1
|
Macea J, Swinnen L, Varon C, De Vos M, Van Paesschen W. Cardiorespiratory disturbances in focal impaired awareness seizures: Insights from wearable ECG monitoring. Epilepsy Behav 2024; 158:109917. [PMID: 38924968 DOI: 10.1016/j.yebeh.2024.109917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/06/2024] [Accepted: 06/22/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Seizures are characterized by periictal autonomic changes. Wearable devices could help improve our understanding of these phenomena through long-term monitoring. In this study, we used wearable electrocardiogram (ECG) data to evaluate differences between temporal and extratemporal focal impaired awareness (FIA) seizures monitored in the hospital and at home. We assessed periictal heart rate, respiratory rate, heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). METHODS We extracted ECG signals across three time points - five minutes baseline and preictal, ten minutes postictal - and the seizure duration. After automatic Rpeak selection, we calculated the heart rate and estimated the respiratory rate using the ECG-derived respiration methodology. HRV was calculated in both time and frequency domains. To evaluate the influence of other modulators on the HRV after removing the respiratory influences, we recalculated the residual power in the high-frequency (HF) and low-frequency (LF) bands using orthogonal subspace projections. Finally, 5-minute and 30-second (ultra-short) ECG segments were used to calculate RSA using three different methods. Seizures from temporal and extratemporal origins were compared using mixed-effects models and estimated marginal means. RESULTS The mean preictal heart rate was 69.95 bpm (95 % CI 65.6 - 74.3), and it increased to 82 bpm, 95 % CI (77.51 - 86.47) and 84.11 bpm, 95 % CI (76.9 - 89.5) during the ictal and postictal periods. Preictal, ictal and postictal respiratory rates were 16.1 (95 % CI 15.2 - 17.1), 14.8 (95 % CI 13.4 - 16.2) and 15.1 (95 % CI 14 - 16.2), showing not statistically significant bradypnea. HRV analysis found a higher baseline power in the LF band, which was still significantly higher after removing the respiratory influences. Postictally, we found decreased power in the HF band and the respiratory influences in both frequency bands. The RSA analysis with the new methods confirmed the lower cardiorespiratory interaction during the postictal period. Additionally, using ultra-short ECG segments, we found that RSA decreases before the electroclinical seizure onset. No differences were observed in the studied parameters between temporal and extratemporal seizures. CONCLUSIONS We found significant increases in the ictal and postictal heart rates and lower respiratory rates. Isolating the respiratory influences on the HRV showed a postictal reduction of respiratory modulations on both LF and HF bands, suggesting a central role of respiratory influences in the periictal HRV, unlike the baseline measurements. We found a reduced cardiorespiratory interaction during the periictal period using other RSA methods, suggesting a blockade in vagal efferences before the electroclinical onset. These findings highlight the importance of respiratory influences in cardiac dynamics during seizures and emphasize the need to longitudinally assess HRV and RSA to gain insights into long-term autonomic dysregulation.
Collapse
Affiliation(s)
- Jaiver Macea
- Laboratory for Epilepsy Research, Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven 3000, Belgium.
| | - Lauren Swinnen
- Laboratory for Epilepsy Research, Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven 3000, Belgium.
| | - Carolina Varon
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven 3000, Belgium.
| | - Maarten De Vos
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven 3000, Belgium; Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium.
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven 3000, Belgium; Department of Neurology, Leuven University Hospitals, Leuven 3000, Belgium.
| |
Collapse
|
2
|
Seth EA, Watterson J, Xie J, Arulsamy A, Md Yusof HH, Ngadimon IW, Khoo CS, Kadirvelu A, Shaikh MF. Feasibility of cardiac-based seizure detection and prediction: A systematic review of non-invasive wearable sensor-based studies. Epilepsia Open 2024; 9:41-59. [PMID: 37881157 PMCID: PMC10839362 DOI: 10.1002/epi4.12854] [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: 05/17/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
A reliable seizure detection or prediction device can potentially reduce the morbidity and mortality associated with epileptic seizures. Previous findings indicating alterations in cardiac activity during seizures suggest the usefulness of cardiac parameters for seizure detection or prediction. This study aims to examine available studies on seizure detection and prediction based on cardiac parameters using non-invasive wearable devices. The Embase, PubMed, and Scopus databases were used to systematically search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Human studies that evaluated seizure detection or prediction based on cardiac parameters collected using wearable devices were included. The QUADAS-2 tool and proposed standards for validation for seizure detection devices were used for quality assessment. Twenty-four articles were identified and included in the analysis. Twenty studies evaluated seizure detection algorithms, and four studies focused on seizure prediction. Most studies used either a wrist-worn or chest-worn device for data acquisition. Among the seizure detection studies, cardiac parameters utilized for the algorithms mainly included heart rate (HR) (n = 11) or a combination of HR and heart rate variability (HRV) (n = 6). HR-based seizure detection studies collectively reported a sensitivity range of 56%-100% and a false alarm rate (FAR) of 0.02-8/h, with most studies performing retrospective validation of the algorithms. Three of the seizure prediction studies retrospectively validated multimodal algorithms, combining cardiac features with other physiological signals. Only one study prospectively validated their seizure prediction algorithm using HRV extracted from ECG data collected from a custom wearable device. These studies have demonstrated the feasibility of using cardiac parameters for seizure detection and prediction with wearable devices, with varying algorithmic performance. Many studies are in the proof-of-principle stage, and evidence for real-time detection or prediction is currently limited. Future studies should prioritize further refinement of the algorithm performance with prospective validation using large-scale longitudinal data. PLAIN LANGUAGE SUMMARY: This systematic review highlights the potential use of wearable devices, like wristbands, for detecting and predicting seizures via the measurement of heart activity. By reviewing 24 articles, it was found that most studies focused on using heart rate and changes in heart rate for seizure detection. There was a lack of studies looking at seizure prediction. The results were promising but most studies were not conducted in real-time. Therefore, more real-time studies are needed to verify the usage of heart activity-related wearable devices to detect seizures and even predict them, which will be beneficial to people with epilepsy.
Collapse
Affiliation(s)
- Eryse Amira Seth
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Jessica Watterson
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Department of Human‐Centred ComputingMonash UniversityMelbourneVictoriaAustralia
| | - Jue Xie
- Department of Human‐Centred ComputingMonash UniversityMelbourneVictoriaAustralia
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Hadri Hadi Md Yusof
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Irma Wati Ngadimon
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Amudha Kadirvelu
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- School of Dentistry and Medical SciencesCharles Sturt UniversityOrangeNew South WalesAustralia
| |
Collapse
|
3
|
Baud MO, Proix T, Gregg NM, Brinkmann BH, Nurse ES, Cook MJ, Karoly PJ. Seizure forecasting: Bifurcations in the long and winding road. Epilepsia 2023; 64 Suppl 4:S78-S98. [PMID: 35604546 PMCID: PMC9681938 DOI: 10.1111/epi.17311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
To date, the unpredictability of seizures remains a source of suffering for people with epilepsy, motivating decades of research into methods to forecast seizures. Originally, only few scientists and neurologists ventured into this niche endeavor, which, given the difficulty of the task, soon turned into a long and winding road. Over the past decade, however, our narrow field has seen a major acceleration, with trials of chronic electroencephalographic devices and the subsequent discovery of cyclical patterns in the occurrence of seizures. Now, a burgeoning science of seizure timing is emerging, which in turn informs best forecasting strategies for upcoming clinical trials. Although the finish line might be in view, many challenges remain to make seizure forecasting a reality. This review covers the most recent scientific, technical, and medical developments, discusses methodology in detail, and sets a number of goals for future studies.
Collapse
Affiliation(s)
- Maxime O Baud
- Sleep-Wake-Epilepsy Center, Center for Experimental Neurology, NeuroTec, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
- Wyss Center for Bio- and Neuro-Engineering, Geneva, Switzerland
| | - Timothée Proix
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicholas M Gregg
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin H Brinkmann
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ewan S Nurse
- Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark J Cook
- Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Philippa J Karoly
- Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Ryan JM, Wagner KT, Yerram S, Concannon C, Lin JX, Rooney P, Hanrahan B, Titoff V, Connolly NL, Cranmer R, DeMaria N, Xia X, Mykins B, Erickson S, Couderc JP, Schifitto G, Hughes I, Wang D, Erba G, Auerbach DS. Heart rate and autonomic biomarkers distinguish convulsive epileptic vs. functional or dissociative seizures. Seizure 2023; 111:178-186. [PMID: 37660533 DOI: 10.1016/j.seizure.2023.08.015] [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: 06/09/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE 20-40% of individuals whose seizures are not controlled by anti-seizure medications exhibit manifestations comparable to epileptic seizures (ES), but there are no EEG correlates. These events are called functional or dissociative seizures (FDS). Due to limited access to EEG-monitoring and inconclusive results, we aimed to develop an alternative diagnostic tool that distinguishes ES vs. FDS. We evaluated the temporal evolution of ECG-based measures of autonomic function (heart rate variability, HRV) to determine whether they distinguish ES vs. FDS. METHODS The prospective study includes patients admitted to the University of Rochester Epilepsy Monitoring Unit. Participants are 18-65 years old, without therapies or co-morbidities associated with altered autonomics. A habitual ES or FDS is recorded during admission. HRV analysis is performed to evaluate the temporal changes in autonomic function during the peri‑ictal period (150-minutes each pre-/post-ictal). We determined if autonomic measures distinguish ES vs. FDS. RESULTS The study includes 53 ES and 46 FDS. Temporal evolution of HR and autonomics significantly differ surrounding ES vs. FDS. The pre-to-post-ictal change (delta) in HR differs surrounding ES vs. FDS, stratified for convulsive and non-convulsive events. Post-ictal HR, total autonomic (SDNN & Total Power), vagal (RMSSD & HF), and baroreflex (LF) function differ for convulsive ES vs. convulsive FDS. HR distinguishes non-convulsive ES vs. non-convulsive FDS with ROC>0.7, sensitivity>70%, but specificity<50%. HR-delta and post-ictal HR, SDNN, RMSSD, LF, HF, and Total Power each distinguish convulsive ES vs. convulsive FDS (ROC, 0.83-0.98). Models with HR-delta and post-ictal HR provide the highest diagnostic accuracy for convulsive ES vs. convulsive FDS: 92% sensitivity, 94% specificity, ROC 0.99). SIGNIFICANCE HR and HRV measures accurately distinguish convulsive, but not non-convulsive, events (ES vs. FDS). Results establish the framework for future studies to apply this diagnostic tool to more heterogeneous populations, and on out-of-hospital recordings, particularly for populations without access to epilepsy monitoring units.
Collapse
Affiliation(s)
- Justin M Ryan
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Kyle T Wagner
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Sushma Yerram
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Cathleen Concannon
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Jennifer X Lin
- School of Medicine, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Patrick Rooney
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Brian Hanrahan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Victoria Titoff
- Department of Neurology-Epilepsy, SUNY Upstate Medical University, Syracuse, NY 13210, United States; Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Noreen L Connolly
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Ramona Cranmer
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Natalia DeMaria
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Xiaojuan Xia
- Clinical Cardiology Research Center Medicine-Cardiology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Betty Mykins
- Clinical Cardiology Research Center Medicine-Cardiology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Steven Erickson
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Jean-Philippe Couderc
- Clinical Cardiology Research Center Medicine-Cardiology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Inna Hughes
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Dongliang Wang
- Department of Public Health, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Giuseppe Erba
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - David S Auerbach
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
| |
Collapse
|
5
|
Uludag IF, Tumer O, Sener U. Peri-ictal heart rate changes in patients with epilepsy. Niger J Clin Pract 2023; 26:1176-1180. [PMID: 37635614 DOI: 10.4103/njcp.njcp_116_23] [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] [Indexed: 08/29/2023]
Abstract
Background Heart rate (HR) changes associated with seizures are promising biomarkers in epilepsy. Aims The aim of our study is to reveal possible HR changes in the peri-ictal period. Methods Long-term video-EEG monitorization records of generalized and focal epilepsy patients were reviewed. HRs were calculated in the pre-ictal (2 min before the first seizure activity in EEG), ictal (the time from the first seizure activity on the EEG to the end of the seizure), and in the interictal period (at least 2 h before or 12 h after the seizure). Interictal, pre-ictal, and ictal HRs were compared with each other. In addition, it was investigated whether peri-ictal HR changes differ between generalized and focal seizure patients. Results Focal motor seizures were observed in 21, and generalized tonic-clonic seizures were observed in 18 of 39 (22 female and 17 male) patients studied. HRs in the pre-ictal and ictal periods were significantly higher than in the interictal period. This significant increase in HR was validated separately in both focal and generalized seizure groups and was not different between the two groups. Conclusion Our study supports previous studies showing the presence of increased peri-ictal HR and also provides new insights by comparing focal and generalized motor seizures. We think that our findings may contribute to the development of early warning signs in epilepsy patients.
Collapse
Affiliation(s)
- I F Uludag
- Department of Neurology, University of Health Sciences, İzmir, Turkey
| | - O Tumer
- Department of Neurology, University of Health Sciences, İzmir, Turkey
| | - U Sener
- Department of Neurology, University of Health Sciences, İzmir, Turkey
| |
Collapse
|
6
|
Lee SS, El Ters N, Vesoulis ZA, Zempel JM, Mathur AM. Variable Association of Physiologic Changes With Electrographic Seizure-Like Events in Infants Born Preterm. J Pediatr 2023; 257:113348. [PMID: 36801212 PMCID: PMC10575679 DOI: 10.1016/j.jpeds.2022.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To determine the incidence of seizure-like events in a cohort of infants born preterm as well as the prevalence of associated vital sign changes (heart rate [HR], respiratory rate, and pulse oximetry [SpO2]). STUDY DESIGN We performed prospective conventional video electroencephalogram monitoring on infants born at 23-30 weeks of gestational age during the first 4 postnatal days. For detected seizure-like events, simultaneously captured vital sign data were analyzed during the pre-event baseline and during the event. Significant vital sign changes were defined as HR or respiratory rate >±2 SD from the infant's own baseline physiologic mean, derived from a 10-minute interval before the seizure-like event. Significant change in SpO2 was defined as oxygen desaturation during the event with a mean SpO2 <88%. RESULTS Our sample included 48 infants with median gestational age of 28 weeks (IQR 26-29) and birth weight of 1125 g (IQR 963-1265). Twelve (25%) infants had seizure-like discharges with a total of 201 events; 83% (10/12) of infants had vital sign changes during these events, and 50% (6/12) had significant vital sign changes during the majority of the seizure-like events. Concurrent HR changes occurred the most frequently. CONCLUSIONS Individual infant variability was observed in the prevalence of concurrent vital sign changes with electroencephalographic seizure-like events. Physiologic changes associated with preterm electrographic seizure-like events should be investigated further as a potential biomarker to assess the clinical significance of such events in the preterm population.
Collapse
Affiliation(s)
- Stephanie S Lee
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Nathalie El Ters
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO.
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO
| | - John M Zempel
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Amit M Mathur
- Saint Louis University School of Medicine, St Louis, MO
| |
Collapse
|
7
|
Pang TD, Nearing BD, Verrier RL, Schachter SC. Response to letter to the editor by Dr. Guilherme Loureiro Fialho and Dr. Katia Lin: "T-wave heterogeneity in epilepsy: Could we kill two (or three) birds with one stone?". Epilepsy Behav 2022; 134:108806. [PMID: 35753899 DOI: 10.1016/j.yebeh.2022.108806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Trudy D Pang
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Bruce D Nearing
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Boston MA, United States.
| | - Richard L Verrier
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Boston MA, United States.
| | - Steven C Schachter
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Consortia for Improving Medicine with Innovation & Technology (CIMIT), Boston, MA, United States.
| |
Collapse
|
8
|
Adams T, Wagner S, Baldinger M, Zellhuber I, Weber M, Nass D, Surges R. Accurate detection of heart rate using in-ear photoplethysmography in a clinical setting. Front Digit Health 2022; 4:909519. [PMID: 36060539 PMCID: PMC9428405 DOI: 10.3389/fdgth.2022.909519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recent research has shown that photoplethysmography (PPG) based wearable sensors offer a promising potential for chronic disease monitoring. The aim of the present study was to assess the performance of an in-ear wearable PPG sensor in acquiring valid and reliable heart rate measurements in a clinical setting, with epileptic patients. Methods Patients undergoing video-electroencephalography (EEG) monitoring with concomitant one-lead electrocardiographic (ECG) recordings were equipped with an in-ear sensor developed by cosinuss°. Results In total, 2,048 h of recording from 97 patients with simultaneous ECG and in-ear heart rate data were included in the analysis. The comparison of the quality-filtered in-ear heart rate data with the reference ECG resulted in a bias of 0.78 bpm with a standard deviation of ±2.54 bpm; Pearson’s Correlation Coefficient PCC = 0.83; Intraclass Correlation Coefficient ICC = 0.81 and mean absolute percentage error MAPE = 2.57. Conclusion These data confirm that the in-ear wearable PPG sensor provides accurate heart rate measurements in comparison with ECG under realistic clinical conditions, especially with a signal quality indicator. Further research is required to investigate whether this technology is helpful in identifying seizure-related cardiovascular changes.
Collapse
Affiliation(s)
| | | | - Melanie Baldinger
- Associate Professorship of Sport Equipment and Sport Materials, Technical University of Munich, Munich, Germany
| | | | | | - Daniel Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Correspondence: Rainer Surges
| |
Collapse
|
9
|
Pang TD, Nearing BD, Verrier RL, Schachter SC. T-wave heterogeneity crescendo in the surface EKG is superior to heart rate acceleration for seizure prediction. Epilepsy Behav 2022; 130:108670. [PMID: 35367725 DOI: 10.1016/j.yebeh.2022.108670] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
We examined whether T-wave heterogeneity (TWH) on the surface electrocardiographic (EKG) could predict epileptic seizure onset. Patients with electroencephalography-confirmed generalized tonic-clonic seizures (GTCS) (n = 6) exhibited abnormal elevations in TWH (>80 µV) at baseline (105 ± 20.4 µV), which increased from 30 min prior to seizure without heart rate increases > 2 beats/min until 10 min pre-seizure. Specifically, TWH on 3-lead surface EKG patch recordings increased from 1-hour baseline to 30 min (<0.05), 20 min (p < 0.002), 10 min (p = 0.01), and 1 min (p = 0.01) before seizure onset. At 10 min following GTCS, TWH returned to 110 ± 20.3 µV, similar to baseline (p = 0.54). This pre-ictal TWH warning pattern was not present in patients with psychogenic nonepileptic seizures (PNES) (n = 3), as TWH did not increase until PNES and returned to baseline within 10 min after PNES. Acute elevations in TWH may predict impending GTCS and may discriminate patients with GTCS from those with behaviorally similar PNES.
Collapse
Affiliation(s)
- Trudy D Pang
- Department of Neurology, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, United States; Harvard Medical School, 99 Brookline Avenue, RN-301, Boston, MA 02215, United States.
| | - Bruce D Nearing
- Harvard Medical School, 99 Brookline Avenue, RN-301, Boston, MA 02215, United States; Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, United States.
| | - Richard L Verrier
- Harvard Medical School, 99 Brookline Avenue, RN-301, Boston, MA 02215, United States; Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, United States.
| | - Steven C Schachter
- Department of Neurology, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, United States; Harvard Medical School, 99 Brookline Avenue, RN-301, Boston, MA 02215, United States; Massachusetts General Hospital, Boston, MA, United States; Consortia for Improving Medicine with Innovation & Technology (CIMIT), 125 Nashua St., Suite 324, Boston, MA 02114, United States.
| |
Collapse
|
10
|
Identifying Barriers to Care in the Pediatric Acute Seizure Care Pathway. Int J Integr Care 2022; 22:28. [PMID: 35431702 PMCID: PMC8973859 DOI: 10.5334/ijic.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway. Methods: We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children’s Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management. Results: Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management. Significance: Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.
Collapse
|
11
|
Statello R, Carnevali L, Sgoifo A, Miragoli M, Pisani F. Heart rate variability in neonatal seizures: Investigation and implications for management. Neurophysiol Clin 2021; 51:483-492. [PMID: 34774410 DOI: 10.1016/j.neucli.2021.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Many factors acting during the neonatal period can affect neurological development of the infant. Neonatal seizures (NS) that frequently occur in the immature brain may influence autonomic maturation and lead to detectable cardiovascular signs. These autonomic manifestations can also have significant diagnostic and prognostic value. The analysis of Heart Rate Variability (HRV) represents the most used and feasible method to evaluate cardiac autonomic regulation. This narrative review summarizes studies investigating HRV dynamics in newborns with seizures, with the aim of highlighting the potential utility of HRV measures for seizure detection and management. While HRV analysis in critically ill newborns is influenced by many potential confounders, we suggest that it can enhance the ability to better diagnose seizures in the clinical setting. We present potential applications of the analysis of HRV, which could have a useful future role, beyond the research setting.
Collapse
Affiliation(s)
- Rosario Statello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Carnevali
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Andrea Sgoifo
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Michele Miragoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Departement of Molecular Cardiology, Humanitas Research Hospital, IRCCS, Rozzano MI, Italy.
| | - Francesco Pisani
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| |
Collapse
|
12
|
Autonomic manifestations of epilepsy: emerging pathways to sudden death? Nat Rev Neurol 2021; 17:774-788. [PMID: 34716432 DOI: 10.1038/s41582-021-00574-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Epileptic networks are intimately connected with the autonomic nervous system, as exemplified by a plethora of ictal (during a seizure) autonomic manifestations, including epigastric sensations, palpitations, goosebumps and syncope (fainting). Ictal autonomic changes might serve as diagnostic clues, provide targets for seizure detection and help us to understand the mechanisms that underlie sudden unexpected death in epilepsy (SUDEP). Autonomic alterations are generally more prominent in focal seizures originating from the temporal lobe, demonstrating the importance of limbic structures to the autonomic nervous system, and are particularly pronounced in focal-to-bilateral and generalized tonic-clonic seizures. The presence, type and severity of autonomic features are determined by the seizure onset zone, propagation pathways, lateralization and timing of the seizures, and the presence of interictal autonomic dysfunction. Evidence is mounting that not all autonomic manifestations are linked to SUDEP. In addition, experimental and clinical data emphasize the heterogeneity of SUDEP and its infrequent overlap with sudden cardiac death. Here, we review the spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy. In particular, we focus on presentations that are likely to contribute to SUDEP and discuss how wearable devices might help to prevent SUDEP.
Collapse
|
13
|
Karoly PJ, Stirling RE, Freestone DR, Nurse ES, Maturana MI, Halliday AJ, Neal A, Gregg NM, Brinkmann BH, Richardson MP, La Gerche A, Grayden DB, D'Souza W, Cook MJ. Multiday cycles of heart rate are associated with seizure likelihood: An observational cohort study. EBioMedicine 2021; 72:103619. [PMID: 34649079 PMCID: PMC8517288 DOI: 10.1016/j.ebiom.2021.103619] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Circadian and multiday rhythms are found across many biological systems, including cardiology, endocrinology, neurology, and immunology. In people with epilepsy, epileptic brain activity and seizure occurrence have been found to follow circadian, weekly, and monthly rhythms. Understanding the relationship between these cycles of brain excitability and other physiological systems can provide new insight into the causes of multiday cycles. The brain-heart link has previously been considered in epilepsy research, with potential implications for seizure forecasting, therapy, and mortality (i.e., sudden unexpected death in epilepsy). Methods We report the results from a non-interventional, observational cohort study, Tracking Seizure Cycles. This study sought to examine multiday cycles of heart rate and seizures in adults with diagnosed uncontrolled epilepsy (N=31) and healthy adult controls (N=15) using wearable smartwatches and mobile seizure diaries over at least four months (M=12.0, SD=5.9; control M=10.6, SD=6.4). Cycles in heart rate were detected using a continuous wavelet transform. Relationships between heart rate cycles and seizure occurrence were measured from the distributions of seizure likelihood with respect to underlying cycle phase. Findings Heart rate cycles were found in all 46 participants (people with epilepsy and healthy controls), with circadian (N=46), about-weekly (N=25) and about-monthly (N=13) rhythms being the most prevalent. Of the participants with epilepsy, 19 people had at least 20 reported seizures, and 10 of these had seizures significantly phase locked to their multiday heart rate cycles. Interpretation Heart rate cycles showed similarities to multiday epileptic rhythms and may be comodulated with seizure likelihood. The relationship between heart rate and seizures is relevant for epilepsy therapy, including seizure forecasting, and may also have implications for cardiovascular disease. More broadly, understanding the link between multiday cycles in the heart and brain can shed new light on endogenous physiological rhythms in humans. Funding This research received funding from the Australian Government National Health and Medical Research Council (investigator grant 1178220), the Australian Government BioMedTech Horizons program, and the Epilepsy Foundation of America's ‘My Seizure Gauge’ grant.
Collapse
Affiliation(s)
- Philippa J Karoly
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Australia; Seer Medical, Australia.
| | - Rachel E Stirling
- Department of Biomedical Engineering, The University of Melbourne, Australia
| | | | - Ewan S Nurse
- Seer Medical, Australia; Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Matias I Maturana
- Seer Medical, Australia; Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Amy J Halliday
- Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Andrew Neal
- Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Nicholas M Gregg
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Benjamin H Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Andre La Gerche
- Sports Cardiology Laboratory, Baker Heart & Diabetes Institute, Melbourne, Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Mark J Cook
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Australia; Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| |
Collapse
|
14
|
Shum J, Friedman D. Commercially available seizure detection devices: A systematic review. J Neurol Sci 2021; 428:117611. [PMID: 34419933 DOI: 10.1016/j.jns.2021.117611] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Epilepsy can be associated with significant morbidity and mortality. Seizure detection devices could be invaluable tools for both people with epilepsy, their caregivers, and clinicians as they could alert caretakers about seizures, reduce the risk of sudden unexpected death in epilepsy, and provide objective and more reliable seizure tracking to guide treatment decisions or monitor outcomes in clinical trials. OBJECTIVE To synthesize the characteristics of commercial seizure detection tools/devices currently available. METHODS We performed a systematic search utilizing a diverse set of resources to identify commercially available seizure detection products for consumer use. Performance data was obtained through a systematic review on commercially available products. OBSERVATIONS We identified 23 products marketed for seizure detection/alerting. Devices utilize a variety of mechanisms to detect seizures, including movement detectors, autonomic change detectors, electroencephalogram (EEG) based detectors, and other mechanisms (audio). The optimal device for a person with epilepsy depends on a variety of factors including the main purpose of the device, their age, seizure type and personal preferences. Only 8 devices have published peer-reviewed performance data and the majority for tonic-clonic seizures. An informed conversation between the clinician and the patient can help guide if a seizure detection device is appropriate. CONCLUSIONS AND RELEVANCE Seizure detection devices have a potential to reduce morbidity and mortality for certain people with epilepsy. Clinicians should be familiar with the characteristics of commercially available devices to best counsel their patients on whether a seizure detection device may be beneficial and what the optimal devices may be.
Collapse
Affiliation(s)
- Jennifer Shum
- Department of Neurology, Comprehensive Epilepsy Center, New York University Gross School of Medicine, New York, NY, USA.
| | - Daniel Friedman
- Department of Neurology, Comprehensive Epilepsy Center, New York University Gross School of Medicine, New York, NY, USA
| |
Collapse
|
15
|
Glasstetter M, Böttcher S, Zabler N, Epitashvili N, Dümpelmann M, Richardson MP, Schulze-Bonhage A. Identification of Ictal Tachycardia in Focal Motor- and Non-Motor Seizures by Means of a Wearable PPG Sensor. SENSORS (BASEL, SWITZERLAND) 2021; 21:6017. [PMID: 34577222 PMCID: PMC8470979 DOI: 10.3390/s21186017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Photoplethysmography (PPG) as an additional biosignal for a seizure detector has been underutilized so far, which is possibly due to its susceptibility to motion artifacts. We investigated 62 focal seizures from 28 patients with electrocardiography-based evidence of ictal tachycardia (IT). Seizures were divided into subgroups: those without epileptic movements and those with epileptic movements not affecting and affecting the extremities. PPG-based heart rate (HR) derived from a wrist-worn device was calculated for sections with high signal quality, which were identified using spectral entropy. Overall, IT based on PPG was identified in 37 of 62 (60%) seizures (9/19, 7/8, and 21/35 in the three groups, respectively) and could be found prior to the onset of epileptic movements affecting the extremities in 14/21 seizures. In 30/37 seizures, PPG-based IT was in good temporal agreement (<10 s) with ECG-based IT, with an average delay of 5.0 s relative to EEG onset. In summary, we observed that the identification of IT by means of a wearable PPG sensor is possible not only for non-motor seizures but also in motor seizures, which is due to the early manifestation of IT in a relevant subset of focal seizures. However, both spontaneous and epileptic movements can impair PPG-based seizure detection.
Collapse
Affiliation(s)
- Martin Glasstetter
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Sebastian Böttcher
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Nicolas Zabler
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Nino Epitashvili
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Matthias Dümpelmann
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| | - Mark P. Richardson
- Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience King’s College London, London SE5 9RT, UK;
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, 79106 Freiburg im Breisgau, Germany; (S.B.); (N.Z.); (N.E.); (M.D.); (A.S.-B.)
| |
Collapse
|
16
|
Costagliola G, Orsini A, Coll M, Brugada R, Parisi P, Striano P. The brain-heart interaction in epilepsy: implications for diagnosis, therapy, and SUDEP prevention. Ann Clin Transl Neurol 2021; 8:1557-1568. [PMID: 34047488 PMCID: PMC8283165 DOI: 10.1002/acn3.51382] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
The influence of the central nervous system and autonomic system on cardiac activity is being intensively studied, as it contributes to the high rate of cardiologic comorbidities observed in people with epilepsy. Indeed, neuroanatomic connections between the brain and the heart provide links that allow cardiac arrhythmias to occur in response to brain activation, have been shown to produce arrhythmia both experimentally and clinically. Moreover, seizures may induce a variety of transient cardiac effects, which include changes in heart rate, heart rate variability, arrhythmias, asystole, and other ECG abnormalities, and can trigger the development of Takotsubo syndrome. People with epilepsy are at a higher risk of death than the general population, and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Although the cause of SUDEP is still unknown, cardiac abnormalities during and between seizures could play a significant role in its pathogenesis, as highlighted by studies on animal models of SUDEP and registration of SUDEP events. Recently, genetic mutations in genes co-expressed in the heart and brain, which may result in epilepsy and cardiac comorbidity/increased risk for SUDEP, have been described. Recognition and a better understanding of brain-heart interactions, together with new advances in sequencing techniques, may provide new insights into future novel therapies and help in the prevention of cardiac dysfunction and sudden death in epileptic individuals.
Collapse
Affiliation(s)
- Giorgio Costagliola
- Pediatric Clinic, Santa Chiara's University Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Orsini
- Pediatric Clinic, Santa Chiara's University Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Monica Coll
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain.,Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| |
Collapse
|
17
|
Biondi A, Laiou P, Bruno E, Viana PF, Schreuder M, Hart W, Nurse E, Pal DK, Richardson MP. Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study. JMIR Res Protoc 2021; 10:e25309. [PMID: 33739290 PMCID: PMC8088854 DOI: 10.2196/25309] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 01/06/2023] Open
Abstract
Background Epileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy. Objective EEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk. Methods A total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King’s College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk. Results The EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022. Conclusions With the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence. International Registered Report Identifier (IRRID) PRR1-10.2196/25309
Collapse
Affiliation(s)
- Andrea Biondi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Petroula Laiou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Elisa Bruno
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Pedro F Viana
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Faculty of Medicine, University of Lisbon, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | - Ewan Nurse
- Seer Medical Inc, Melbourne, Australia.,Department of Medicine, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Deb K Pal
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mark P Richardson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
18
|
Leal A, Pinto MF, Lopes F, Bianchi AM, Henriques J, Ruano MG, de Carvalho P, Dourado A, Teixeira CA. Heart rate variability analysis for the identification of the preictal interval in patients with drug-resistant epilepsy. Sci Rep 2021; 11:5987. [PMID: 33727606 PMCID: PMC7966782 DOI: 10.1038/s41598-021-85350-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 02/02/2021] [Indexed: 11/08/2022] Open
Abstract
Electrocardiogram (ECG) recordings, lasting hours before epileptic seizures, have been studied in the search for evidence of the existence of a preictal interval that follows a normal ECG trace and precedes the seizure's clinical manifestation. The preictal interval has not yet been clinically parametrized. Furthermore, the duration of this interval varies for seizures both among patients and from the same patient. In this study, we performed a heart rate variability (HRV) analysis to investigate the discriminative power of the features of HRV in the identification of the preictal interval. HRV information extracted from the linear time and frequency domains as well as from nonlinear dynamics were analysed. We inspected data from 238 temporal lobe seizures recorded from 41 patients with drug-resistant epilepsy from the EPILEPSIAE database. Unsupervised methods were applied to the HRV feature dataset, thus leading to a new perspective in preictal interval characterization. Distinguishable preictal behaviour was exhibited by 41% of the seizures and 90% of the patients. Half of the preictal intervals were identified in the 40 min before seizure onset. The results demonstrate the potential of applying clustering methods to HRV features to deepen the current understanding of the preictal state.
Collapse
Affiliation(s)
- Adriana Leal
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal.
| | - Mauro F Pinto
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
| | - Fábio Lopes
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
| | - Anna M Bianchi
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, Milan, Italy
| | - Jorge Henriques
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
| | - Maria G Ruano
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
- University of Algarve, Department of Electronics and Informatics Engineering, Faculty of Science and Technology, Faro, Portugal
| | - Paulo de Carvalho
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
| | - António Dourado
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
| | - César A Teixeira
- University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal
| |
Collapse
|
19
|
Mazzola L, Rheims S. Ictal and Interictal Cardiac Manifestations in Epilepsy. A Review of Their Relation With an Altered Central Control of Autonomic Functions and With the Risk of SUDEP. Front Neurol 2021; 12:642645. [PMID: 33776894 PMCID: PMC7994524 DOI: 10.3389/fneur.2021.642645] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
There is a complex interrelation between epilepsy and cardiac pathology, with both acute and long-term effects of seizures on the regulation of the cardiac rhythm and on the heart functioning. A specific issue is the potential relation between these cardiac manifestations and the risk of Sudden and Unexpected Death in Epilepsy (SUDEP), with unclear respective role of centrally-control ictal changes, long-term epilepsy-related dysregulation of the neurovegetative control and direct effects on the heart function. In the present review, we detailed available data about ictal cardiac changes, along with interictal cardiac manifestations associated with long-term functional and structural alterations of the heart. Pathophysiological mechanisms of these cardiac changes are discussed, with a specific focus on central mechanisms and the investigation of a possible deregulation of the central control of autonomic functions in addition to the role of catecholamine and hypoxemia on heart.
Collapse
Affiliation(s)
- Laure Mazzola
- Neurology Department, University Hospital, Saint-Étienne, France.,Lyon Neuroscience Research Center, INSERM U 1028, CNRS UMR, Lyon, France
| | - Sylvain Rheims
- Lyon Neuroscience Research Center, INSERM U 1028, CNRS UMR, Lyon, France.,Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| |
Collapse
|
20
|
Cardiovascular complications of epileptic seizures. Epilepsy Behav 2020; 111:107185. [PMID: 32554232 DOI: 10.1016/j.yebeh.2020.107185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022]
Abstract
Seizure disorders are associated with multisystem complications. Cardiovascular complications account for a significant proportion of morbidity and mortality in these patients. As such, particular attention must be paid to the incidence of cardiovascular complications especially in populations at increased risk. The background for cardiac dysfunction lies in the interplay of genetic/molecular, autonomic, and iatrogenic factors that contribute to its onset. The purpose of this review was to summarize the state of literature in the last decade with regard to cardiac complications of epileptic seizures in order to increase awareness of short- and long-term debilitating cardiac complications as well as facilitate informed clinical decision-making. Taken together, the evidence provided in this review suggests that cardiac dysfunction following seizures should not be viewed as a separate entity but as an important complication of epileptic seizures. Appropriate cardiac therapy should be instituted in the postictal medical management of epileptic seizures. In acute states, postictal cardiac troponinemia (elevated cTn) should be worked up. Longer-term, monitoring for the development of cardiac structural and functional abnormalities is prudent.
Collapse
|
21
|
Stirling RE, Cook MJ, Grayden DB, Karoly PJ. Seizure forecasting and cyclic control of seizures. Epilepsia 2020; 62 Suppl 1:S2-S14. [PMID: 32712968 DOI: 10.1111/epi.16541] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
Epilepsy is a unique neurologic condition characterized by recurrent seizures, where causes, underlying biomarkers, triggers, and patterns differ across individuals. The unpredictability of seizures can heighten fear and anxiety in people with epilepsy, making it difficult to take part in day-to-day activities. Epilepsy researchers have prioritized developing seizure prediction algorithms to combat episodic seizures for decades, but the utility and effectiveness of prediction algorithms has not been investigated thoroughly in clinical settings. In contrast, seizure forecasts, which theoretically provide the probability of a seizure at any time (as opposed to predicting the next seizure occurrence), may be more feasible. Many advances have been made over the past decade in the field of seizure forecasting, including improvements in algorithms as a result of machine learning and exploration of non-EEG-based measures of seizure susceptibility, such as physiological biomarkers, behavioral changes, environmental drivers, and cyclic seizure patterns. For example, recent work investigating periodicities in individual seizure patterns has determined that more than 90% of people have circadian rhythms in their seizures, and many also experience multiday, weekly, or longer cycles. Other potential indicators of seizure susceptibility include stress levels, heart rate, and sleep quality, all of which have the potential to be captured noninvasively over long time scales. There are many possible applications of a seizure-forecasting device, including improving quality of life for people with epilepsy, guiding treatment plans and medication titration, optimizing presurgical monitoring, and focusing scientific research. To realize this potential, it is vital to better understand the user requirements of a seizure-forecasting device, continue to advance forecasting algorithms, and design clear guidelines for prospective clinical trials of seizure forecasting.
Collapse
Affiliation(s)
- Rachel E Stirling
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Vic., Australia
| | - Mark J Cook
- Graeme Clark Institute & St Vincent's Hospital, The University of Melbourne, Melbourne, Vic., Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Vic., Australia
| | - Philippa J Karoly
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Vic., Australia.,Graeme Clark Institute & St Vincent's Hospital, The University of Melbourne, Melbourne, Vic., Australia
| |
Collapse
|
22
|
El Atrache R, Tamilia E, Mohammadpour Touserkani F, Hammond S, Papadelis C, Kapur K, Jackson M, Bucciarelli B, Tsuboyama M, Sarkis RA, Loddenkemper T. Photoplethysmography: A measure for the function of the autonomic nervous system in focal impaired awareness seizures. Epilepsia 2020; 61:1617-1626. [DOI: 10.1111/epi.16621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Rima El Atrache
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Eleonora Tamilia
- Children's Brain Dynamics Division of Newborn Medicine Department of Medicine Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
- Fetal‐Neonatal Neuroimaging and Developmental Science Center Boston Children's Hospital Boston Massachusetts USA
| | - Fatemeh Mohammadpour Touserkani
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
- Department of Neurology SUNY Downstate Medical Center Brooklyn New York USA
| | - Sarah Hammond
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Christos Papadelis
- Children's Brain Dynamics Division of Newborn Medicine Department of Medicine Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
- Jane and John Justin Neurosciences Center Cook Children's Health Care System Fort Worth Texas USA
- Department of Bioengineering University of Texas at Arlington Arlington Texas USA
| | - Kush Kapur
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Bethany Bucciarelli
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Melissa Tsuboyama
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Rani A. Sarkis
- Department of Neurology Brigham and Women's HospitalHarvard Medical School Boston Massachusetts USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| |
Collapse
|
23
|
Nasseri M, Nurse E, Glasstetter M, Böttcher S, Gregg NM, Laks Nandakumar A, Joseph B, Pal Attia T, Viana PF, Bruno E, Biondi A, Cook M, Worrell GA, Schulze-Bonhage A, Dümpelmann M, Freestone DR, Richardson MP, Brinkmann BH. Signal quality and patient experience with wearable devices for epilepsy management. Epilepsia 2020; 61 Suppl 1:S25-S35. [PMID: 32497269 DOI: 10.1111/epi.16527] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/24/2023]
Abstract
Noninvasive wearable devices have great potential to aid the management of epilepsy, but these devices must have robust signal quality, and patients must be willing to wear them for long periods of time. Automated machine learning classification of wearable biosensor signals requires quantitative measures of signal quality to automatically reject poor-quality or corrupt data segments. In this study, commercially available wearable sensors were placed on patients with epilepsy undergoing in-hospital or in-home electroencephalographic (EEG) monitoring, and healthy volunteers. Empatica E4 and Biovotion Everion were used to record accelerometry (ACC), photoplethysmography (PPG), and electrodermal activity (EDA). Byteflies Sensor Dots were used to record ACC and PPG, the Activinsights GENEActiv watch to record ACC, and Epitel Epilog to record EEG data. PPG and EDA signals were recorded for multiple days, then epochs of high-quality, marginal-quality, or poor-quality data were visually identified by reviewers, and reviewer annotations were compared to automated signal quality measures. For ACC, the ratio of spectral power from 0.8 to 5 Hz to broadband power was used to separate good-quality signals from noise. For EDA, the rate of amplitude change and prevalence of sharp peaks significantly differentiated between good-quality data and noise. Spectral entropy was used to assess PPG and showed significant differences between good-, marginal-, and poor-quality signals. EEG data were evaluated using methods to identify a spectral noise cutoff frequency. Patients were asked to rate the usability and comfort of each device in several categories. Patients showed a significant preference for the wrist-worn devices, and the Empatica E4 device was preferred most often. Current wearable devices can provide high-quality data and are acceptable for routine use, but continued development is needed to improve data quality, consistency, and management, as well as acceptability to patients.
Collapse
Affiliation(s)
- Mona Nasseri
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ewan Nurse
- Seer Medical, Melbourne, Victoria, Australia.,Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Glasstetter
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sebastian Böttcher
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nicholas M Gregg
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Boney Joseph
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tal Pal Attia
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro F Viana
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Elisa Bruno
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Andrea Biondi
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Gregory A Worrell
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andreas Schulze-Bonhage
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Matthias Dümpelmann
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | - Mark P Richardson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Benjamin H Brinkmann
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
24
|
Karoly PJ, Cook MJ, Maturana M, Nurse ES, Payne D, Brinkmann BH, Grayden DB, Dumanis SB, Richardson MP, Worrell GA, Schulze‐Bonhage A, Kuhlmann L, Freestone DR. Forecasting cycles of seizure likelihood. Epilepsia 2020; 61:776-786. [DOI: 10.1111/epi.16485] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Philippa J. Karoly
- Graeme Clark Institute and St Vincent’s Hospital University of Melbourne Melbourne Victoria Australia
- Department of Biomedical Engineering University of Melbourne Melbourne Victoria Australia
| | - Mark J. Cook
- Graeme Clark Institute and St Vincent’s Hospital University of Melbourne Melbourne Victoria Australia
| | - Matias Maturana
- Graeme Clark Institute and St Vincent’s Hospital University of Melbourne Melbourne Victoria Australia
- Seer Medical Melbourne Victoria Australia
| | - Ewan S. Nurse
- Graeme Clark Institute and St Vincent’s Hospital University of Melbourne Melbourne Victoria Australia
- Seer Medical Melbourne Victoria Australia
| | - Daniel Payne
- Department of Biomedical Engineering University of Melbourne Melbourne Victoria Australia
| | | | - David B. Grayden
- Department of Biomedical Engineering University of Melbourne Melbourne Victoria Australia
| | | | | | | | - Andreas Schulze‐Bonhage
- Faculty of Medicine Epilepsy Center Medical Center University of Freiburg Freiburg Germany
- European Reference Network EpiCare Freiburg Germany
| | - Levin Kuhlmann
- Department of Data Science and AI Faculty of Information Technology Monash University Clayton Victoria Australia
| | | |
Collapse
|
25
|
Ufongene C, El Atrache R, Loddenkemper T, Meisel C. Electrocardiographic changes associated with epilepsy beyond heart rate and their utilization in future seizure detection and forecasting methods. Clin Neurophysiol 2020; 131:866-879. [PMID: 32066106 DOI: 10.1016/j.clinph.2020.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022]
Abstract
The ability to assess seizure risk may help provide timely warnings and more personalized treatment plans for people with epilepsy (PWE). ECG changes are commonly observed in epilepsy which make ECG a promising candidate to monitor seizure risk. Most ECG research in this domain has focused on heart rate-related changes. However, several studies have identified a range of other peri-ictal ECG parameter changes that may potentially prove useful for seizure detection and forecasting. Here, we offer a systematic review of ECG changes in epilepsy outside of heart rate. We performed the systematic literature review according to PRISMA guidelines using key words related to ECG, SUDEP and epilepsy. We identified and screened 502 abstracts, read 110 full papers, and included 24 papers in the final review. Our results suggest that PWE may be more prone to cardiac conduction abnormalities than healthy controls. During interictal periods, PWE were more likely to have abnormal QTc intervals, ST segment abnormalities, elevated T Waves, early repolarization (ER), increased P Wave dispersion and PR intervals when compared to controls. Apart from these baseline abnormalities, changes during the pre-ictal and ictal states have been reported, with arrhythmias, QTc prolongation and ST segment changes being the most common. A better understanding of these state-dependent changes may afford less-cumbersome and less-stigmatizing epilepsy monitoring tools in the future.
Collapse
|
26
|
Abstract
Over the last few years, there has been significant expansion of wearable technologies and devices into the health sector, including for conditions such as epilepsy. Although there is significant potential to benefit patients, there is a paucity of well-conducted scientific research in order to inform patients and healthcare providers of the most appropriate technology. In addition to either directly or indirectly identifying seizure activity, the ideal device should improve quality of life and reduce the risk of sudden unexpected death in epilepsy (SUDEP). Devices typically monitor a number of parameters including electroencephalographic (EEG), cardiac, and respiratory patterns and can detect movement, changes in skin conductance, and muscle activity. Multimodal devices are emerging with improved seizure detection rates and reduced false positive alarms. While convulsive seizures are reliably identified by most unimodal and multimodal devices, seizures associated with no, or minimal, movement are frequently undetected. The vast majority of current devices detect but do not actively intervene. At best, therefore, they indicate the presence of seizure activity in order to accurately ascertain true seizure frequency or facilitate intervention by others, which may, nevertheless, impact the rate of SUDEP. Future devices are likely to both detect and intervene within an autonomous closed-loop system tailored to the individual and by self-learning from the analysis of patient-specific parameters. The formulation of standards for regulatory bodies to validate seizure detection devices is also of paramount importance in order to confidently ascertain the performance of a device; and this will be facilitated by the creation of a large, open database containing multimodal annotated data in order to test device algorithms. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen.
Collapse
Affiliation(s)
- Fergus Rugg-Gunn
- Dept. of Clinical and Experimental Epilepsy, National Hospital for Neurology & Neurosurgery, National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom; Epilepsy Society Research Centre, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom.
| |
Collapse
|
27
|
Giannakakis G, Tsiknakis M, Vorgia P. Focal epileptic seizures anticipation based on patterns of heart rate variability parameters. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 178:123-133. [PMID: 31416541 DOI: 10.1016/j.cmpb.2019.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/18/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Heart rate variability parameters are studied by the research community as potential valuable indices for seizure detection and anticipation. This paper investigates heart activity abnormalities during focal epileptic seizures in childhood. METHODS Seizures affect both the sympathetic and parasympathetic system which is expressed as abnormal patterns of heart rate variability (HRV) parameters. In the present study, a clinical dataset containing 42 focal seizures in long-term electrocardiographic (ECG) recordings from drug-resistant pediatric epileptic patients (with age 8.2 ± 4.3 years) was analyzed. RESULTS Results indicate that the time domain HRV parameters (heart rate, SDNN, standard deviation of heart rate, upper envelope) and spectral HRV parameters (LF/HF, normalized HF, normalized LF, total power) are significantly affected during ictal periods. The HRV features were ranked in terms of their relevance and efficacy to discriminate non-ictal/ictal periods and the top-ranked features were selected using the minimum Redundancy Maximum Relevance algorithm for further analysis. Then, a personalized anticipation algorithm based on multiple regression was introduced providing an "epileptic index" of imminent seizures. The performance of the system resulted in anticipation accuracy of 77.1% and an anticipation time of 21.8 s. CONCLUSIONS The results of this analysis could permit the anticipation of focal seizures only using electrocardiographic signals and the implementation of seizure anticipation strategies for a range of real-life clinical applications.
Collapse
Affiliation(s)
- Giorgos Giannakakis
- Institute of Computer Science, Foundation for Research and Technology - Hellas, N. Plastira 100, Vassilika Vouton, 70013 Heraklion, Crete, Greece.
| | - Manolis Tsiknakis
- Institute of Computer Science, Foundation for Research and Technology - Hellas, N. Plastira 100, Vassilika Vouton, 70013 Heraklion, Crete, Greece; Department of Informatics Engineering, Technological Educational Institute of Crete, Heraklion, Crete, Greece
| | - Pelagia Vorgia
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| |
Collapse
|
28
|
Kuhlmann L, Lehnertz K, Richardson MP, Schelter B, Zaveri HP. Seizure prediction - ready for a new era. Nat Rev Neurol 2019; 14:618-630. [PMID: 30131521 DOI: 10.1038/s41582-018-0055-2] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epilepsy is a common disorder characterized by recurrent seizures. An overwhelming majority of people with epilepsy regard the unpredictability of seizures as a major issue. More than 30 years of international effort have been devoted to the prediction of seizures, aiming to remove the burden of unpredictability and to couple novel, time-specific treatment to seizure prediction technology. A highly influential review published in 2007 concluded that insufficient evidence indicated that seizures could be predicted. Since then, several advances have been made, including successful prospective seizure prediction using intracranial EEG in a small number of people in a trial of a real-time seizure prediction device. In this Review, we examine advances in the field, including EEG databases, seizure prediction competitions, the prospective trial mentioned and advances in our understanding of the mechanisms of seizures. We argue that these advances, together with statistical evaluations, set the stage for a resurgence in efforts towards the development of seizure prediction methodologies. We propose new avenues of investigation involving a synergy between mechanisms, models, data, devices and algorithms and refine the existing guidelines for the development of seizure prediction technology to instigate development of a solution that removes the burden of the unpredictability of seizures.
Collapse
Affiliation(s)
- Levin Kuhlmann
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Medicine - St. Vincent's, The University of Melbourne, Parkville, Victoria, Australia.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Klaus Lehnertz
- Department of Epileptology, University of Bonn, Bonn, Germany. .,Interdisciplinary Center for Complex Systems, University of Bonn, Bonn, Germany.
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Björn Schelter
- Institute for Complex Systems and Mathematical Biology, University of Aberdeen, Aberdeen, UK
| | - Hitten P Zaveri
- Department of Neurology, Yale University, New Haven, CT, USA
| |
Collapse
|
29
|
Picking up the pace. Clin Neurophysiol 2019; 130:1528-1530. [PMID: 31295722 DOI: 10.1016/j.clinph.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022]
|
30
|
Catala A, Cousillas H, Hausberger M, Grandgeorge M. Dog alerting and/or responding to epileptic seizures: A scoping review. PLoS One 2018; 13:e0208280. [PMID: 30513112 PMCID: PMC6279040 DOI: 10.1371/journal.pone.0208280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/14/2018] [Indexed: 11/20/2022] Open
Abstract
Recently, there has been a rising interest in service dogs for people with epilepsy. Dogs have been reported as being sensitive to epileptic episodes in their owners, alerting before and/or responding during or after a seizure, with or without specific training. The purpose of this review is to present a comprehensive overview of the scientific research on seizure-alert/response dogs for people with epilepsy. We aimed to identify the existing scientific literature on the topic, describe the characteristics of seizure-alert/response dogs, and evaluate the state of the evidence base and outcomes. Out of 28 studies published in peer-reviewed journals dealing with this topic, only 5 (one prospective study and four self-reported questionnaires) qualified for inclusion according to PRISMA guidelines. Reported times of alert before seizure varied widely among dogs (with a range from 10 seconds to 5 hours) but seemed to be reliable (accuracy from ≥70% to 85% according to owner reports). Alerting behaviors were generally described as attention-getting. The alert applied to many seizure types. Dogs mentioned as being seizure-alert dogs varied in size and breed. Training methods differed between service animal programs, partially relying on hypothesized cues used by dogs (e.g., variations in behavior, scent, heart rate). Most studies indicated an increase in quality of life and a reduction in the seizure frequency when living with a dog demonstrating seizure-related behavior. However, the level of methodological rigor was generally poor. In conclusion, scientific data are still too scarce and preliminary to reach any definitive conclusion regarding the success of dogs in alerting for an impending seizure, the cues on which this ability may be based, the best type of dog, and associated training. While these preliminary data suggest that this is a promising topic, further research is needed.
Collapse
Affiliation(s)
- Amélie Catala
- Université de Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
- Association Handi’Chiens, Paris, France
| | - Hugo Cousillas
- Université de Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Rennes, France
| | - Martine Hausberger
- CNRS, Université de Rennes, Normandie Univ, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
| | - Marine Grandgeorge
- Université de Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
| |
Collapse
|
31
|
Ictal autonomic changes as a tool for seizure detection: a systematic review. Clin Auton Res 2018; 29:161-181. [PMID: 30377843 PMCID: PMC6459795 DOI: 10.1007/s10286-018-0568-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/07/2018] [Indexed: 12/05/2022]
Abstract
Purpose Adequate epileptic seizure detection may have the potential to minimize seizure-related complications and improve treatment evaluation. Autonomic changes often precede ictal electroencephalographic discharges and therefore provide a promising tool for timely seizure detection. We reviewed the literature for seizure detection algorithms using autonomic nervous system parameters.
Methods The PubMed and Embase databases were systematically searched for original human studies that validate an algorithm for automatic seizure detection based on autonomic function alterations. Studies on neonates only and pilot studies without performance data were excluded. Algorithm performance was compared for studies with a similar design (retrospective vs. prospective) reporting both sensitivity and false alarm rate (FAR). Quality assessment was performed using QUADAS-2 and recently reported quality standards on reporting seizure detection algorithms. Results Twenty-one out of 638 studies were included in the analysis. Fifteen studies presented a single-modality algorithm based on heart rate variability (n = 10), heart rate (n = 4), or QRS morphology (n = 1), while six studies assessed multimodal algorithms using various combinations of HR, corrected QT interval, oxygen saturation, electrodermal activity, and accelerometry. Most studies had small sample sizes and a short follow-up period. Only two studies performed a prospective validation. A tendency for a lower FAR was found for retrospectively validated algorithms using multimodal autonomic parameters compared to those using single modalities (mean sensitivity per participant 71–100% vs. 64–96%, and mean FAR per participant 0.0–2.4/h vs. 0.7–5.4/h). Conclusions The overall quality of studies on seizure detection using autonomic parameters is low. Unimodal autonomic algorithms cannot reach acceptable performance as false alarm rates are still too high. Larger prospective studies are needed to validate multimodal automatic seizure detection. Electronic supplementary material The online version of this article (10.1007/s10286-018-0568-1) contains supplementary material, which is available to authorized users.
Collapse
|
32
|
Statello R, Carnevali L, Alinovi D, Pisani F, Sgoifo A. Heart rate variability in neonatal patients with seizures. Clin Neurophysiol 2018; 129:2534-2540. [PMID: 30384023 DOI: 10.1016/j.clinph.2018.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 10/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Seizures are frequently observed in neurological conditions affecting newborns. Since autonomic alterations are commonly associated with neonatal seizures (NS), we investigated the utility of heart rate variability (HRV) indexes of cardiac autonomic regulation for NS detection. METHODS HRV analysis was conducted on ECG tracings recorded during video-EEG monitoring in newborns with NS and matched-controls. The effects of gestational age on HRV were also evaluated. RESULTS Newborns with NS showed lower resting state HRV compared to controls. Moreover, seizure episodes were characterized by a short-lasting increase in vagal indexes of HRV. Pre-term newborns with NS had a lower HRV than full-term at rest. In pre-term newborns, no changes in HRV were observed before and during NS. On the contrary, full-term newborns showed significantly higher HRV before and during NS compared to the respective baseline values. CONCLUSION Our data point to resting autonomic impairment in newborns with NS. In addition, an increment in HRV has been observed during NS only in full term newborns. SIGNIFICANCE Although these findings do not allow validation of HRV measures for NS prediction and detection, they suggest that a putative protective vagal mechanism might be adopted when an advanced maturation of autonomic nervous system is achieved.
Collapse
Affiliation(s)
- Rosario Statello
- Department of Chemistry, Life Sciences and Environmental Sustainability, Stress Physiology Lab, University of Parma, Italy
| | - Luca Carnevali
- Department of Chemistry, Life Sciences and Environmental Sustainability, Stress Physiology Lab, University of Parma, Italy
| | - Davide Alinovi
- Department of Engineering and Architecture, Information Engineering Unit, University of Parma, Italy
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Italy
| | - Andrea Sgoifo
- Department of Chemistry, Life Sciences and Environmental Sustainability, Stress Physiology Lab, University of Parma, Italy.
| |
Collapse
|
33
|
Parasomnia versus epilepsy: An affair of the heart? Neurophysiol Clin 2018; 48:277-286. [DOI: 10.1016/j.neucli.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/03/2018] [Accepted: 08/27/2018] [Indexed: 01/07/2023] Open
|