1
|
Han K, Liu C, Friedman D. Artificial intelligence/machine learning for epilepsy and seizure diagnosis. Epilepsy Behav 2024; 155:109736. [PMID: 38636146 DOI: 10.1016/j.yebeh.2024.109736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/03/2024] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
Accurate seizure and epilepsy diagnosis remains a challenging task due to the complexity and variability of manifestations, which can lead to delayed or missed diagnosis. Machine learning (ML) and artificial intelligence (AI) is a rapidly developing field, with growing interest in integrating and applying these tools to aid clinicians facing diagnostic uncertainties. ML algorithms, particularly deep neural networks, are increasingly employed in interpreting electroencephalograms (EEG), neuroimaging, wearable data, and seizure videos. This review discusses the development and testing phases of AI/ML tools, emphasizing the importance of generalizability and interpretability in medical applications, and highlights recent publications that demonstrate the current and potential utility of AI to aid clinicians in diagnosing epilepsy. Current barriers of AI integration in patient care include dataset availability and heterogeneity, which limit studies' quality, interpretability, comparability, and generalizability. ML and AI offer substantial promise in improving the accuracy and efficiency of epilepsy diagnosis. The growing availability of diverse datasets, enhanced processing speed, and ongoing efforts to standardize reporting contribute to the evolving landscape of AI applications in clinical care.
Collapse
Affiliation(s)
- Kenneth Han
- Departments of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Chris Liu
- Departments of Neurosurgery, NYU Grossman School of Medicine, New York, NY, United States
| | - Daniel Friedman
- Departments of Neurology, NYU Grossman School of Medicine, New York, NY, United States.
| |
Collapse
|
2
|
Brown BM, Boyne AMH, Hassan AM, Allam AK, Cotton RJ, Haneef Z. Computer vision for automated seizure detection and classification: A systematic review. Epilepsia 2024; 65:1176-1202. [PMID: 38426252 DOI: 10.1111/epi.17926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Computer vision (CV) shows increasing promise as an efficient, low-cost tool for video seizure detection and classification. Here, we provide an overview of the fundamental concepts needed to understand CV and summarize the structure and performance of various model architectures used in video seizure analysis. We conduct a systematic literature review of the PubMed, Embase, and Web of Science databases from January 1, 2000 to September 15, 2023, to identify the strengths and limitations of CV seizure analysis methods and discuss the utility of these models when applied to different clinical seizure phenotypes. Reviews, nonhuman studies, and those with insufficient or poor quality data are excluded from the review. Of the 1942 records identified, 45 meet inclusion criteria and are analyzed. We conclude that the field has shown tremendous growth over the past 2 decades, leading to several model architectures with impressive accuracy and efficiency. The rapid and scalable detection offered by CV models holds the potential to reduce sudden unexpected death in epilepsy and help alleviate resource limitations in epilepsy monitoring units. However, a lack of standardized, thorough validation measures and concerns about patient privacy remain important obstacles for widespread acceptance and adoption. Investigation into the performance of models across varied datasets from clinical and nonclinical environments is an essential area for further research.
Collapse
Affiliation(s)
- Brandon M Brown
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Aidan M H Boyne
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Adel M Hassan
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Anthony K Allam
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - R James Cotton
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| |
Collapse
|
3
|
Bernini A, Dan J, Ryvlin P. Ambulatory seizure detection. Curr Opin Neurol 2024; 37:99-104. [PMID: 38328946 DOI: 10.1097/wco.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW To review recent advances in the field of seizure detection in ambulatory patients with epilepsy. RECENT FINDINGS Recent studies have shown that wrist or arm wearable sensors, using 3D-accelerometry, electrodermal activity or photoplethysmography, in isolation or in combination, can reliably detect focal-to-bilateral and generalized tonic-clonic seizures (GTCS), with a sensitivity over 90%, and false alarm rates varying from 0.1 to 1.2 per day. A headband EEG has also demonstrated a high sensitivity for detecting and help monitoring generalized absence seizures. In contrast, no appropriate solution is yet available to detect focal seizures, though some promising findings were reported using ECG-based heart rate variability biomarkers and subcutaneous EEG. SUMMARY Several FDA and/or EU-certified solutions are available to detect GTCS and trigger an alarm with acceptable rates of false alarms. However, data are still missing regarding the impact of such intervention on patients' safety. Noninvasive solutions to reliably detect focal seizures in ambulatory patients, based on either EEG or non-EEG biosignals, remain to be developed. To this end, a number of challenges need to be addressed, including the performance, but also the transparency and interpretability of machine learning algorithms.
Collapse
Affiliation(s)
- Adriano Bernini
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne
| | - Jonathan Dan
- Embedded Systems Laboratory, Swiss Federal Institute of Technology of Lausanne (EPFL), Lausanne, Switzerland
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne
| |
Collapse
|
4
|
Terman SW, Kirkpatrick L, Kerr WT, Akiyama LF, Baajour W, Atilgan D, Dorotan MKC, Choi HW, French JA. Challenges and directions in epilepsy diagnostics and therapeutics: Proceedings of the 17th Epilepsy Therapies and Diagnostics Development conference. Epilepsia 2024; 65:846-860. [PMID: 38135921 PMCID: PMC11018495 DOI: 10.1111/epi.17875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
Substantial efforts are underway toward optimizing the diagnosis, monitoring, and treatment of seizures and epilepsy. We describe preclinical programs in place for screening investigational therapeutic candidates in animal models, with particular attention to identifying and eliminating drugs that might paradoxically aggravate seizure burden. After preclinical development, we discuss challenges and solutions in the design and regulatory logistics of clinical trial execution, and efforts to develop disease biomarkers and interventions that may be not only seizure-suppressing, but also disease-modifying. As disease-modifying treatments are designed, there is clear recognition that, although seizures represent one critical therapeutic target, targeting nonseizure outcomes like cognitive development or functional outcomes requires changes to traditional designs. This reflects our increasing understanding that epilepsy is a disease with profound impact on quality of life for the patient and caregivers due to both seizures themselves and other nonseizure factors. This review examines selected key challenges and future directions in epilepsy diagnostics and therapeutics, from drug discovery to translational application.
Collapse
Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
| | - Laura Kirkpatrick
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Pediatrics, Pittsburgh, PA 15213, USA
| | - Wesley T Kerr
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Biomedical Informatics, Pittsburgh, PA 15213, USA
| | - Lisa F Akiyama
- University of Washington Department of Neurology, Seattle, WA 98105, USA
| | - Wadih Baajour
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | - Deniz Atilgan
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | | | - Hyoung Won Choi
- Emory University Department of Pediatrics, Division of Neurology, Atlanta, GA 30322
| | - Jacqueline A French
- NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| |
Collapse
|
5
|
Terman SW, Kirkpatrick L, Akiyama LF, Baajour W, Atilgan D, Dorotan MKC, Choi HW, French JA. Current state of the epilepsy drug and device pipeline. Epilepsia 2024; 65:833-845. [PMID: 38345387 PMCID: PMC11018510 DOI: 10.1111/epi.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
The field of epilepsy has undergone substantial advances as we develop novel drugs and devices. Yet considerable challenges remain in developing broadly effective, well-tolerated treatments, but also precision treatments for rare epilepsies and seizure-monitoring devices. We summarize major recent and ongoing innovations in diagnostic and therapeutic products presented at the seventeenth Epilepsy Therapies & Diagnostics Development (ETDD) conference, which occurred May 31 to June 2, 2023, in Aventura, Florida. Therapeutics under development are targeting genetics, ion channels and other neurotransmitters, and many other potentially first-in-class interventions such as stem cells, glycogen metabolism, cholesterol, the gut microbiome, and novel modalities for delivering electrical neuromodulation.
Collapse
Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
| | - Laura Kirkpatrick
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Pediatrics, Pittsburgh, PA 15213, USA
| | - Lisa F Akiyama
- University of Washington Department of Neurology, Seattle, WA 98105, USA
| | - Wadih Baajour
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | - Deniz Atilgan
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | | | - Hyoung Won Choi
- Emory University Department of Pediatrics, Division of Neurology, Atlanta, GA 30322
| | - Jacqueline A French
- NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| |
Collapse
|
6
|
Sabio J, Williams NS, McArthur GM, Badcock NA. A scoping review on the use of consumer-grade EEG devices for research. PLoS One 2024; 19:e0291186. [PMID: 38446762 PMCID: PMC10917334 DOI: 10.1371/journal.pone.0291186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/23/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Commercial electroencephalography (EEG) devices have become increasingly available over the last decade. These devices have been used in a wide variety of fields ranging from engineering to cognitive neuroscience. PURPOSE The aim of this study was to chart peer-review articles that used consumer-grade EEG devices to collect neural data. We provide an overview of the research conducted with these relatively more affordable and user-friendly devices. We also inform future research by exploring the current and potential scope of consumer-grade EEG. METHODS We followed a five-stage methodological framework for a scoping review that included a systematic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched the following online databases: PsycINFO, MEDLINE, Embase, Web of Science, and IEEE Xplore. We charted study data according to application (BCI, experimental research, validation, signal processing, and clinical) and location of use as indexed by the first author's country. RESULTS We identified 916 studies that used data recorded with consumer-grade EEG: 531 were reported in journal articles and 385 in conference papers. Emotiv devices were used most, followed by the NeuroSky MindWave, OpenBCI, interaXon Muse, and MyndPlay Mindband. The most common usage was for brain-computer interfaces, followed by experimental research, signal processing, validation, and clinical purposes. CONCLUSIONS Consumer-grade EEG is a useful tool for neuroscientific research and will likely continue to be used well into the future. Our study provides a comprehensive review of their application, as well as future directions for researchers who plan to use these devices.
Collapse
Affiliation(s)
- Joshua Sabio
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Nikolas S. Williams
- School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
- Emotiv Inc., San Francisco, California, United States of America
| | - Genevieve M. McArthur
- School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| | - Nicholas A. Badcock
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
- School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Komal K, Cleary F, Wells JSG, Bennett L. A systematic review of the literature reporting on remote monitoring epileptic seizure detection devices. Epilepsy Res 2024; 201:107334. [PMID: 38442551 DOI: 10.1016/j.eplepsyres.2024.107334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
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.
Collapse
Affiliation(s)
- K Komal
- School of Health Sciences, South East Technological University, Cork Road, Waterford, Ireland; Walton Institute, South East Technological University, Cork Road, Waterford, Ireland.
| | - F Cleary
- Walton Institute, South East Technological University, Cork Road, Waterford, Ireland
| | - J S G Wells
- School of Health Sciences, South East Technological University, Cork Road, Waterford, Ireland
| | - L Bennett
- School of Health Sciences, South East Technological University, Cork Road, Waterford, Ireland
| |
Collapse
|
8
|
Alshakhouri M, Sharpe C, Bergin P, Sumner RL. Female sex steroids and epilepsy: Part 2. A practical and human focus on catamenial epilepsy. Epilepsia 2024; 65:569-582. [PMID: 37925609 DOI: 10.1111/epi.17820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/06/2023]
Abstract
Catamenial epilepsy is the best described and most researched sex steroid-specific seizure exacerbation. Yet despite this there are no current evidence-based treatments, nor an accepted diagnostic tool. The best tool we currently have is tracking seizures over menstrual cycles; however, the reality of tracking seizures and menstrual cycles is fraught with challenges. In Part 1 of this two-part review, we outlined the often complex and reciprocal relationship between seizures and sex steroids. An adaptable means of tracking is required. In this review, we outline the extent and limitations of current knowledge on catamenial epilepsy. We use sample data to show how seizure exacerbations can be tracked in short/long and even irregular menstrual cycles. We describe how seizure severity, an often overlooked and underresearched form of catamenial seizure exacerbation, can also be tracked. Finally, given the lack of treatment options for females profoundly affected by catamenial epilepsy, Section 3 focuses on current methods and models for researching sex steroids and seizures as well as limitations and future directions. To permit more informative, mechanism-focused research in humans, the need for both a consistent classification of catamenial epilepsy and an objective biomarker is highlighted.
Collapse
Affiliation(s)
| | - Cynthia Sharpe
- Department of Paediatric Neurology, Starship Children's Health, Auckland, New Zealand
| | - Peter Bergin
- Neurology Department, Auckland Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Rachael L Sumner
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Donner E, Devinsky O, Friedman D. Wearable Digital Health Technology for Epilepsy. N Engl J Med 2024; 390:736-745. [PMID: 38381676 DOI: 10.1056/nejmra2301913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Elizabeth Donner
- From the Division of Neurology, Hospital for Sick Children, and the Department of Paediatrics, University of Toronto - both in Toronto (E.D.); and the Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York (O.D., D.F.)
| | - Orrin Devinsky
- From the Division of Neurology, Hospital for Sick Children, and the Department of Paediatrics, University of Toronto - both in Toronto (E.D.); and the Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York (O.D., D.F.)
| | - Daniel Friedman
- From the Division of Neurology, Hospital for Sick Children, and the Department of Paediatrics, University of Toronto - both in Toronto (E.D.); and the Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York (O.D., D.F.)
| |
Collapse
|
10
|
Delazer L, Bao H, Lauseker M, Stauner L, Nübling G, Conrad J, Noachtar S, Havla J, Kaufmann E. Association between retinal thickness and disease characteristics in adult epilepsy: A cross-sectional OCT evaluation. Epilepsia Open 2024; 9:236-249. [PMID: 37920967 PMCID: PMC10839337 DOI: 10.1002/epi4.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/29/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Thinning of the peripapillary retinal nerve fiber layer (p-RNFL), as measured by optical coherence tomography (OCT), was recently introduced as a promising marker for cerebral neuronal loss in people with epilepsy (PwE). However, its clinical implication remains to be elucidated. We thus aimed to (1) systematically characterize the extent of the retinal neuroaxonal loss in a broad spectrum of unselected PwE and (2) to evaluate the main clinical determinants. METHODS In this prospective study, a spectral-domain OCT evaluation was performed on 98 well-characterized PwE and 85 healthy controls (HCs) (18-55 years of age). All inner retinal layers and the total macula volume were assessed. Group comparisons and linear regression analyses with stepwise backward selection were performed to identify relevant clinical and demographic modulators of the retinal neuroaxonal integrity. RESULTS PwE (age: 33.7 ± 10.6 years; 58.2% female) revealed a significant neuroaxonal loss across all assessed retinal layers (global pRNFL, P = 0.001, Δ = 4.24 μm; macular RNFL, P < 0.001, Δ = 0.05 mm3 ; ganglion cell inner plexiform layer, P < 0.001, Δ = 0.11 mm3 ; inner nuclear layer, INL, P = 0.03, Δ = 0.02 mm3 ) as well as significantly reduced total macula volumes (TMV, P < 0.001, Δ = 0.18 mm3 ) compared to HCs (age: 31.2 ± 9.0 years; 57.6% female). The extent of retinal neuroaxonal loss was associated with the occurrence and frequency of tonic-clonic seizures and the number of antiseizure medications, and was most pronounced in male patients. SIGNIFICANCE PwE presented an extensive retinal neuroaxonal loss, affecting not only the peripapillary but also macular structures. The noninvasive and economic measurement via OCT bears the potential to establish as a practical tool to inform patient management, as the extent of the retinal neuroaxonal loss reflects aspects of disease severity and sex-specific vulnerability. PLAIN LANGUAGE SUMMARY The retina is an extension of the brain and closely connected to it. Thus, cerebral alterations like atrophy reflect also on the retinal level. This is advantageous, as the retina is easily accessible and measureable with help of the optical coherence tomography. Here we report that adults with epilepsy have a significantly thinner retina than healthy persons. Especially people with many big seizures and a lot of medications have a thinner retina. We propose that measurement of the retina can be useful as a marker of disease severity and to inform patient management.
Collapse
Affiliation(s)
- Luisa Delazer
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Han Bao
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig Maximilians UniversityMunichGermany
- Institute for StatisticsMunichGermany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig Maximilians UniversityMunichGermany
| | - Livia Stauner
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Georg Nübling
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- German Center for Neurodegenerative DiseasesMunichGermany
| | - Julian Conrad
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Division for Neurodegenerative DiseasesUniversitätsmedizin Mannheim, University of HeidelbergHeidelbergGermany
| | - Soheyl Noachtar
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Joachim Havla
- Institute of Clinical NeuroimmunologyLMU HospitalLMU Hospital, Ludwig Maximilians UniversityMunichGermany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| |
Collapse
|
11
|
Cook G, Bray L, Carter B, Gringras P, Morris C, Pal DK, Saron H, Tudur Smith C, Wiggs L. A cross-sectional survey of healthcare professionals supporting children and young people with epilepsy and their parents/carers: which topics are raised in clinical consultations and can healthcare professionals provide the support needed? Epilepsy Behav 2023; 149:109543. [PMID: 38006842 DOI: 10.1016/j.yebeh.2023.109543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND PURPOSE Children and young people (CYP) with epilepsy see healthcare professionals (HCPs) for management of their seizures but may require information, advice and support with a range of broader topics. The purpose of the survey was to identify from HCPs, which topics CYP with epilepsy and their parents/carers ask about other than seizure management, and how adequately HCPs feel able to support them with these topics. METHOD A cross-sectional online survey was used to collect data. Adverts which included a link to the survey were shared via social media channels, professional networks and United Kingdom (UK)-based epilepsy networks. Eighty-eight HCPs in the UK (who worked with CYP with epilepsy and their parents/carers) completed the survey. Quantitative data are presented descriptively. Qualitative data (free-text responses) were reflexively thematically analysed. RESULTS CYP with epilepsy and their parents/carers were reported to ask HCPs for information, advice and support about a range of topics, most commonly, cognition and mental health. CYP were reported as also frequently asking about aspects of their social life while parents/carers commonly asked about sleep. HCPs varied in how able they felt to adequately support families about these topics, as well as in their views about which resources could be most useful. Having insufficient time and a lack of suitable services and resources to refer to, or draw upon, were key barriers to HCPs being able to support CYP and their families. DISCUSSION Findings highlight the broad array of topics CYP with epilepsy and their families are reported as seeking support for. HCPs identified gaps in services and their abilities to meet those needs. There appeared to be a mismatch between the support that families were seeking and the ability of HCPs to meet these needs. Findings have implications for how HCPs could best be supported to deal with topics raised by CYP and families in clinic, highlighting the potential usefulness of informational resources on key topics for HCPs, parents/carers and CYP.
Collapse
Affiliation(s)
- Georgia Cook
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Paul Gringras
- Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK; Kings College London, Strand, London, WC2R 2LS, UK
| | - Christopher Morris
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Deb K Pal
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; MRC Centre for Neurodevelopmental Disorders, Neurodevelopmental Disorders, New Hunt's House, Guy's Campus, King's College London, SE1 1UL, UK; Variety Club Children's Department, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Catrin Tudur Smith
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Luci Wiggs
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK
| |
Collapse
|
12
|
Cai Y, Chang K, Nazeha N, Gosavi TD, Shen JY, Hong W, Tan YL, Graves N. The cost-effectiveness of a real-time seizure detection application for people with epilepsy. Epilepsy Behav 2023; 148:109441. [PMID: 37748415 DOI: 10.1016/j.yebeh.2023.109441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Automated seizure detection modalities can increase safety among people with epilepsy (PWE) and reduce seizure-related anxiety. We evaluated the potential cost-effectiveness of a seizure detection mobile application for PWE in Singapore. METHODS We used a Markov cohort model to estimate the expected changes to total costs and health outcomes from a decision to adopt the seizure detection application versus the current standard of care from the health provider perspective. The time horizon is ten years and cycle duration is one month. Parameter values were updated from national databases and published literature. As we do not know the application efficacy in reducing seizure-related injuries, a conservative estimate of 1% reduction was used. Probabilistic sensitivity analysis, scenario analyses, and value of information analysis were performed. RESULTS At a willingness-to-pay of $45,000/ quality-adjusted life-years (QALY), the incremental cost-effectiveness ratio was $1,096/QALY, and the incremental net monetary benefit was $13,656. Probabilistic sensitivity analyses reported that the application had a 99.5% chance of being cost-effective. In a scenario analysis in which the reduction in risk of seizure-related injury was 20%, there was a 99.8% chance that the application was cost-effective. Value of information analysis revealed that health utilities was the most important parameter group contributing to model uncertainty. CONCLUSIONS This early-stage modeling study reveals that the seizure detection application is likely to be cost-effective compared to current standard of care. Future prospective trials will be needed to demonstrate the real-world impact of the application. Changes in health-related quality of life should also be measured in future trials.
Collapse
Affiliation(s)
- Yiying Cai
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Kevin Chang
- Office for Service Transformation, SingHealth, 10 Hospital Boulevard, SingHealth Tower, Singapore 168582, Singapore
| | - Nuraini Nazeha
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Tushar Divakar Gosavi
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Jia Yi Shen
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Weiwei Hong
- Office for Service Transformation, SingHealth, 10 Hospital Boulevard, SingHealth Tower, Singapore 168582, Singapore
| | - Yee-Leng Tan
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Nicholas Graves
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
| |
Collapse
|
13
|
Gould L, Delavale V, Plovnick C, Wisniewski T, Devinsky O. Are brief febrile seizures benign? A systematic review and narrative synthesis. Epilepsia 2023; 64:2539-2549. [PMID: 37466925 DOI: 10.1111/epi.17720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Abstract
Febrile seizures affect 2%-5% of U.S. children and are considered benign although associated with an increased risk of epilepsy and, rarely, with sudden unexplained death. We compared rates of mortality, neurodevelopmental disorders, and neuropathology in young children with simple and complex febrile seizures to healthy controls. We systematically reviewed studies of 3- to 72-month-old children with simple or complex febrile seizures ≤30 min. We searched studies with outcome measures on mortality, neurodevelopment, or neuropathology through July 18, 2022. Bias risk was assessed per study design. Each outcome measure was stratified by study design. PROSPERO registration is CRD42022361645. Twenty-six studies met criteria reporting mortality (11), neurodevelopment (11), and neuropathology (13), including 2665 children with febrile seizures and 1206 seizure-free controls. Study designs varied: 15 cohort, 2 cross-sectional, 3 case-control, 5 series, and 1 case report. Mortality outcomes showed stark contrasts. Six cohort studies following children after febrile seizure (n = 1348) reported no deaths, whereas four child death series and 1 case report identified 24.1% (108/449) deaths associated with simple (n = 104) and complex (n = 3) febrile seizures ≤30 min. Minor hippocampal histopathological anomalies were common in sudden deaths with or without febrile seizure history. Most electroencephalography (EEG) studies were normal. Neuroimaging studies suggested increased right hippocampal volumes. When present, neurodevelopmental problems usually preexisted febrile-seizure onset. Risk bias was medium or high in 95% (18/19) of cohort and case-control studies vs medium to low across remaining study designs. Research on outcomes after simple or brief complex febrile seizures is limited. Cohort studies suffered from inadequate sample size, bias risk, and limited follow-up durations to make valid conclusions on mortality, neurodevelopment, and neuropathology. Sudden death registries, focused on a very small percentage of all cases, strongly suggest that simple febrile seizures are associated with increased mortality. Although most children with febrile seizures have favorable outcomes, longer-term prospective studies are needed.
Collapse
Affiliation(s)
- Laura Gould
- Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Victoria Delavale
- Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Caitlin Plovnick
- Health Sciences Library, NYU Grossman School of Medicine, New York, New York, USA
| | - Thomas Wisniewski
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Department of Pathology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Center for Cognitive Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Department of Psychiatry, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Department of Psychiatry, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
14
|
van Westrhenen A, Lazeron RHC, van Dijk JP, Leijten FSS, Thijs RD. Multimodal nocturnal seizure detection in children with epilepsy: A prospective, multicenter, long-term, in-home trial. Epilepsia 2023; 64:2137-2152. [PMID: 37195144 DOI: 10.1111/epi.17654] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE There is a pressing need for reliable automated seizure detection in epilepsy care. Performance evidence on ambulatory non-electroencephalography-based seizure detection devices is low, and evidence on their effect on caregiver's stress, sleep, and quality of life (QoL) is still lacking. We aimed to determine the performance of NightWatch, a wearable nocturnal seizure detection device, in children with epilepsy in the family home setting and to assess its impact on caregiver burden. METHODS We conducted a phase 4, multicenter, prospective, video-controlled, in-home NightWatch implementation study (NCT03909984). We included children aged 4-16 years, with ≥1 weekly nocturnal major motor seizure, living at home. We compared a 2-month baseline period with a 2-month NightWatch intervention. The primary outcome was the detection performance of NightWatch for major motor seizures (focal to bilateral or generalized tonic-clonic [TC] seizures, focal to bilateral or generalized tonic seizures lasting >30 s, hyperkinetic seizures, and a remainder category of focal to bilateral or generalized clonic seizures and "TC-like" seizures). Secondary outcomes included caregivers' stress (Caregiver Strain Index [CSI]), sleep (Pittsburgh Quality of Sleep Index), and QoL (EuroQol five-dimension five-level scale). RESULTS We included 53 children (55% male, mean age = 9.7 ± 3.6 years, 68% learning disability) and analyzed 2310 nights (28 173 h), including 552 major motor seizures. Nineteen participants did not experience any episode of interest during the trial. The median detection sensitivity per participant was 100% (range = 46%-100%), and the median individual false alarm rate was .04 per hour (range = 0-.53). Caregiver's stress decreased significantly (mean total CSI score = 8.0 vs. 7.1, p = .032), whereas caregiver's sleep and QoL did not change significantly during the trial. SIGNIFICANCE The NightWatch system demonstrated high sensitivity for detecting nocturnal major motor seizures in children in a family home setting and reduced caregiver stress.
Collapse
Affiliation(s)
- Anouk van Westrhenen
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Richard H C Lazeron
- Academic Center of Epileptology Kempenhaeghe, Heeze, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Johannes P van Dijk
- Academic Center of Epileptology Kempenhaeghe, Heeze, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Orthodontics, Ulm University, Ulm, Germany
| | - Frans S S Leijten
- Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
- UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
15
|
Gelbard-Sagiv H, Pardo S, Getter N, Guendelman M, Benninger F, Kraus D, Shriki O, Ben-Sasson S. Optimizing Electrode Configurations for Wearable EEG Seizure Detection Using Machine Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:5805. [PMID: 37447653 DOI: 10.3390/s23135805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Epilepsy, a prevalent neurological disorder, profoundly affects patients' quality of life due to the unpredictable nature of seizures. The development of a reliable and user-friendly wearable EEG system capable of detecting and predicting seizures has the potential to revolutionize epilepsy care. However, optimizing electrode configurations for such systems, which is crucial for balancing accuracy and practicality, remains to be explored. This study addresses this gap by developing a systematic approach to optimize electrode configurations for a seizure detection machine-learning algorithm. Our approach was applied to an extensive database of prolonged annotated EEG recordings from 158 epilepsy patients. Multiple electrode configurations ranging from one to eighteen were assessed to determine the optimal number of electrodes. Results indicated that the performance was initially maintained as the number of electrodes decreased, but a drop in performance was found to have occurred at around eight electrodes. Subsequently, a comprehensive analysis of all eight-electrode configurations was conducted using a computationally intensive workflow to identify the optimal configurations. This approach can inform the mechanical design process of an EEG system that balances seizure detection accuracy with the ease of use and portability. Additionally, this framework holds potential for optimizing hardware in other machine learning applications. The study presents a significant step towards the development of an efficient wearable EEG system for seizure detection.
Collapse
Affiliation(s)
| | - Snir Pardo
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
| | - Nir Getter
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Miriam Guendelman
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dror Kraus
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel
| | - Oren Shriki
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | | |
Collapse
|
16
|
Nouboue C, Selfi S, Diab E, Chen S, Périn B, Szurhaj W. Assessment of an under-mattress sensor as a seizure detection tool in an adult epilepsy monitoring unit. Seizure 2023; 105:17-21. [PMID: 36652886 DOI: 10.1016/j.seizure.2023.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Because of SUDEP (Sudden and unexpected death in epilepsy) and other direct consequences of generalized tonic-clonic seizures, the use of efficient seizure detection tool may be helpful for patients, relatives and caregivers. We aimed to evaluate an under-mattress detection tool (EMFIT®) in real-life hospital conditions, in particular its sensitivity and false alarm rate (FAR), as well as its impact on patient care. METHODS We carried out a retrospective study on a cohort of patients with epilepsy admitted between September 2017 and June 2021 to Amiens University Hospital for a video-EEG of at least 24 h, during which at least one epileptic seizure was recorded. All video-EEGs records were analyzed visually in order to assess the sensitivity of the under-mattress tool (triggering of the alarm) and to classify the seizure type (convulsive/non convulsive). We also considered whether nurses intervened during the seizure, and the time of their intervention if applicable. An additional prospective survey was conducted over 272 days to analyze the FAR of the tool. RESULTS A total of 220 seizures were included in the study, from 55 patients, including 23 convulsive seizures from 15 patients and 197 non-convulsive seizures. Sensitivity for convulsive seizure detection was 69.6%. As expected, none of the non-convulsive seizures was detected. The false alarm rate was 0.007/day. Median trigger time was 74 s, decreasing to 5 s for generalized tonic-clonic seizure. The frequency of nurses' intervention during convulsive seizures was significantly greater in case of the alarm triggering (100% vs 57%, p<0.02). SIGNIFICANCE These results suggest that EMFIT® sensor is able to detect convulsive seizures with good sensitivity and low FAR, and allows caregivers to intervene more often in the event of a nocturnal seizure. This would be an interesting complementary tool to better secure the patients with epilepsy during hospitalization or at home.
Collapse
Affiliation(s)
- Carole Nouboue
- Clinical Neurophysiology Department, CHU Amiens, France; UR 7516, CHIMERE, University of Picardie Jules Verne, Amiens, France
| | - Sarah Selfi
- Clinical Neurophysiology Department, CHU Amiens, France
| | - Eva Diab
- Clinical Neurophysiology Department, CHU Amiens, France; UR 7516, CHIMERE, University of Picardie Jules Verne, Amiens, France
| | - Simone Chen
- Clinical Neurophysiology Department, CHU Amiens, France
| | | | - William Szurhaj
- Clinical Neurophysiology Department, CHU Amiens, France; UR 7516, CHIMERE, University of Picardie Jules Verne, Amiens, France.
| |
Collapse
|
17
|
Goldenholz DM, Westover MB. Flexible realistic simulation of seizure occurrence recapitulating statistical properties of seizure diaries. Epilepsia 2023; 64:396-405. [PMID: 36401798 PMCID: PMC9905290 DOI: 10.1111/epi.17471] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A realistic seizure diary simulator is currently unavailable for many research needs, including clinical trial analysis and evaluation of seizure detection and seizure-forecasting tools. In recent years, important statistical features of seizure diaries have been characterized. These include (1) heterogeneity of individual seizure frequencies, (2) the relation between average seizure rate and standard deviation, (3) multiple risk cycles, (4) seizure clusters, and (5) limitations on inter-seizure intervals. The present study unifies these features into a single model. METHODS Our approach, Cyclic Heterogeneous Overdispersed Clustered Open-source L-relationship Adjustable Temporally limited E-diary Simulator (CHOCOLATES) is based on a hierarchical model centered on a gamma Poisson generator with several modifiers. This model accounts for the aforementioned statistical properties. The model was validated by simulating 10 000 randomized clinical trials (RCTs) of medication to compare with 23 historical RCTs. Metrics of 50% responder rate (RR50) and median percent change (MPC) were evaluated. We also used CHOCOLATES as input to a seizure-forecasting tool to test the flexibility of the model. We examined the area under the receiver-operating characteristic (ROC) curve (AUC) for test data with and without cycles and clusters. RESULTS The model recapitulated typical findings in 23 historical RCTs without the necessity of introducing an additional "placebo effect." The model produced the following RR50 values: placebo: 17 ± 4%; drug 38 ± 5%; and the following MPC values: placebo: 13 ± 6%; drug 40 ± 4%. These values are similar to historical data: for RR50: placebo, 21 ± 10%, drug: 43 ± 13%; and for MPC: placebo: 17 ± 10%, drug: 41 ± 11%. The seizure forecasts achieved an AUC of 0.68 with cycles and clusters, whereas without them the AUC was 0.51. SIGNIFICANCE CHOCOLATES represents the most realistic seizure occurrence simulator to date, based on observations from thousands of patients in different contexts. This tool is open source and flexible, and can be used for many applications, including clinical trial simulation and testing of seizure-forecasting tools.
Collapse
Affiliation(s)
- Daniel M. Goldenholz
- Dept. of Neurology, Beth Israel Deaconess Medical Center, Boston 02215 MA
- Dept. of Neurology, Harvard Medical School, Boston 02215 MA
| | - M. Brandon Westover
- Dept. of Neurology, Beth Israel Deaconess Medical Center, Boston 02215 MA
- Dept. of Neurology, Harvard Medical School, Boston 02215 MA
- Dept. of Neurology, Massachusetts General Hospital, Boston 02114 MA
- McCance Center for Brain Health, Boston, 02114 MA
| |
Collapse
|
18
|
Prieto-Avalos G, Sánchez-Morales LN, Alor-Hernández G, Sánchez-Cervantes JL. A Review of Commercial and Non-Commercial Wearables Devices for Monitoring Motor Impairments Caused by Neurodegenerative Diseases. BIOSENSORS 2022; 13:72. [PMID: 36671907 PMCID: PMC9856141 DOI: 10.3390/bios13010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Neurodegenerative diseases (NDDs) are among the 10 causes of death worldwide. The effects of NDDs, including irreversible motor impairments, have an impact not only on patients themselves but also on their families and social environments. One strategy to mitigate the pain of NDDs is to early identify and remotely monitor related motor impairments using wearable devices. Technological progress has contributed to reducing the hardware complexity of mobile devices while simultaneously improving their efficiency in terms of data collection and processing and energy consumption. However, perhaps the greatest challenges of current mobile devices are to successfully manage the security and privacy of patient medical data and maintain reasonable costs with respect to the traditional patient consultation scheme. In this work, we conclude: (1) Falls are most monitored for Parkinson's disease, while tremors predominate in epilepsy and Alzheimer's disease. These findings will provide guidance for wearable device manufacturers to strengthen areas of opportunity that need to be addressed, and (2) Of the total universe of commercial wearables devices that are available on the market, only a few have FDA approval, which means that there is a large number of devices that do not safeguard the integrity of the users who use them.
Collapse
Affiliation(s)
- Guillermo Prieto-Avalos
- Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| | - Laura Nely Sánchez-Morales
- CONACYT-Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| | - Giner Alor-Hernández
- Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| | - José Luis Sánchez-Cervantes
- CONACYT-Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| |
Collapse
|
19
|
Chougale A, Vedante S, Kulkarni G, Patnawar S. Recent Progress on Biosensors for the Early Detection of Neurological Disorders. ChemistrySelect 2022. [DOI: 10.1002/slct.202203155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Amit Chougale
- Department of Chemical Engineering University of Adelaide SA Australia 5000
| | - Shruti Vedante
- Department of Chemical Engineering University of Adelaide SA Australia 5000
| | - Guruprasad Kulkarni
- Department of Biotechnology Kolhapur Institute of Technology's College of Engineering Kolhapur Maharashtra India 416234
| | - Sneha Patnawar
- Department of Biotechnology Kolhapur Institute of Technology's College of Engineering Kolhapur Maharashtra India. 416234
| |
Collapse
|
20
|
Wheless JW, Friedman D, Krauss GL, Rao VR, Sperling MR, Carrazana E, Rabinowicz AL. Future Opportunities for Research in Rescue Treatments. Epilepsia 2022; 63 Suppl 1:S55-S68. [PMID: 35822912 PMCID: PMC9541657 DOI: 10.1111/epi.17363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/16/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
Clinical studies of rescue medications for seizure clusters are limited and are designed to satisfy regulatory requirements, which may not fully consider the needs of the diverse patient population that experiences seizure clusters or utilize rescue medication. The purpose of this narrative review is to examine the factors that contribute to, or may influence the quality of, seizure cluster research with a goal of improving clinical practice. We address five areas of unmet needs and provide advice for how they could enhance future trials of seizure cluster treatments. The topics addressed in this article are: (1) unaddressed end points to pursue in future studies, (2) roles for devices to enhance rescue medication clinical development programs, (3) tools to study seizure cluster prediction and prevention, (4) the value of other designs for seizure cluster studies, and (5) unique challenges of future trial paradigms for seizure clusters. By focusing on novel end points and technologies with value to patients, caregivers, and clinicians, data obtained from future studies can benefit the diverse patient population that experiences seizure clusters, providing more effective, appropriate care as well as alleviating demands on health care resources.
Collapse
Affiliation(s)
- James W Wheless
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel Friedman
- New York University Grossman School of Medicine, New York, New York, USA
| | - Gregory L Krauss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vikram R Rao
- University of California, San Francisco, California, USA
| | | | - Enrique Carrazana
- Neurelis, San Diego, California, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | | |
Collapse
|
21
|
EEG Oscillatory Power and Complexity for Epileptic Seizure Detection. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Monitoring patients at risk of epileptic seizure is critical for optimal treatment and ensuing the reduction of seizure risk and complications. In general, seizure detection is done manually in hospitals and involves time-consuming visual inspection and interpretation by experts of electroencephalography (EEG) recordings. The purpose of this study is to investigate the pertinence of band-limited spectral power and signal complexity in order to discriminate between seizure and seizure-free EEG brain activity. The signal complexity and spectral power are evaluated in five frequency intervals, namely, the delta, theta, alpha, beta, and gamma bands, to be used as EEG signal feature representation. Classification of seizure and seizure-free data was performed by prevalent potent classifiers. Substantial comparative performance evaluation experiments were performed on a large EEG data record of 341 patients in the Temple University Hospital EEG seizure database. Based on statistically validated criteria, results show the efficiency of band-limited spectral power and signal complexity when using random forest and gradient-boosting decision tree classifiers (95% of the area under the curve (AUC) and 91% for both F-measure and accuracy). These results support the use of these automatic classification schemes to assist the practicing neurologist interpret EEG records more accurately and without tedious visual inspection.
Collapse
|
22
|
Mudigoudar B, Wheless JW. Sudden Unexpected Death in Epilepsy (SUDEP): How Do We Prevent This Childhood Tragedy? J Pediatr Pharmacol Ther 2022; 27:99-101. [DOI: 10.5863/1551-6776-27.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Basanagoud Mudigoudar
- Le Bonheur Comprehensive Epilepsy Program and Neuroscience Institute (BM, JWW), Le Bonheur Children's Hospital, Memphis, TN; Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
- Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - James W. Wheless
- Le Bonheur Comprehensive Epilepsy Program and Neuroscience Institute (BM, JWW), Le Bonheur Children's Hospital, Memphis, TN; Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
- Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| |
Collapse
|