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Miron G, Halimeh M, Jeppesen J, Loddenkemper T, Meisel C. Autonomic biosignals, seizure detection, and forecasting. Epilepsia 2024. [PMID: 38837428 DOI: 10.1111/epi.18034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
Wearable devices have attracted significant attention in epilepsy research in recent years for their potential to enhance patient care through improved seizure monitoring and forecasting. This narrative review presents a detailed overview of the current clinical state of the art while addressing how devices that assess autonomic nervous system (ANS) function reflect seizures and central nervous system (CNS) state changes. This includes a description of the interactions between the CNS and the ANS, including physiological and epilepsy-related changes affecting their dynamics. We first discuss technical aspects of measuring autonomic biosignals and considerations for using ANS sensors in clinical practice. We then review recent seizure detection and seizure forecasting studies, highlighting their performance and capability for seizure detection and forecasting using devices measuring ANS biomarkers. Finally, we address the field's challenges and provide an outlook for future developments.
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Affiliation(s)
- Gadi Miron
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Mustafa Halimeh
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Jesper Jeppesen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tobias Loddenkemper
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christian Meisel
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
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Yu S, El Atrache R, Tang J, Jackson M, Makarucha A, Cantley S, Sheehan T, Vieluf S, Zhang B, Rogers JL, Mareels I, Harrer S, Loddenkemper T. Artificial intelligence-enhanced epileptic seizure detection by wearables. Epilepsia 2023; 64:3213-3226. [PMID: 37715325 DOI: 10.1111/epi.17774] [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: 04/18/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Wrist- or ankle-worn devices are less intrusive than the widely used electroencephalographic (EEG) systems for monitoring epileptic seizures. Using custom-developed deep-learning seizure detection models, we demonstrate the detection of a broad range of seizure types by wearable signals. METHODS Patients admitted to the epilepsy monitoring unit were enrolled and asked to wear wearable sensors on either wrists or ankles. We collected patients' electrodermal activity, accelerometry (ACC), and photoplethysmography, from which blood volume pulse (BVP) is derived. Board-certified epileptologists determined seizure onset, offset, and types using video and EEG recordings per the International League Against Epilepsy 2017 classification. We applied three neural network models-a convolutional neural network (CNN) and a CNN-long short-term memory (LSTM)-based generalized detection model and an autoencoder-based personalized detection model-to the raw time-series sensor data to detect seizures and utilized performance measures, including sensitivity, false positive rate (the number of false alarms divided by the total number of nonseizure segments), number of false alarms per day, and detection delay. We applied a 10-fold patientwise cross-validation scheme to the multisignal biosensor data and evaluated model performance on 28 seizure types. RESULTS We analyzed 166 patients (47.6% female, median age = 10.0 years) and 900 seizures (13 254 h of sensor data) for 28 seizure types. With a CNN-LSTM-based seizure detection model, ACC, BVP, and their fusion performed better than chance; ACC and BVP data fusion reached the best detection performance of 83.9% sensitivity and 35.3% false positive rate. Nineteen of 28 seizure types could be detected by at least one data modality with area under receiver operating characteristic curve > .8 performance. SIGNIFICANCE Results from this in-hospital study contribute to a paradigm shift in epilepsy care that entails noninvasive seizure detection, provides time-sensitive and accurate data on additional clinical seizure types, and proposes a novel combination of an out-of-the-box monitoring algorithm with an individualized person-oriented seizure detection approach.
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Affiliation(s)
- Shuang Yu
- IBM Australia, Melbourne, Victoria, Australia
| | - Rima El Atrache
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michele Jackson
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sarah Cantley
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore Sheehan
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Solveig Vieluf
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Zhang
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey L Rogers
- Digital Health, IBM T. J. Watson Research Center, Yorktown Heights, New York, USA
| | | | - Stefan Harrer
- IBM Australia, Melbourne, Victoria, Australia
- Digital Health Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Tobias Loddenkemper
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Assessing epilepsy-related autonomic manifestations: Beyond cardiac and respiratory investigations. Neurophysiol Clin 2023; 53:102850. [PMID: 36913775 DOI: 10.1016/j.neucli.2023.102850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/13/2023] Open
Abstract
The Autonomic Nervous System (ANS) regulates many critical physiological functions. Its control relies on cortical input, especially limbic areas, which are often involved in epilepsy. Peri-ictal autonomic dysfunction is now well documented, but inter-ictal dysregulation is less studied. In this review, we discuss the available data on epilepsy-related autonomic dysfunction and the objective tests available. Epilepsy is associated with sympathetic-parasympathetic imbalance and a shift towards sympathetic dominance. Objective tests report alterations in heart rate, baroreflex function, cerebral autoregulation, sweat glands activity, thermoregulation, gastrointestinal and urinary function. However, some tests have found contradictory results and many tests suffer from a lack of sensitivity and reproducibility. Further study on interictal ANS function is required to further understand autonomic dysregulation and the potential association with clinically-relevant complications, including risk of Sudden Unexpected Death In Epilepsy (SUDEP).
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Seizure-related differences in biosignal 24-h modulation patterns. Sci Rep 2022; 12:15070. [PMID: 36064877 PMCID: PMC9445076 DOI: 10.1038/s41598-022-18271-z] [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: 02/18/2022] [Accepted: 08/08/2022] [Indexed: 11/08/2022] Open
Abstract
A seizure likelihood biomarker could improve seizure monitoring and facilitate adjustment of treatments based on seizure risk. Here, we tested differences in patient-specific 24-h-modulation patterns of electrodermal activity (EDA), peripheral body temperature (TEMP), and heart rate (HR) between patients with and without seizures. We enrolled patients who underwent continuous video-EEG monitoring at Boston Children's Hospital to wear a biosensor. We divided patients into two groups: those with no seizures and those with at least one seizure during the recording period. We assessed the 24-h modulation level and amplitude of EDA, TEMP, and HR. We performed machine learning including physiological and clinical variables. Subsequently, we determined classifier performance by cross-validated machine learning. Patients with seizures (n = 49) had lower EDA levels (p = 0.031), EDA amplitudes (p = 0.045), and trended toward lower HR levels (p = 0.060) compared to patients without seizures (n = 68). Averaged cross-validated classification accuracy was 69% (AUC-ROC: 0.75). Our results show the potential to monitor and forecast risk for epileptic seizures based on changes in 24-h patterns in wearable recordings in combination with clinical variables. Such biomarkers might be applicable to inform care, such as treatment or seizure injury risk during specific periods, scheduling diagnostic tests, such as admission to the epilepsy monitoring unit, and potentially other neurological and chronic conditions.
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Esmaeili B, Vieluf S, Dworetzky BA, Reinsberger C. The Potential of Wearable Devices and Mobile Health Applications in the Evaluation and Treatment of Epilepsy. Neurol Clin 2022; 40:729-739. [DOI: 10.1016/j.ncl.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Vieluf S, Hasija T, Schreier PJ, El Atrache R, Hammond S, Mohammadpour Touserkani F, Sarkis RA, Loddenkemper T, Reinsberger C. Generalized tonic-clonic seizures are accompanied by changes of interrelations within the autonomic nervous system. Epilepsy Behav 2021; 124:108321. [PMID: 34624803 DOI: 10.1016/j.yebeh.2021.108321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE A seizure is a strong central stimulus that affects multiple subsystems of the autonomic nervous system (ANS), and results in different interactions across ANS modalities. Here, we aimed to evaluate whether multimodal peripheral ANS measures demonstrate interactions before and after seizures as compared to controls to provide the basis for seizure detection and forecasting based on peripheral ANS signals. METHODS Continuous electrodermal activity (EDA), heart rate (HR), peripheral body temperature (TEMP), and respiratory rate (RR) calculated based on blood volume pulse were acquired by a wireless multi-sensor device. We selected 45 min of preictal and 60 min of postictal data and time-matched segments for controls. Data were analyzed over 15-min windows. For unimodal analysis, mean values over each time window were calculated for all modalities and analyzed by Friedman's two-way analysis of variance. RESULTS Twenty-one children with recorded generalized tonic-clonic seizures (GTCS), and 21 age- and gender-matched controls were included. Unimodal results revealed no significant effect for RR and TEMP, but EDA (p = 0.002) and HR (p < 0.001) were elevated 0-15 min after seizures. The averaged bimodal correlation across all pairs of modalities changed for 15-min windows in patients with seizures. The highest correlations were observed immediately before (0.85) and the lowest correlation immediately after seizures. Overall, average correlations for controls were higher. SIGNIFICANCE Multimodal ANS changes related to GTCS occur within and across autonomic nervous system modalities. While unimodal changes were most prominent during postictal segments, bimodal correlations increased before seizures and decreased postictally. This offers a promising avenue for further research on seizure detection, and potentially risk assessment for seizure recurrence and sudden unexplained death in epilepsy.
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Affiliation(s)
- Solveig Vieluf
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA; Institute of Sports Medicine, Paderborn University, Paderborn, Germany.
| | - Tanuj Hasija
- Signal and System Theory Group, Paderborn University, Paderborn, Germany
| | - Peter J Schreier
- Signal and System Theory Group, Paderborn University, Paderborn, Germany
| | - Rima El Atrache
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Sarah Hammond
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Fatemeh Mohammadpour Touserkani
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA; Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Rani A Sarkis
- Division of Epilepsy, Dept. of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany; Division of Epilepsy, Dept. of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Cousyn L, Navarro V, Chavez M. Outliers in clinical symptoms as preictal biomarkers. Epilepsy Res 2021; 177:106774. [PMID: 34571459 DOI: 10.1016/j.eplepsyres.2021.106774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/26/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
Previous findings have suggested that a preictal state might precede the epileptic seizure onset, which is the basis for seizure prediction attempts. Preictal states can be apprehended as outliers that differ from an interictal baseline and display clinical changes. We collected daily clinical scores from patients with epilepsy who underwent continuous video-EEG and assessed the ability of several outlier detection methods to identify preictal states. Results from 24 patients suggested that outlying clinical features were suggestive of preictal states and can be identified by statistical methods: AUC = 0.71, 95 % CI = [0.63 - 0.79]; PPV = 0.77, 95 % CI = [0.70 - 0.84]; FPR = 0.31, 95 % CI = [0.21 - 0.44]); and F1 score = 0.74, 95 % CI = [0.64 - 0.81]. Such algorithms could be straightforwardly implemented in a mobile device (e.g., tablet or smartphone), which would allow a longer data collection that could improve prediction performances. Additional clinical - and even multimodal - parameters could identify more subtle physiological modifications.
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Affiliation(s)
- Louis Cousyn
- Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris, France; AP-HP, Department of Neurology, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.
| | - Vincent Navarro
- Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris, France; AP-HP, Department of Neurology, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Mario Chavez
- CNRS UMR-7225, Pitié-Salpêtrière Hospital, Paris, France
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Tang J, El Atrache R, Yu S, Asif U, Jackson M, Roy S, Mirmomeni M, Cantley S, Sheehan T, Schubach S, Ufongene C, Vieluf S, Meisel C, Harrer S, Loddenkemper T. Seizure detection using wearable sensors and machine learning: Setting a benchmark. Epilepsia 2021; 62:1807-1819. [PMID: 34268728 PMCID: PMC8457135 DOI: 10.1111/epi.16967] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Tracking seizures is crucial for epilepsy monitoring and treatment evaluation. Current epilepsy care relies on caretaker seizure diaries, but clinical seizure monitoring may miss seizures. Wearable devices may be better tolerated and more suitable for long-term ambulatory monitoring. This study evaluates the seizure detection performance of custom-developed machine learning (ML) algorithms across a broad spectrum of epileptic seizures utilizing wrist- and ankle-worn multisignal biosensors. METHODS We enrolled patients admitted to the epilepsy monitoring unit and asked them to wear a wearable sensor on either their wrists or ankles. The sensor recorded body temperature, electrodermal activity, accelerometry (ACC), and photoplethysmography, which provides blood volume pulse (BVP). We used electroencephalographic seizure onset and offset as determined by a board-certified epileptologist as a standard comparison. We trained and validated ML for two different algorithms: Algorithm 1, ML methods for developing seizure type-specific detection models for nine individual seizure types; and Algorithm 2, ML methods for building general seizure type-agnostic detection, lumping together all seizure types. RESULTS We included 94 patients (57.4% female, median age = 9.9 years) and 548 epileptic seizures (11 066 h of sensor data) for a total of 930 seizures and nine seizure types. Algorithm 1 detected eight of nine seizure types better than chance (area under the receiver operating characteristic curve [AUC-ROC] = .648-.976). Algorithm 2 detected all nine seizure types better than chance (AUC-ROC = .642-.995); a fusion of ACC and BVP modalities achieved the best AUC-ROC (.752) when combining all seizure types together. SIGNIFICANCE Automatic seizure detection using ML from multimodal wearable sensor data is feasible across a broad spectrum of epileptic seizures. Preliminary results show better than chance seizure detection. The next steps include validation of our results in larger datasets, evaluation of the detection utility tool for additional clinical seizure types, and integration of additional clinical information.
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Affiliation(s)
- Jianbin Tang
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Rima El Atrache
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shuang Yu
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Umar Asif
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Michele Jackson
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Subhrajit Roy
- IBM Research Australia, Melbourne, Victoria, Australia.,Google Brain, London, UK
| | | | - Sarah Cantley
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore Sheehan
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Schubach
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Ufongene
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Solveig Vieluf
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Meisel
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Stefan Harrer
- IBM Research Australia, Melbourne, Victoria, Australia.,Digital Health Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Tobias Loddenkemper
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Gualniera L, Singh J, Fiori F, Santosh P. Emotional Behavioural and Autonomic Dysregulation (EBAD) in Rett Syndrome - EDA and HRV monitoring using wearable sensor technology. J Psychiatr Res 2021; 138:186-193. [PMID: 33862302 DOI: 10.1016/j.jpsychires.2021.03.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/01/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rett syndrome (RTT) is a severe genetic neurodevelopmental disorder. Emotional, Behavioural and Autonomic Dysregulation (EBAD), is frequent in RTT and is associated with multiple impairments. There are major challenges in the clinical assessment of emotions, behaviours, and autonomic function in RTT patients that limit the management of symptoms. METHODS Web-based technology (HealthTracker™) to measure the phenotype, and non-invasive, wearable sensor technology to evaluate autonomic function through Electrodermal Activity (EDA) and Heart Rate Variability (HRV) in 10 RTT patients was used, and treatment response of EBAD symptoms was monitored after different pharmacological treatments. RESULTS and discussion: 4 patients received buspirone, 2 sertraline, 1 gabapentin and 3 were not started on medications. Buspirone normalized the EDA in 3 patients with associated improvement in EBAD, whilst another patient only improved marginally. Both patients treated with sertraline (including one with normal EDA) significantly improved symptomatically. The patients on unchanged regimens showed no change in symptoms and autonomic function. Within 24 h of our assessment, one patient required intensive inpatient care due to septicaemia - this patient had been on gabapentin and showed a sharp and sustained EDA increase without obvious worsening of emotional and behavioural symptoms. Unlike the EDA, the analyses of HRV metrics did not reveal patterns that were associated with clinical outcomes. Our findings suggest a reasonable association of EDA normalization and symptomatic improvement in RTT subjects with EBAD treated with buspirone and point out its potential application as a measure of dysautonomia in RTT. Very high and sustained EDA levels may be a biomarker for concurrent serious physical illness in RTT.
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Affiliation(s)
- Ludovica Gualniera
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK; Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK; Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federico Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK; Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK; Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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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
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Vieluf S, Reinsberger C, El Atrache R, Jackson M, Schubach S, Ufongene C, Loddenkemper T, Meisel C. Autonomic nervous system changes detected with peripheral sensors in the setting of epileptic seizures. Sci Rep 2020; 10:11560. [PMID: 32665704 PMCID: PMC7360606 DOI: 10.1038/s41598-020-68434-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 11/09/2022] Open
Abstract
A better understanding of the early detection of seizures is highly desirable as identification of an impending seizure may afford improved treatments, such as antiepileptic drug chronotherapy, or timely warning to patients. While epileptic seizures are known to often manifest also with autonomic nervous system (ANS) changes, it is not clear whether ANS markers, if recorded from a wearable device, are also informative about an impending seizure with statistically significant sensitivity and specificity. Using statistical testing with seizure surrogate data and a unique dataset of continuously recorded multi-day wristband data including electrodermal activity (EDA), temperature (TEMP) and heart rate (HR) from 66 people with epilepsy (9.9 ± 5.8 years; 27 females; 161 seizures) we investigated differences between inter- and preictal periods in terms of mean, variance, and entropy of these signals. We found that signal mean and variance do not differentiate between inter- and preictal periods in a statistically meaningful way. EDA signal entropy was found to be increased prior to seizures in a small subset of patients. Findings may provide novel insights into the pathophysiology of epileptic seizures with respect to ANS function, and, while further validation and investigation of potential causes of the observed changes are needed, indicate that epilepsy-related state changes may be detectable using peripheral wearable devices. Detection of such changes with wearable devices may be more feasible for everyday monitoring than utilizing an electroencephalogram.
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Affiliation(s)
- Solveig Vieluf
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.,Institute of Sports Medicine, Paderborn University, Warburger Str. 100, 33098, Paderborn, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Warburger Str. 100, 33098, Paderborn, Germany.,Edward E. Bromfield Epilepsy Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Rima El Atrache
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Sarah Schubach
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Claire Ufongene
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Christian Meisel
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Neurology, University Clinic Carl Gustav Carus, Fetscherstraße 74, Dresden, 01307, Germany.
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