Lagae L, Van Huffel S (2017) Online automated seizure detection in temporal lobe epilepsy patients using single-lead ECG. Int J Neural Syst 27(07):1750022

    Article  PubMed  Google Scholar 

  25. Gu Y, Cleeren E, Dan J, Claes K, Van Paesschen W, Van Huffel S et al (2018) Comparison between scalp EEG and behind-the-ear EEG for development of a wearable seizure detection system for patients with focal epilepsy. Sensors (Switzerland) 18(1):1–17

    Google Scholar 

  26. Vandecasteele K, De Cooman T, Dan J et al (2020) Visual seizure annotation and automated seizure detection using behind-the-ear EEG channels. Epilepsia 61(4):766–775. https://doi.org/10.1111/epi.16470

    Article  PubMed  PubMed Central  Google Scholar 

  27. De Cooman T, Vandecasteele K, Varon C, Hunyadi B, Cleeren E, Van Paesschen W et al (2020) Personalizing heart rate based seizure detection using supervised SVM transfer learning. Front Neurol 11:1–9

    Article  Google Scholar 

  28. Sim I (2019) Mobile devices and health. N Engl J Med 381:956–968

    Article  PubMed  Google Scholar 

  29. Hoppe C, Feldmann M, Blachut B, Surges R, Elger CE, Helmstaedter C (2015) Novel techniques for automated seizure registration: Patients’ wants and needs. Epilepsy Behav 52:1–7. https://doi.org/10.1016/j.yebeh.2015.08.006

    Article  PubMed  Google Scholar 

  30. Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N et al (2017) Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 58(4):531–542

    Article  PubMed  Google Scholar 

  31. Van Paesschen W (2018) The future of seizure detection. Lancet Neurol 17(3):200–202. https://doi.org/10.1016/S1474-4422(18)30034-6

    Article  PubMed  Google Scholar 

  32. Sveinsson O, Andersson T, Mattsson P, Carlsson S, Tomson T (2020) Clinical risk factors in SUDEP: a nationwide population-based case–control study. Neurology 94(4):e419–e429

    Article  PubMed  PubMed Central  Google Scholar 

  33. Okanari K, Otsubo H, Kouzmitcheva E, Rangrej J, Baba S, Ochi A et al (2017) Ictal symmetric tonic extension posturing and postictal generalized EEG suppression arising from sleep in children with epilepsy. Pediatr Neurol 76:54–59. https://doi.org/10.1016/j.pediatrneurol.2017.06.018

    Article  PubMed  Google Scholar 

  34. Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A et al (2013) Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol 12(10):966–977

    Article  PubMed  Google Scholar 

  35. Picard RW, Migliorini M (2017) Clinical/scientific notes. Neurology 89(6):633–636

    Article  PubMed  Google Scholar 

  36. Van de Vel A, Cuppens K, Bonroy B, Milosevic M, Jansen K, Van Huffel S et al (2016) Non-EEG seizure detection systems and potential SUDEP prevention: state of the art: review and update. Seizure 41:141–153. https://doi.org/10.1016/j.seizure.2016.07.012

    Article  PubMed  Google Scholar 

  37. Ulate-Campos A, Coughlin F, Gaínza-Lein M, Fernández IS, Pearl PL, Loddenkemper T (2016) Automated seizure detection systems and their effectiveness for each type of seizure. Seizure 40:88–101

    Article  CAS  PubMed  Google Scholar 

  38. Cook MJ, O’Brien TJ, Berkovic SF, Murphy M, Morokoff A, Fabinyi G et al (2013) Prediction of seizure likelihood with a long-term, implanted seizure advisory system in patients with drug-resistant epilepsy: a first-in-man study. Lancet Neurol 12(6):563–571

    Article  PubMed  Google Scholar 

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Funding

EIT Health (Grant/Award Number: 19263 SeizeIT2).

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Authors and Affiliations

  1. Faculty of Medicine/UZ Leuven, KU Leuven, Leuven, Belgium

    Julie Verdru

  2. Laboratory for Epilepsy Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Wim Van Paesschen

  3. Department of Neurology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    Wim Van Paesschen

Authors
  1. Julie Verdru
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  2. Wim Van Paesschen
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Correspondence to Julie Verdru.

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The study was approved by ethische commissie onderzoek UZ/KU Leuven.

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Verdru, J., Van Paesschen, W. Wearable seizure detection devices in refractory epilepsy. Acta Neurol Belg 120, 1271–1281 (2020). https://doi.org/10.1007/s13760-020-01417-z

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  • DOI: https://doi.org/10.1007/s13760-020-01417-z

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