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Seizure detection: do current devices work? And when can they be useful?

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Abstract

Purpose of Review

The unpredictability and apparent randomness of epileptic seizures is one of the most vexing aspects of epilepsy. Methods or devices capable of detecting seizures may help prevent injury or even death and significantly improve quality of life. Here, we summarize and evaluate currently available, unimodal, or polymodal detection systems for epileptic seizures, mainly in the ambulatory setting.

Recent Findings

There are two broad categories of detection devices: EEG-based and non-EEG-based systems. Wireless wearable EEG devices are now available both in research and commercial arenas. Neuro-stimulation devices are currently evolving and initial experiences of these show potential promise. As for non-EEG devices, different detecting systems show different sensitivity according to the different patient and seizure types. Regardless, when used in combination, these modalities may complement each other to increase positive predictive value.

Summary

Although some devices with high sensitivity are promising, practical widespread use of such detection systems is still some way away. More research and experience are needed to evaluate the most efficient and integrated systems, to allow for better approaches to detection and prediction of seizures. The concept of closed-loop systems and prompt intervention may substantially improve quality of life for patients and carers.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1

    Sun FT, Morrell MJ. Closed-loop neurostimulation: the clinical experience. Neurotherapeutics. 2014;11(3):553–63.

  2. 2

    Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. The prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296–303.

  3. 3

    Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223.

  4. 4

    Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314–9.

  5. 5

    Morrell MJ. Antiepileptic medications for the treatment of epilepsy. Semin Neurol. 2002;22(3):247–58.

  6. 6

    Kassiri H, Tonekaboni S, Salam MT, Soltani N, Abdelhalim K, Velazquez JLP, et al. Closed-loop neurostimulators: a survey and a seizure-predicting design example for intractable epilepsy treatment. IEEE Trans Biomed Circuits Syst. 2017; https://doi.org/10.1109/TBCAS.2017.2694638.

  7. 7

    Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311–8.

  8. 8

    Jacoby A. Epilepsy and the quality of everyday life. Findings from a study of people with well-controlled epilepsy. Soc Sci Med. 1992;34(6):657–66.

  9. 9

    van Andel J, Thijs RD, de Weerd A, Arends J, Leijten F. Non-EEG based ambulatory seizure detection designed for home use: what is available and how will it influence epilepsy care? Epilepsy Behav. 2016;57(Pt A):82–9.

  10. 10

    Christensen J, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term mortality in children and young adults with epilepsy—a population-based cohort study. Epilepsy Res. 2015;114:81–8.

  11. 11

    Bell GS, Sinha S, Tisi JD, Stephani C, Scott CA, Harkness WF, et al. Premature mortality in refractory partial epilepsy: does surgical treatment make a difference? J Neurol Neurosurg Psychiatry. 2010;81(7):716–8.

  12. 12

    Holst AG, Winkel BG, Risgaard B, Nielsen JB, Rasmussen PV, Haunsø S, et al. Epilepsy and risk of death and sudden unexpected death in the young: a nationwide study. Epilepsia. 2013;54(9):1613–20.

  13. 13

    Nashef L, Fish DR, Sander JW, Shorvon SD. Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral center. J Neurol Neurosurg Psychiatry. 1995;58(4):462–4.

  14. 14

    Sillanpaa M, Shinnar S. SUDEP and other causes of mortality in childhoodonset epilepsy. Epilepsy Behav. 2013;28(2):249–55.

  15. 15

    Bidwell J, Khuwatsamrit T, Askew B, Ehrenberg JA, Helmers S. Seizure reporting technologies for epilepsy treatment: a review of clinical information needs and supporting technologies. Seizure. 2015;32:109–17.

  16. 16

    Blum DE, Eskola J, Bortz JJ, Fisher RS. Patient awareness of seizures. Neurology. 1996;47(1):260–4.

  17. 17

    Blumenfeld H. Impaired consciousness in epilepsy. Lancet Neurol. 2012;11(9):814–26.

  18. 18

    Hoppe C, Poepel A, Elger CE. Epilepsy: accuracy of patient seizure counts. Arch Neurol. 2007;64(11):1595–9.

  19. 19

    Kerling F, Mueller S, Pauli E, Stefan H. When do patients forget their seizures?An electroclinical study. Epilepsy Behav. 2006;9(2):281–5.

  20. 20

    Detyniecki K, Blumenfeld H. Consciousness of seizures and consciousness during seizures: are they related? Epilepsy Behav. 2014;30:6–9.

  21. 21

    Fisher RS, Blum DE, DiVentura B, Vannest J, Hixson JD, Moss R, et al. Seizure diaries for clinical research and practice: limitations and future prospects. Epilepsy Behav. 2012;24(3):304–10.

  22. 22

    Rugg-Gunn FJ, Harrison NA, Duncan JS. Evaluation of the accuracy of seizure descriptions by the relatives of patients with epilepsy. Epilepsy Res. 2001;43(3):193–9.

  23. 23

    Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, et al. Ethosuximide: valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010;362(9):790–9.

  24. 24

    Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia. 2013;54(1):141–55.

  25. 25

    Nijsen TM, Arends JB, Griep PA, Cluitmans PJ. The potential value of threedimensional accelerometry for detection of motor seizures in severe epilepsy. Epilepsy Behav. 2005;7(1):74–84.

  26. 26

    •• Ulate-Campos A, Coughlin F, Gaínza-Lein M, Fernández IS, Pearl PL, Loddenkemper T. Automated seizure detection systems and their effectiveness for each type of seizure. Seizure. 2016;40:88–101. This review evaluates seizure detection devices and their effectiveness for different seizure types.

  27. 27

    • Ramgopal S, Thome-Souza S, Jackson M, Kadish NE, Sánchez Fernández I, Klehm J, et al. Seizure detection, seizure prediction, and closed-loop warning systems in epilepsy. Epilepsy Behav. 2014;37:291–307. This paper presents an overview of seizure detection and related prediction methods and discusses the potential use in closed-loop systems in epilepsy.

  28. 28

    Bialer M, Johannessen SI, Levy RH, Perucca E, Tomson T, White HS, et al. Seizure detection and neuromodulation: a summary of data presented at the XIII conference on new antiepileptic drug and devices (EILAT XIII). Epilepsy Res. 2017;130:27–36.

  29. 29

    Gotman J. Automatic recognition of epileptic seizures in the EEG. Electroencephalogr Clin Neurophysiol. 1982;54(5):530–40.

  30. 30

    Qu H, Gotman J. A patient-specific algorithm for the detection of seizure onset in long-term EEG monitoring: possible use as a warning device. IEEE Trans Biomed Eng. 1997;44(2):115–22.

  31. 31

    Qu H, Gotman J. Improvement in seizure detection performance by automatic adaptation to the EEG of each patient. Electroencephalogr Clin Neurophysiol. 1993;86(2):79–87.

  32. 32

    Iasemidis LD. Seizure prediction and its applications. Neurosurg Clin N Am. 2011;22(4):489–506.

  33. 33

    Murro AM, King DW, Smith JR, Gallagher BB, Flanigin HF, Meador K. Computerized seizure detection of complex partial seizures. Electroencephalogr Clin Neurophysiol. 1991;79(4):330–3.

  34. 34

    Harding GW. An automated seizure monitoring system for patients with indwelling recording electrodes. Electroencephalogr Clin Neurophysiol. 1993;86(6):428–37.

  35. 35

    Osorio I, Frei MG, Wilkinson SB. Real-time automated detection and quantitative analysis of seizures and short-term prediction of clinical onset. Epilepsia. 1998;39(6):615–27.

  36. 36

    Osorio I, Frei MG, Giftakis J, Peters T, Ingram J, Turnbull M, et al. Performance reassessment of a real-time seizure-detection algorithm on long ECoG series. Epilepsia. 2002;43(12):1522–35.

  37. 37

    Schulze-Bonhage A, Sales F, Wagner K, Teotonio R, Carius A, Schelle A, et al. Views of patients with epilepsy on seizure prediction devices. Epilepsy Behav. 2010;18(4):388–96.

  38. 38

    •• Luan B, Sun M. A simulation study on a single-unit wireless EEG sensor. Proc IEEE Annu Northeast Bioeng Conf. 2015; https://doi.org/10.1109/NEBEC.2015.7117176. Using a novel device named single-unit wireless EEG sensor, this study demonstrates that it can acquire EEG reliably and the selection of sensor orientation should be an important factor to influence signal strength, thus warranting the further design and construction of a single-unit wireless EEG sensor.

  39. 39

    Luan B, Jia W, Thirumala PD, Balzer J, Gao D, Sun M. A feasibility study on a single-unit wireless EEG sensor. Int Conf Signal Process Proc. 2014;2014:2282–5.

  40. 40

    •• Wyckoff SN, Sherlin LH, Ford NL, Dalke D. Validation of a wireless dry electrode system for electroencephalography. J Neuroeng Rehabil. 2015;12(1):95. This report demonstrates that EEG data recorded from the wireless dry electrode system is comparable to data recorded from a conventional system.

  41. 41

    • Do Valle BG, Cash SS, Sodini CG. Wireless behind-the-ear EEG recording device with wireless interface to a mobile device (iPhone/iPod touch). Conf Proc IEEE Eng Med Biol Soc. 2014;2014:5952–5. This paper presents a novel behind-the-ear EEG recording device that uses an iPhone or iPod Touch to continuously upload the patient’s data to a secure server.

  42. 42

    Mihajlovic V, Grundlehner B, Vullers R, Penders J. Wearable, wireless EEG solutions in daily life applications: what are we missing? IEEE J Biomed Health Inform. 2015;19(1):6–21.

  43. 43

    •• Grant AC, Abdel-Baki SG, Omurtag A, Sinert R, Chari G, Malhotra S, et al. Diagnostic accuracy of microEEG: a miniature, wireless EEG device. Epilepsy Behav. 2014;34:81–5. This study finds that the diagnosis accuracy of microEEG was comparable to that of the reference system.

  44. 44

    •• Kjaer TW, Sorensen HBD, Groenborg S, Pedersen CR, Duun-Henriksen J. Detection of paroxysms in long-term, single-channel EEG-monitoring of patients with typical absence seizures. IEEE J Transl Eng Health Med. 2017;5:2000108. https://doi.org/10.1109/JTEHM.2017.2649491. This study suggested that portable EEG-recorders identifying paroxystic events in epilepsy outpatients are a promising tool for patients and physicians dealing with absence epilepsy.

  45. 45

    • Cook MJ, O'Brien TJ, Berkovic SF, Murphy M, Morokoff A, Fabinyi G, et al. 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. 2013;12(6):563–71. This study showed that intracranial electroencephalographic monitoring is feasible in ambulatory patients with drug-resistant epilepsy.

  46. 46

    Thomas GP, Jobst BC. Critical review of the responsive neurostimulator system for epilepsy. Med Devices (Auckl). 2015;8:405–11.

  47. 47

    Lee B, Zubair MN, Marquez YD, Lee DM, Kalayjian LA, Heck CN, et al. A single-center experience with the NeuroPace RNS system: a review of techniques and potential problems. World Neurosurg. 2015;84(3):719–26.

  48. 48

    Grummett TS, Leibbrandt RE, Lewis TW, DeLosAngeles D, Powers DM, Willoughby JO, et al. Measurement of neural signals from inexpensive: wireless and dry EEG systems. Physiol Meas. 2015;36(7):1469–84.

  49. 49

    David Hairston W, Whitaker KW, Ries AJ, Vettel JM, Cortney Bradford J, Kerick SE, et al. Usability of four commercially-oriented EEG systems. J Neural Eng. 2014;11(4):046018.

  50. 50

    • Jakab A, Kulkas A, Salpavaara T, Kauppinen P, Verho J, Heikkila H, et al. Novel wireless electroencephalography system with a minimal preparation time for use in emergencies and prehospital care. Biomed Eng Online. 2014;13:60. This study finds that the emEEG system may be used to record high-quality EEG data in emergency medicine and during ambulance transportation.

  51. 51

    Patki S, Grundlehner B, Verwegen A, Mitra S, Xu J, Matsumoto A, et al. Wireless EEG system with real time impedance monitoring and active electrodes. Biomed Circ Syst Conf (BioCAS) 2012;2012 IEEE, https://doi.org/10.1109/BioCAS.2012.6418408.

  52. 52

    “Qasar,” December 2013, http://www.quasarusa.com.

  53. 53

    “g.tec,” December 2013, http://www.gtec.at

  54. 54

    •• Fürbass F, Ossenblok P, Hartmann M, Perko H, Skupch AM, Lindinger G, et al. Prospective multi-center study of an automatic online seizure detection system for epilepsy monitoring units. Clin Neurophysiol. 2015;126(6):1124–31. This study finds the automatic seizure detection method EpiScan showed high sensitivity and low false alarm rate in a prospective multi-center study on a large number of patients.

  55. 55

    “NeuroSky,” December 2013, http://www.neurosky.com

  56. 56

    Looney D, Kidmose P, Park C, Ungstrup M, Rank M, Rosenkranz K, et al. The in-the-ear recording concept: user-centered and wearable brain monitoring. IEEE Pulse. 2012;3(6):32–42.

  57. 57

    •• Zibrandtsen IC, Kidmose P, Christensen CB, Kjaer TW. Ear-EEG detects ictal and interictal abnormalities in focal and generalized epilepsy—a comparison with scalp EEG monitoring. Clin Neurophysiol. 2017;128(12):2454–61. These results suggest that ear-EEG can reliably detect electroencephalographic patterns associated with focal temporal lobe seizures.

  58. 58

    •• Gu Y, Cleeren E, Dan J, Claes K, Van Paesschen W, Van Huffel S, et al. Comparison between scalp EEG and behind-the-ear eeg for development of a wearable seizure detection system for patients with focal epilepsy. Sensors (Basel). 2017;18(1):28, https://doi.org/10.3390/s18010029. This study finds the behind-the-ear EEG had a median sensitivity of 94.5% and a false detection rate of 0.52 per hour for patients with focal epilepsy.

  59. 59

    •• Bleichner MG, Debener S. Concealed, Unobtrusive ear-centered eeg acquisition: cEEGrids for transparent EEG. Front Hum Neurosci. 2017;11:163. The authors found that the cEEGrid enables the recording of meaningful continuous EEG, event-related potentials, and neural oscillations.

  60. 60

    Wilder P, Herbert J. Epilepsy and the functional anatomy of the human brain. Little, Brown: Boston; 1954.

  61. 61

    •• Dalkilic EB. Neurostimulation devices used in treatment of epilepsy. Curr Treat Options Neurol. 2017;19(2):7. This review contributes to the foundation for new research to expand on current knowledge and practice by reviewing the current status of the literature about different types of neurostimulation devices.

  62. 62

    Rolston JD, Englot DJ, Wang DD, Shih T, Chang EF. Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: evidence from randomized controlled trials. Neurosurg Focus. 2012;32(3):E14.

  63. 63

    • Morrell MJ. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011;77(13):1295–304. This study provides class I evidence that responsive cortical stimulation is effective in significantly reducing seizure frequency for 12 weeks in adults.

  64. 64

    •• Bergey GK, Morrell MJ, Mizrahi EM, Goldman A, King-Stephens D, Nair D, et al. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology. 2015;84(8):810–7. This study provides class IV evidence that for adults with medically refractory partial onset seizures, responsive direct cortical stimulation reduces seizures and improves quality of life over a mean follow-up of 5.4 years.

  65. 65

    • Meador KJ, Kapur R, Loring DW, Kanner AM, Morrell MJ, RNS® System Pivotal Trial Investigators. Quality of life and mood in patients with medically intractable epilepsy treated with targeted responsive neurostimulation. Epilepsy Behav. 2015;45:242–7. This study finds that treatment with targeted responsive neurostimulation does not adversely affect QOL or mood and may be associated with improvements in QOL in patients, including those with seizures of either mesial temporal origin or neocortical origin.

  66. 66

    •• Geller EB, Skarpaas TL, Gross RE, Goodman RR, Barkley GL, Bazil CW, et al. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia. 2017;58(6):994–1004. The authors suggests that brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior MTL resection.

  67. 67

    •• Jobst BC, Kapur R, Barkley GL, Bazil CW, Berg MJ, Bergey GK, et al. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia. 2017;58(6):1005–14. This study suggests that brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex.

  68. 68

    • Heck CN, King-Stephens D, Massey AD, Nair DR, Jobst BC, Barkley GL, et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia. 2014;55(3):432–41. This study finds that responsive stimulation to the seizure focus reduced the frequency of partial-onset seizures acutely, showed improving seizure reduction over time, was well tolerated, and was acceptably safe.

  69. 69

    •• Sun FT, Arcot Desai S, Tcheng TK, Morrell MJ. Changes in the electrocorticogram after implantation of intracranial electrodes in humans: the implant effect. Clin Neurophysiol. 2018;129(3):676–86. This study reports that ECoG spectral power and spike rates are not stable in the first 5 months after implantation, presumably due to neurophysiological and electrode-tissue interface changes.

  70. 70

    Cooper IS, Amin I, Riklan M, Waltz JM, Poon TP. Chronic cerebellar stimulation in epilepsy. Clinical and anatomical studies. Arch Neurol. 1976;33(8):559–70.

  71. 71

    Cooper IS, Amin I, Upton A, Riklan M, Watkins S, McLellan L. Safety and effcacy of chronic cerebellar stimulation. Appl Neurophysiol. 1977;40(2-4):124–34.

  72. 72

    Rosenow J, Das K, Rovit RL, Couldwell WT, Irving S. Cooper and his role in intracranial stimulation for movement disorders and epilepsy. Stereotact Funct Neurosurg 2002;78(2):95-112.

  73. 73

    Van Buren JM, Wood JH, Oakley J, Hambrecht F. Preliminary evaluation of cerebellar stimulation by double-blind stimulation and biological criteria in the treatment of epilepsy. J Neurosurg. 1978;48(3):407–16.

  74. 74

    Velasco AL, Velasco F, Velasco M, Trejo D, Castro G, Carrillo-Ruiz JD. Electrical stimulation of the hippocampal epileptic foci for seizure control: a double-blind, long-term follow-up study. Epilepsia. 2007;48(10):1895–903.

  75. 75

    Boon P, Vonck K, De Herdt V, Van Dycke A, Goethals M, Goossens L, et al. Deep brain stimulation in patients with refractory temporal lobe epilepsy. Epilepsia. 2007;48(8):1551–60.

  76. 76

    Velasco F, Velasco M, Ogarrio C, Fanghanel G. Electrical stimulation of the centromedian thalamic nucleus in the treatment of convulsive seizures: a preliminary report. Epilepsia. 1987;28(4):421–30.

  77. 77

    Kinoshita M, Ikeda A, Matsuhashi M, Matsumoto R, Hitomi T, Begum T, et al. Electric cortical stimulation suppresses epileptic and background activities in neocortical epilepsy and mesial temporal lobe epilepsy. Clin Neurophysiol. 2005;116(6):1291–9.

  78. 78

    Kinoshita M, Ikeda A, Matsumoto R, Begum T, Usui K, Yamamoto J, et al. Electric stimulation on human cortex suppresses fast cortical activity and epileptic spikes. Epilepsia. 2004;45(7):787–91.

  79. 79

    Fisher R, Salanova V, Witt T, Worth R, Henry T, Gross R, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51(5):899–908.

  80. 80

    Ben-Menachem E, Revesz D, Simon BJ, Silberstein S. Surgically implanted and non-invasive vagus nerve stimulation: a review of effcacy, safety and tolerability. Eur J Neurol. 2015;22(9):1260–8.

  81. 81

    Kassir R, Barthelemy JC, Roche F, Blanc P, Zufferey P, Galusca B, et al. Bariatric surgery associated with percutaneous auricular vagal stimulation: a new prospective treatment on weight loss. Int J Surg. 2015;18:55–6.

  82. 82

    Deuschl G, Paschen S, Witt K. Clinical outcome of deep brain stimulation for Parkinson’s disease. Handb Clin Neurol. 2013;116:107–28.

  83. 83

    Morris GL III, Gloss D, Buchhalter J, Mack KJ, Nickels K, Harden C. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81(16):1453–9.

  84. 84

    Sprengers M, Vonck K, Carrette E, Marson AG, Boon P. Deep brain and cortical stimulation for epilepsy. Cochrane Database Syst Rev. 2014;6:CD008497.

  85. 85

    Ben-Menachem E. Neurostimulation-past, present, and beyond. Epilepsy Curr. 2012;12(5):188–91.

  86. 86

    Ben-Menachem E, Mañon-Espaillat R, Ristanovic R, Wilder BJ, Stefan H, Mirza W, et al. Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia. 1994;35(3):616–26.

  87. 87

    Michael JE, Wegener K, Barnes DW. Vagus nerve stimulation for intractable seizures: one year follow-up. J Neurosci Nurs. 1993;25(6):362–6.

  88. 88

    Salinsky MC, Burchiel KJ. Vagus nerve stimulation has no effect on awake EEG rhythms in humans. Epilepsia. 1993;34(2):299–304.

  89. 89

    Panebianco M, Rigby A, Weston J, Marson AG. Vagus nerve stimulation for partial seizures. Cochrane Database Syst Rev. 2015;4:CD002896.

  90. 90

    The Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology. 1995;45(2):224–30.

  91. 91

    Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51(1):48–55.

  92. 92

    Morris GL III, Mueller WM. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy: the Vagus Nerve Stimulation Study Group E01–E05. Neurology. 1999;53(8):1731–5.

  93. 93

    Stefan H, Kreiselmeyer G, Kerling F, Kurzbuch K, Rauch C, Heers M, et al. Transcutaneous vagus nerve stimulation (t-VNS) in pharmacoresistant epilepsies: a proof of concept trial. Epilepsia. 2012;53(7):e115–8.

  94. 94

    •• Ryvlin P, So EL, Gordon CM, Hesdorffer DC, Sperling MR, Devinsky O, et al. Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS Therapy. Epilepsia. 2018;59(3):562–72. This data suggest that SUDEP risk significantly decreases during long-term follow-up of patients with refractory epilepsy receiving VNS Therapy.

  95. 95

    Kostov K, Kostov H, Taubøll E. Long-term vagus nerve stimulation in the treatment of Lennox-Gastaut syndrome. Epilepsy Behav. 2009;16:321–4.

  96. 96

    Osorio I, Schachter S. Extracerebral detection of seizures: a new era in epileptology? Epilepsy Behav. 2011;22(Suppl 1):S82–7.

  97. 97

    Van Buren J. Some autonomic concomitants of ictal automatism: a study of temporal lobe attacks. Brain. 1958;81(4):505–39.

  98. 98

    Wannamaker BB. Autonomic nervous system and epilepsy. Epilepsy. 1985;26(suppl 1):s31–9.

  99. 99

    Smith PEM, Howell SJL, Owen L, Blumhardt DL. Profiles of instant heart rate during partial seizures. Electroencephalogr Clin Neurophysiol. 1989;72(3):207–17.

  100. 100

    Epstein MA, Sperling MR, O'Connor MJ. Cardiac rhythm during temporal lobe seizures. Neurology. 1992;42:50–3.

  101. 101

    Galemberti CA, Marchiani E, Barzizza F, Manni R, Sartori I, Tartara A. Partial epileptic seizures of different origin variably affect cardiac rhythm. Epilepsia. 1996;37(8):742–7.

  102. 102

    Vaughn BV, Quint SR, Tennison MB, Messenheiemr JA. Monitoring heart period variability changes during seizures II. Diversity and trends. J Epilepsy. 1996;9(1):27–34.

  103. 103

    Novak V, Reeves AL, Novak P, low PA, Sharbrough FW. Time-frequency mapping of R-R intervals during complex partial seizures of temporal lobe origin. J Auton Nerv Syst. 1999;77(2-3):195–202.

  104. 104

    Ziljmans M, Flanagan D, Gotman J. Heart rate changes and ECG abnormalities during epileptic seizures: prevalence and objective definition of an objective clinical sign. Epilepsia. 2002;43(8):847–54.

  105. 105

    Opherk C, Coronillas J, Hirsch LJ. Heart rate and EKG changes in 102 seizures: analysis of influencing factors. Epilepsy Res. 2002;52(2):117–27.

  106. 106

    Leutmezer F, Schernthaner C, Lurger S, Potzelberger K, Baumgartner C. Electrocardiographic changes at the onset of epileptic seizures. Epilepsia. 2003;44(3):348–54.

  107. 107

    Mayer H, Benninger F, Urak L, Plattner B, Geldner J, Feucht M. EKG abnormalities in children and adolescents with temporal lobe epilepsy. Neurology. 2004;63(2):324–8.

  108. 108

    Di Gennaro G, Quarato PP, Sebastiano F, Esposito V, Onorati P, Grammaldo LG, et al. Ictal heart rate increases precede EEG discharges in drug-resistant mesial temporal lobe seizures. Clin Neurophysiol. 2004;115(5):1169–77.

  109. 109

    Weil S, Arnold S, Eisensehr I, Noachtar S. Heart rate increases in otherwise sublinical seizures is different in temporal versus extra-temporal seizure onset. Epileptic Disord. 2005;7(3):199–204.

  110. 110

    Jansen K, Varon C, Van Huffel S, Lagae L. Peri-ictal ECG changes in childhood epilepsy: implications for detection systems. Epilepsy Behav. 2013;29(1):72–6.

  111. 111

    Devinsky O. Diagnosis and treatment of temporal lobe epilepsy. Rev Neurol Dis. 2004;1(1):2–9.

  112. 112

    Jansen K, Lagae L. Cardiac changes in epilepsy. Seizure. 2010;19(8):45–60.

  113. 113

    • Van de Vel A, Cuppens K, Bonroy B, Milosevic M, Jansen K, Van Huffel S, et al. Non-EEG seizure detection systems and potential SUDEP prevention: state of the art: review and update. Seizure. 2016;41:141–53. This review article gives an updated overview of body signals and methods for seizure detection, international research, and (commercially) available systems and applications.

  114. 114

    Behbahani S, Dabanloo NJ, Nasrabadi AM, Teixeira CA, Dourado A. Pre-ictal heart rate variability assessment of epileptic seizures by means of linear and non-linear analyses. Anadolu Kardiyol Derg. 2013;13(8):797–803.

  115. 115

    •• Cogan D, Nourani M, Harvey J, Nagaraddi V. Epileptic seizure detection using wristworn biosensors. Conf Proc IEEE Eng Med Biol Soc. 2015;2015:5086–9. Based on a wrist-worn device with single signal seizure detection algorithms, the authors collected 108 h of data from three EMU patients and found it can distinguish the seizures from non-seizure events with 100% accuracy.

  116. 116

    De Cooman T, Varon C, Hunyadi B, Van Paesschen W, Lagae L, Van Huffel S. Online automated seizure detection in temporal lobe epilepsy patients using single-lead ecg. Int J Neural Syst. 2017;27(7):1750022.

  117. 117

    Masse F, van Bussel M, Serteyn A, Arends J, Penders J. Miniaturized wireless ECG monitor for real-time detection of epileptic seizures. ACM Trans Embedd Comput Syst. 2013;12(4):102. 21 pages

  118. 118

    Massé F, Penders J, Sereteyn A, van Bussel M, Arends J. Miniaturized wireless ECG-monitor for real-time detection of epileptic seizures. Proc Wirel Health. 2010;11:1–7.

  119. 119

    van Elmpt WJ, Nijsen TM, Griep PA, Arends JB. A model of heart rate changes to detect seizures in severe epilepsy. Seizure. 2006;15(6):366–75.

  120. 120

    Varon C, Caicedo A, Jansen K, Lagae L, Van Huffel S. Detection of epileptic seizures from single lead ECG by means of phase rectified signal averaging. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:3789–90.

  121. 121

    Becq G, Bonnet S, Minotti L, Antonakios M, Guillemaud R, Kahane P. Classification of epileptic motor manifestations using inertial and magnetic sensors. Comput Biol Med. 2011;41(1):46–55.

  122. 122

    • Beniczky S, Polster T, Kjaer TW, Hjalgrim H. Detection of generalized tonic clonic seizures by a wireless wrist accelerometer: a prospective, multicenter study. Epilepsia. 2013;54(4):e58–61. The results suggest that the wireless wrist accelerometer sensor detects GTCS with high sensitivity and specificity.

  123. 123

    Borujeny GT, Yazdi M, Keshavarz-Haddad A, Borujeny AR. Detection of epileptic seizure using wireless sensor networks. J Med Signals Sens. 2013;3(2):63–8.

  124. 124

    Cuppens K, Karsmakers P, Van de Vel A, Bonroy B, Milosevic M, Luca S, et al. Accelerometry-based home monitoring for detection of nocturnal hypermotor seizures based on novelty detection. IEEE J Biomed Health Inform. 2014;18(3):1026–33.

  125. 125

    Dalton A, Patel S, Chowdhury AR, Welsh M, Pang T, Schachter S, et al. Development of a body sensor network to detect motor patterns of epileptic seizures. IEEE Trans Biomed Eng. 2012;59(11):3204–11.

  126. 126

    •• Gubbi J, Kusmakar S, Rao AS, Yan B, OBrien T, Palaniswami M. Automatic detection and classification of convulsive psychogenic nonepileptic seizures using a wearable device. IEEE J Biomed Health Inform. 2016;20(4):1061–72. In this study, a wearable device with accelerometer sensor is proposed as a new solution in the detection and diagnosis of PNES. A very high seizure detection rate is achieved with 100% sensitivity and few false alarms. A leave-one-out error of 6:67% is achieved in PNES classification demonstrating the usefulness of wearable device in diagnosis of PNES.

  127. 127

    Jallon P. A Bayesian approach for epileptic seizures detection with 3D accelerometers. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:6325–8.

  128. 128

    Joo HS, Han SH, Lee J, Jang DP, Kang JK, Woo J. Spectral analysis of acceleration data for detection of generalized tonic-clonic seizures. Sensors (Basel). 2017;17(3):481, https://doi.org/10.3390/s17030481.

  129. 129

    Kramer U, Kipervasser S, Shlitner A, Kuzniecky R. A novel portable seizure detection alarm system: preliminary results. J Clin Neurophysiol. 2011;28(1):36–8.

  130. 130

    • Lockman J, Fisher RS, Olson DM. Detection of seizure-like movements using a wrist accelerometer. Epilepsy Behav. 2011;20(4):638–41. This study finds the wrist accelerometer should allow caregivers of people with tonic–clonic seizures to be alerted when a seizure occurs.

  131. 131

    • Narechania AP, Garić II, Sen-Gupta I, Macken MP, Gerard EE, Schuele SU. Assessment of a quasi-piezoelectric mattress monitor as a detection system for generalized convulsions. Epilepsy Behav. 2013;28(2):172–6. The data suggest that the detection device has a high predictive value for generalized convulsions, offers caregivers a reliable and early warning to assist the patient during convulsions, and may be a novel way to prevent SUDEP.

  132. 132

    Nijsen TME, Aarts RM, Arends JBAM, Cluitmans PJM. Automated detection of tonic seizures using 3-D accelerometry. IFMBE Proc. 2008;22:188–91.

  133. 133

    Nijsen TM, Aarts RM, Cluitmans PJ, Griep PA. Time-frequency analysis of accelerometry data for detection of myoclonic seizures. IEEE Trans Inf Technol Biomed. 2010;14(5):1197–203.

  134. 134

    Patterson AL, Mudigoudar B, Fulton S, McGregor A, Poppel KV, Wheless MC, et al. SmartWatch by SmartMonitor: assessment of seizure detection efficacy for various seizure types in children, a large prospective single-center study. Pediatr Neurol. 2015;53(4):309–11.

  135. 135

    • Schulc E, Unterberger I, Saboor S, Hilbe J, Ertl M, Ammenwerth E, et al. Measurement and quantification of generalized tonic-clonic seizures in epilepsy patients by means of accelerometry—an explorative study. Epilepsy Res. 2011;95(1-2):173–83. In this study, the ACM sensors recorded increased activities at the stated seizure time, which clearly differed from everyday movements. The temporary sensitivity (100%), the specificity (≥ 88%), and the positive predictive value (≥ 75%) of the detection suggest a promising alarm/false alarm ratio.

  136. 136

    • Van de Vel A, Cuppens K, Bonroy B, Milosevic M, Van Huffel S, Vanrumste B, et al. Long-term home monitoring of hypermotor seizures by patient-worn accelerometers. Epilepsy Behav. 2013;26(1):118–25. It is the first detection system focusing on hypermotor seizures. The authors compared video/EEG-based seizure detection with ACM data in seven patients and found a sensitivity of 95.71% and a positive predictive value of 57.84%.

  137. 137

    Van Poppel K, Fulton SP, McGregor A, Ellis M, Patters A, Wheless J. Prospective study of the Emfit movement monitor. J Child Neurol. 2013;28(11):1434–6.

  138. 138

    •• Velez M. Fisher RS1, Bartlett V, Le S. Tracking generalized tonic-clonic seizures with a wrist accelerometer linked to an online database. Seizure. 2016;39:13–8. This study suggests that automatic detection and recording of GTCS to an online database is feasible and may be more informative than seizure logging in a paper diary.

  139. 139

    •• Van de Vel A, Milosevic M, Bonroy B, Cuppens K, Lagae L, Vanrumste B, et al. Long-term accelerometry-triggered video monitoring and detection of tonic-clonic and clonic seizures in a home environment: pilot study. Epilepsy Behav Case Rep. 2016;5:66–71. This is the first results of long-term, wireless testing in a home environment. It gave a mean sensitivity of 66.87% and false detection rate of 1.16 per night.

  140. 140

    •• Beniczky S, Conradsen I, Henning O, Fabricius M, Wolf P. Automated real-time detection of tonic-clonic seizures using a wearable EMG device. Neurology. 2018;90(5):e428–34. This study gives a mean sensitivity of 66.87% and false detection rate of 1.16 per night using a wearable surface EMG device.

  141. 141

    • Conradsen I, Beniczky S, Wolf P, Jennum P, Sorensen HB. Evaluation of novel algorithm embedded in a wearable sEMG device for seizure detection. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:2048–51. The device detected four of seven seizures and had a false detection rate of 0.003/h or one in 12 days using a wearable surface EMG device.

  142. 142

    Halford JJ, Sperling MR, Nair DR, Dlugos DJ, Tatum WO, Harvey J, et al. Detection of generalized tonic-clonic seizures using surface electromyographic monitoring. Epilepsia. 2017;58(11):1861–9.

  143. 143

    Larsen SN, Conradsen I, Beniczky S, Sorensen HB. Detection of tonic epileptic seizures based on surface electromyography. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:942–5.

  144. 144

    Szabó CÁ, Morgan LC, Karkar KM, Leary LD, Lie OV, Girouard M, et al. Electromyography-based seizure detector: preliminary results comparing a generalized tonic-clonic seizure detection algorithm to video-EEG recordings. Epilepsia. 2015;56(9):1432–7.

  145. 145

    • Fulton S, Poppel KV, McGregor A, Ellis M, Patters A, Wheless J. Prospective study of 2 bed alarms for detection of nocturnal seizures. J Child Neurol. 2012;28(11):1430–3. Using a MP5 alarm, the authors detected 1 of 15 in sleeping patients: a generalized tonic–clonic seizure, suggesting the Medpage seizure alarms do not appear to adequately detect nocturnal seizures.

  146. 146

    Carlson C, Arnedo V, Cahill M, Devinsky O. Detecting nocturnal convulsions: efficacy of the MP5 monitor. Seizure. 2009;18(3):225–7.

  147. 147

    •• Jeppesen J, Beniczky S, Johansen P, Sidenius P, Fuglsang-Frederiksen A. Exploring the capability of wireless near infrared spectroscopy as a portable seizure detection device for epilepsy patients. Seizure. 2015;26:43–8. This study suggests that NIRS does not seem to be a suitable technology for generic seizure detection given the device, settings, and methods used in this study.

  148. 148

    •• Heldberg BE, Kautz T, Leutheuser H, Hopfengartner R, Kasper BS, Eskofier BM. Using wearable sensors for semiology-independent seizure detection—towards ambulatory monitoring of epilepsy. Conf Proc IEEE Eng Med Biol Soc. 2015;2015:5593–6. In this study, EDA and ACC from eight patients were analyzed and an overall sensitivity of 89.1% and an overall specificity of 93.1% were achieved; for seizures without motor activity, the sensitivity was 97.1% and the specificity was 92.9%.

  149. 149

    Poh MZ, Loddenkemper T, Reinsberger C, Swenson NC, Goyal S, Sabtala MC, et al. Convulsive seizure detection using a wrist-worn electrodermal activity and accelerometry biosensor. Epilepsia. 2012;53(5):e93–7.

  150. 150

    Sabesan S, Sankar R. Improving long-term management of epilepsy using a wearable multimodal seizure detection system. Epilepsy Behav. 2015;46:56–7.

  151. 151

    van Andel J, Ungureanu C, Petkov G, Kalitzin S, Gutter T, de Weerd A, et al. Multimodal, automated detection of nocturnal motor seizures at home: is a reliable seizure detector feasible? Unpublished results

  152. 152

    •• Milosevic M, Van de Vel A, Bonroy B, Ceulemans B, Lagae L, Vanrumste B, et al. Automated detection of tonic-clonic seizures using 3-D accelerometry and surface electromyography in pediatric patients. IEEE J Biomed Health Inform. 2016;20(5):1333–41. This study demonstrates that a multimodal approach resulted in a more robust detection of short and non-stereotypical seizures (91%), while the number of false alarms increased significantly compared with the use of single sEMG modality (0.28 to 0.5/12 h).

  153. 153

    Conradsen I, Beniczky S, Wolf P, Kjaer TW, Sams T, Sorensen HB. Automatic multi-modal intelligent seizure acquisition (MISA) system for detection of motor seizures from electromyographic data and motion data. Comput Methods Prog Biomed. 2012;107(2):97–110.

  154. 154

    Fürbass F, Kampusch S, Kaniusas E, Koren J, Pirker S, Hopfengärtner R, et al. Automatic multimodal detection for long-term seizure documentation in epilepsy. Clin Neurophysiol. 2017;128(8):1466–72.

  155. 155

    •• Fujiwara K, Miyajima M, Yamakawa T, Abe E, Suzuki Y, Sawada Y, et al. Epileptic seizure prediction based on multivariate statistical process control of heart rate variability features. IEEE Trans Biomed Eng. 2016;63(6):1321–32. This work proposed a new HRV-based epileptic seizure prediction method, and the possibility of realizing an HRV-based epileptic seizure prediction system was shown.

  156. 156

    •• Jeppesen J, Beniczky S, Fuglsang Frederiksen A, Sidenius P, Johansen P. Modified automatic R-peak detection algorithm for patients with epilepsy using a portable electrocardiogram recorder. Conf Proc IEEE Eng Med Biol Soc. 2017;2017:4082–5. The novel R-peak detection algorithm designed to avoid jitter has very high sensitivity and specificity and thus is a suitable tool for a robust, fast, real-time HRV-analysis in patients with epilepsy, creating the possibility for real-time seizure detection for these patients.

  157. 157

    •• van Andel J, Ungureanu C, Aarts R, Leijten F, Arends J. Using photoplethy- smography in heart rate monitoring of patients with epilepsy. Epilepsy Behav. 2015;45:142–5. This study indicates that the optical heart rate sensor may fill the gap of systems for ambulatory heart rate monitoring and can be especially useful in the context of seizure detection in patients with epilepsy.

  158. 158

    •• Vandecasteele K, De Cooman T, Gu Y, Cleeren E, Claes K, Paesschen WV, et al. Automated epileptic seizure detection based on wearable ECG and PPG in a Hospital environment. Sensors (Basel). 2017;17(10), https://doi.org/10.3390/s17102338. In this study, whereas seizure detection performance using the wrist-worn PPG device was considerably lower, the performance using the wearable ECG is proven to be similar to that of the hospital ECG.

  159. 159.

    Nijsen TM, Aarts RM, Arends JB, Cluitmans PJ. Model for arm movements during myoclonic seizures. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:1582–5.

  160. 160.

    Van de Vel A, Verhaert K, Ceulemans B. Critical evaluation of four different seizure detection systems tested on one patient with focal and generalized tonic and clonic seizures. Epilepsy Behav. 2014;37:91–4.

  161. 161.

    Jory C, Shankar R, Coker D, McLean B, Hanna J, Newman C. Safe and sound? A systematic literature review of seizure detection methods for personal use. Seizure. 2016;36:4–15.

  162. 162

    • Kusmakar S, Muthuganapathy R, Yan B, O'Brien TJ, Palaniswami M. Gaussian mixture model for the identification of psychogenic non-epileptic seizures using a wearable accelerometer sensor. Conf Proc IEEE Eng Med Biol Soc. 2016;2016:1006–9. This research presents an algorithm based on Gaussian mixture model (GMM) for the identification of PNES, ES, and normal movements using a wrist-worn accelerometer device. The new algorithm was tested on data collected from 16 patients and showed an overall detection accuracy of 91% with 25 false alarms.

  163. 163.

    Conradsen I, Beniczky S, Hoppe K, Wolf P, Sorensen HB. Automated algorithm for generalized tonic-clonic epileptic seizure onset detection based on sEMG zero-crossing rate. IEEE Trans Biomed Eng. 2012;59(2):579–85.

  164. 164.

    Conradsen I, Wolf P, Sams T, Sorensen HB, Beniczky S. Patterns of muscle activation during generalized tonic and tonic-clonic epileptic seizures. Epilepsia. 2011;52(11):2125–32.

  165. 165

    • Beniczky S, Conradsen I, Moldovan M, Jennum P, Fabricius M, Benedek K, et al. Quantitative analysis of surface electromyography during epileptic and nonepileptic convulsive seizures. Epilepsia. 2014;55(7):1128–34. This study supports that surface EMG features can accurately distinguish convulsive epileptic from non-epileptic psychogenic seizures, even in PNES cases without rhythmic clonic movements.

  166. 166

    •• Beniczky S, Conradsen I, Moldovan M, Jennum P, Fabricius M, Benedek K, et al. Automated differentiation between epileptic and non-epileptic convulsive seizures. Ann Neurol. 2015;77(2):348–51. This automated algorithm is useful for distinguishing between epileptic and psychogenic convulsive seizures.

  167. 167.

    Beniczky S, Conradsen I, Pressler R, Wolf P. Quantitative analysis of surface electromyography: biomarkers for convulsive seizures. Clin Neurophysiol. 2016;127(8):2900–7.

  168. 168.

    Poh MZ, Loddenkemper T, Swenson NC, Goyal S, Madsen JR, Picard RW. Continuous monitoring of electrodermal activity during epileptic seizures using a wearable sensor. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:4415–8.

  169. 169.

    Poh MZ, Loddenkemper T, Reinsberger C, Swenson NC, Goyal S, Madsen JR, et al. Autonomic changes with seizures correlate with postictal EEG suppression. Neurology. 2012;78(23):1868–76.

  170. 170.

    Sarkis RA, Thome-Souza S, Poh MZ, Llewellyn N, Klehm J, Madsen JR, et al. Autonomic changes following generalized tonic clonic seizures: an analysis of adult and pediatric patients with epilepsy. Epilepsy Res. 2015;115:113–8.

  171. 171

    •• Picard RW, Migliorini M, Caborni C, Onorati F, Regalia G, Friedman D, et al. Wrist sensor reveals sympathetic hyperactivity and hypoventilation before probable SUDEP. Neurology. 2017;89(6):633–5. They report a probable SUDEP in a 20-year-old man wearing a smartwatch that recorded wrist motion via three-axis accelerometer (ACC) and electrodermal activity (EDA).

  172. 172.

    Nickels KC, Grossardt BR, Wirrell EC. Epilepsy-related mortality is low in children: a 30-year population-based study in Olmsted County, MN. Epilepsia. 2012;53(12):2164–71.

  173. 173.

    Rémi J, Silva Cunha JP, Vollmar C, Topcuoglu ÖB, Meier A, Ulowetz S, et al. Quantitative movement analysis differentiates focal seizures characterized by automatisms. Epilepsy Behav. 2011;20(4):642–7.

  174. 174.

    Pediaditis M, Tsiknakis M, Leitgeb N. Vision-based motion detection: analysis and recognition of epileptic seizures—a systematic review. Comput Methods Prog Biomed. 2012;108(3):1133–48.

  175. 175.

    Lu H, Pan Y, Mandal B, Eng HL, Guan C, Chan DW. Quantifying limb movements in epileptic seizures through color-based video analysis. IEEE Trans Biomed Eng. 2013;60(2):461–9.

  176. 176.

    Cuppens K, Chen CW, Wong KB, Van de Vel A, Lagae L, Ceulemans B, et al. Using spatio-temporal interest points (STIP) for myoclonic jerk detection in nocturnal video. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:4454–7.

  177. 177.

    Kalitzin S, Petkov G, Velis D, Vledder B, Lopes da Silva F. Automatic segmentation of episodes containing epileptic clonic seizures in video sequences. IEEE Trans Biomed Eng. 2012;59(12):3379–85.

  178. 178.

    Mandal B, Eng HL, Lu H, Chan DW, Ng YL. Non-intrusive head movement analysis of videotaped seizures of epileptic origin. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:6060–3.

  179. 179.

    van der Lende M, Cox FM, Visser GH, Sander JW, Thijs RD. Value of video monitoring for nocturnal seizure detection in a residential setting. Epilepsia. 2016;57(11):1748–53.

  180. 180.

    Shankar R, Jory C, Tripp M, Cox D. Monitoring nocturnal seizure in vulnerable patients. Learn Disabil Pract. 2013;16(9):36–8.

  181. 181.

    Garbey M, Sun N, Merla A, Pavlidis I. Contact-free measurement of cardiac pulse based on the analysis of thermal imagery. IEEE Trans Biomed Eng. 2007;54(8):1418–26.

  182. 182.

    Murthy JN, van Jaarsveld J, Fei J, Pavlidis I, Harrykissoon RI, Lucke JF, et al. Thermal infrared imaging: a novel method to monitor airflow during polysomnography. Sleep. 2009;32(11):1521–7.

  183. 183.

    Lamberts RJ, Thijs RD, Laffan A, Langan Y, Sander JW. Sudden unexpected death in epilepsy: people with nocturnal seizures may be at highest risk. Epilepsia. 2012;53(2):253–7.

  184. 184.

    Langan Y, Nashef L, Sander JW. Case-control study of SUDEP. Neurology. 2005;64(7):1131–3.

  185. 185.

    Seyal M. Frontal hemodynamic changes precede EEG onset of temporal lobe seizures. Clin Neurophysiol. 2014;125(3):442–8.

  186. 186.

    Roche-Labarbe N, Zaaimi B, Berquin P, Nehlig A, Grebe R, Wallois F. NIRS measured oxy- and deoxyhemoglobin changes associated with EEG spikeand-wave discharges in children. Epilepsia. 2008;49(11):1871–80.

  187. 187

    • Lareau E, Lesage F, Pouliot P, Nguyen D, Le Lan J, Sawan M. Multichannel wearable system dedicated for simultaneous electroencephalography∕near-infrared spectroscopy real-time data acquisitions. J Biomed Opt. 2011;16(9):096014. Using a multichannel system (a battery-powered, portable system with potentially up to 32 EEG channels, 32 NIRS light sources, and 32 detectors), this study finds good concordance with literature regarding functional activations and suggests sufficient performance for clinical use, provided that some minor adjustments were made.

  188. 188

    •• Kassab A, Le Lan J, Tremblay J, Vannasing P, Dehbozorgi M, Pouliot P, et al. Multichannel wearable fNIRS-EEG system for long-term clinical monitoring. Hum Brain Mapp. 2018;39(1):7–23. This is the first demonstration of a wearable wireless multichannel fNIRS-EEG monitoring system in patients with neurological conditions. Data analysis confirmed expected hemodynamic variations during validation recordings and useful clinical information during in-hospital testing.

  189. 189

    •• Rodriguez-Villegas E, Chen G, Radcliffe J, Duncan J. A pilot study of a wearable apnea detection device. BMJ Open. 2014;4(10):e005299. The authors find that the performance of the novel apnea detection device compares very well to the scoring by an experienced clinician even in the presence of breathing artefacts, in this small pilot study. This can potentially make it a real solution for apnea home monitoring.

  190. 190

    •• El Tahry R, Hirsch M, Van Rijckevorsel K, Santos SF, de Tourtchaninoff M, Rooijakkers H, et al. Early experiences with tachycardia-triggered vagus nerve stimulation using the AspireSR stimulator. Epileptic Disord. 2016;18(2):155–62. The authors report their experience with three patients in assessing the functionality of ictal stimulation, illustrating the detection system in practice. Detection of ictal tachycardia and variable additional detections of physiological tachycardia depended on the individual seizure-detecting algorithm settings.

  191. 191.

    Hampel KG, Vatter H, Elger CE, Surges R. Cardiac-based vagus nerve stimulation reduced seizure duration in a patient with refractory epilepsy. Seizure. 2015;26:81–5.

  192. 192

    •• Ravan M. Investigating the correlation between short-term effectiveness of VNS Therapy in reducing the severity of seizures and long-term responsiveness. Epilepsy Res. 2017;133:46–53. This study shows that automatic delivery of VNS Therapy reduces ictal spatial synchronization (EEG-based quantitative feature) in patients who responded (≥ 50% reduction in seizure frequency) to VNS Therapy. This feature may be used as potential biomarker for predicting long-term response to VNS therapy.

  193. 193.

    Simon RP. Heart and lung in the postictal state. Epilepsy Behav. 2010;19(2):167–71.

  194. 194.

    Binks AP, Banzett RB, Duvivier C. An inexpensive, MRI compatible device to measure tidal volume from chest-wall circumference. Physiol Meas. 2007;28(2):149–59.

  195. 195

    •• Cogan D, Birjandtalab J, Nourani M, Harvey J, Nagaraddi V. Multi-biosignal analysis for epileptic seizure monitoring. Int J Neural Syst. 2017;27(1):1650031. This study developed a three-stage seizure detection methodology based on 339 h of data (26 seizures) collected from 10 patients in an epilepsy monitoring unit, so to develop a wearable system that will detect seizures, alert a caregiver, and record the time of seizure in an electronic diary for the patient’s physician.

  196. 196

    •• Onorati F, Regalia G, Caborni C, Migliorini M, Bender D, Poh MZ, et al. Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors. Epilepsia. 2017;58(11):1870–9. The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring.

  197. 197.

    Conradsen I, Beniczky S, Wolf P, Terney D, Sams T, Sorensen HB. Multi-modal intelligent seizure acquisition (MISA) system—a new approach towards seizure detection based on full body motion measures. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:2591–5.

  198. 198.

    Conradsen I, Beniczky S, Wolf P, Henriksen J, Sams T, Sorensen HB. Seizure onset detection based on a uni- or multi-modal intelligent seizure acquisition (UISA/MISA) system. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:3269–72.

  199. 199.

    Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol. 2016;15(10):1075–88.

  200. 200.

    Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol. 2013;12(10):966–77.

  201. 201.

    Seyal M, Bateman LM, Li C-S. Impact of periictal interventions on respiratory dysfunction, postictal EEG suppression, and postictal immobility. Epilepsia. 2013;54:377–82.

  202. 202.

    Kuo J, Zhao W, Li CS, Kennedy JD, Seyal M. Postictal immobility and generalized EEG suppression are associated with the severity of respiratory dysfunction. Epilepsia. 2016;57(3):412–7.

  203. 203.

    Azar NJ, Tayah TF, Wang L, Song Y, Abou-Khalil BW. Postictal breathing pattern distinguishes epileptic from nonepileptic convulsive seizures. Epilepsia. 2008;49(1):132–7.

  204. 204.

    Rugg-Gunn F, Duncan J, Hjalgrim H, Seyal M, Bateman L. From unwitnessed fatality to witnessed rescue: nonpharmacologic interventions in sudden unexpected death in epilepsy. Epilepsia. 2016;57(Suppl 1:26–34.

  205. 205.

    Tomson T, Surges R, Delamont R, Haywood S, Hesdorffer DC. Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, biomarkers, and intervention study designs. Epilepsia. 2016;57(suppl 1):4–16.

  206. 206.

    Brown S, Hanna J, Hirst J, Hughes E, Kerr M, Leach JP, et al. Statement of research need: the epilepsy deaths register: making every epilepsy death count. Available at: sudep.org/ statement research-need. Accessed June 1, 2017.

  207. 207.

    Van de Vel A, Smets K, Wouters K, Ceulemans B. Automated non-EEG based seizure detection: do users have a say? Epilepsy Behav. 2016;62:121–8.

  208. 208.

    Patel AD, Moss R, Rust SW, Patterson J, Strouse R, Gedela S, et al. Patient-centered design criteria for wearable seizure detection devices. Epilepsy Behav. 2016;64(Pt A):116–21.

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Correspondence to Samden D. Lhatoo.

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Zhao, X., Lhatoo, S.D. Seizure detection: do current devices work? And when can they be useful?. Curr Neurol Neurosci Rep 18, 40 (2018). https://doi.org/10.1007/s11910-018-0849-z

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Keywords

  • Epilepsy
  • Seizure detection