When should we obtain a routine EEG while managing people with epilepsy?

A systematic review of the literature reporting on remote monitoring epileptic seizure detection devices

BACKGROUND

Early detection and alert notification of an impending seizure for people with epilepsy have the potential to reduce Sudden Unexpected Death in Epilepsy (SUDEP). Current remote monitoring seizure detection devices for people with epilepsy are designed to support real-time monitoring of their vital health parameters linked to seizure alert notification. An understanding of the rapidly growing literature on remote seizure detection devices is essential to address the needs of people with epilepsy and their carers.

AIM

This review aims to examine the technical characteristics, device performance, user preference, and effectiveness of remote monitoring seizure detection devices.

METHODOLOGY

A systematic review referenced to PRISMA guidelines was used.

RESULTS

A total of 1095 papers were identified from the initial search with 30 papers included in the review. Sixteen non-invasive remote monitoring seizure detection devices are currently available. Such seizure detection devices were found to have inbuilt intelligent sensor functionality to monitor electroencephalography, muscle movement, and accelerometer-based motion movement for detecting seizures remotely. Current challenges of these devices for people with epilepsy include skin irritation due to the type of patch electrode used and false alarm notifications, particularly during physical activity. The tight-fitted accelerometer-type devices are reported as uncomfortable from a wearability perspective for long-term monitoring. Also, continuous recording of physiological signals and triggering alert notifications significantly reduce the battery life of the devices. The literature highlights that 3.2 out of 5 people with epilepsy are not using seizure detection devices because of the cost and appearance of the device.

CONCLUSION

Seizure detection devices can potentially reduce morbidity and mortality for people with epilepsy. Therefore, further collaboration of clinicians, technical experts, and researchers is needed for the future development of these devices. Finally, it is important to always take into consideration the expectations and requirements of people with epilepsy and their carers to facilitate the next generation of remote monitoring seizure detection devices.

Pandemic Effect on Healthcare Use and Death in Adults with Epilepsy: A Population Study

OBJECTIVES

We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death.

METHODS

Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models. Two-way interactions were calculated using Quasi-Poisson models.

RESULTS

In adults with epilepsy during the first quarter of the pandemic, we demonstrated a reduction in all-cause outpatient visits, diagnostic testing, ED visits and hospitalizations, and a temporary increase in mortality (observed rates of 355.8 vs projected 308.8, 95% CI: 276.3-345.1). By the end of the year, outpatient visits increased (85,535.4 vs 76,620.6, 95% CI: 71,546.9-82,059.4), and most of the diagnostic test rates returned to the projected. The increase in the rate of all-cause mortality during the pandemic, compared to pre-pandemic, was greater during months with the lower frequency of diagnostic tests than months with higher frequency (interaction p-values <.0001).

CONCLUSION

We described the impact of the pandemic on healthcare utilization and mortality in adults with epilepsy during the first year. We demonstrated that access to relevant diagnostic testing is likely important for this population while planning restrictions on non-urgent health services.

Healthcare Professionals' Electroencephalography Competency: A Disconnect Between Self-Assessment and Objective Testing

ABSTRACT

BACKGROUND: The role of the healthcare professional (HCP) in performing high-quality electroencephalography (EEG) is critical to ensuring accurate results. This study analyzes HCPs' subjectively and objectively assessed EEG competence to provide information on their EEG competence and competence needs for the development of their education and training. METHODS: The study was a descriptive cross-sectional study. The target group of the study was HCPs working in the clinical neurophysiology departments of university hospitals in Finland. The research data were collected using the EEG Competence instrument created for this research. The instrument consisted of a self-assessment section and a knowledge test component. RESULTS: The participants (N = 65; response rate, 81%) consisted of 34 registered nurses and 31 laboratory technologists. In the self-assessment section, the highest mean score was in patient observation (mean, 4.6) and the lowest was in EEG theoretical knowledge (mean, 3.9). In the test section, most of the respondents (73.8%) answered all questions correctly (maximum, 6 points). There was a positive correlation between age, work experience, own satisfaction with EEG competence, and subjective self-assessment. Those familiar with EEG guidelines and who participated in training days assessed their competence as significantly better ( P < .05). Respondents who read EEG-related literature on their own identified artifacts better ( P = .005). CONCLUSIONS: Laboratory technologists' and registered nurses' subjectively and objectively assessed EEG competence was high. In the future, the EEG competence instrument should be developed further, and more research is needed to assess its psychometric properties to provide more information on HCPs' competence in the diagnostic process.