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Stirling RE, Nurse ES, Payne D, Naim-Feil J, Coleman H, Freestone DR, Richarson MP, Brinkmann BH, D'Souza WJ, Grayden DB, Cook MJ, Karoly PJ. User experience of a seizure risk forecasting app: A mixed methods investigation. Epilepsy Behav 2024; 157:109876. [PMID: 38851123 DOI: 10.1016/j.yebeh.2024.109876] [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: 02/22/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Over recent years, there has been a growing interest in exploring the utility of seizure risk forecasting, particularly how it could improve quality of life for people living with epilepsy. This study reports on user experiences and perspectives of a seizure risk forecaster app, as well as the potential impact on mood and adjustment to epilepsy. METHODS Active app users were asked to complete a survey (baseline and 3-month follow-up) to assess perspectives on the forecast feature as well as mood and adjustment. Post-hoc, nine neutral forecast users (neither agreed nor disagreed it was useful) completed semi-structured interviews, to gain further insight into their perspectives of epilepsy management and seizure forecasting. Non-parametric statistical tests and inductive thematic analyses were used to analyse the quantitative and qualitative data, respectively. RESULTS Surveys were completed by 111 users. Responders consisted of "app users" (n = 58), and "app and forecast users" (n = 53). Of the "app and forecast users", 40 % believed the forecast was accurate enough to be useful in monitoring for seizure risk, and 60 % adopted it for purposes like scheduling activities and helping mental state. Feeling more in control was the most common response to both high and low risk forecasted states. In-depth interviews revealed five broad themes, of which 'frustrations with lack of direction' (regarding their current epilepsy management approach), 'benefits of increased self-knowledge' and 'current and anticipated usefulness of forecasting' were the most common. SIGNIFICANCE Preliminary results suggest that seizure risk forecasting can be a useful tool for people with epilepsy to make lifestyle changes, such as scheduling daily events, and experience greater feelings of control. These improvements may be attributed, at least partly, to the improvements in self-knowledge experienced through forecast use.
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Affiliation(s)
- Rachel E Stirling
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Graeme Clark Institute of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
| | - Ewan S Nurse
- Graeme Clark Institute of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Seer Medical, Melbourne, Victoria, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia.
| | | | - Jodie Naim-Feil
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Graeme Clark Institute of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
| | - Honor Coleman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia; Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Victoria, Melbourne, Australia; Department of Neuroscience, Faculty of Medicine, Nursing & Health Science, Monash University, Melbourne, Australia.
| | | | | | | | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia.
| | - David B Grayden
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Graeme Clark Institute of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia.
| | - Mark J Cook
- Graeme Clark Institute of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Seer Medical, Melbourne, Victoria, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia.
| | - Philippa J Karoly
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Graeme Clark Institute of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
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2
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Monfort E, Latour P. Fostering patient engagement through the co-design of seizure detection and monitoring technologies: A roadmap for collaboration between research and development. Rev Neurol (Paris) 2024; 180:211-215. [PMID: 38040546 DOI: 10.1016/j.neurol.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/02/2023] [Indexed: 12/03/2023]
Abstract
The large number of technological developments suggests that patients with epilepsy can be better supported in the management of their seizures, especially when their condition is drug resistant. Patients and their caregivers, who are generally supportive of seizure detection and monitoring technologies, can provide relevant information to improve their effectiveness. We propose a comprehensive co-design approach to support more efficient development of seizure detection and monitoring technologies. Such an approach should follow the steps of the research and development process, take into account the temporal requirements characteristic of seizure management, focus on the themes of autonomy and self-management, and be guided by disease experts. If co-design practices are to continue to contribute to their development, they must also meet the scientific requirements of validity and reproducibility.
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Affiliation(s)
- E Monfort
- University of Grenoble Alpes, CNRS, TIMC, UFR SHS, 1251, avenue Centrale, CS 40700, 38000 Grenoble cedex 9, France.
| | - P Latour
- Medical Center of La Teppe, 26600 Tain-l'Hermitage, France
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3
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Biondi A, Simblett SK, Viana PF, Laiou P, Fiori AMG, Nurse E, Schreuder M, Pal DK, Richardson MP. Feasibility and acceptability of an ultra-long-term at-home EEG monitoring system (EEG@HOME) for people with epilepsy. Epilepsy Behav 2024; 151:109609. [PMID: 38160578 DOI: 10.1016/j.yebeh.2023.109609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Recent technological advancements offer new ways to monitor and manage epilepsy. The adoption of these devices in routine clinical practice will strongly depend on patient acceptability and usability, with their perspectives being crucial. Previous studies provided feedback from patients, but few explored the experience of them using independently multiple devices independently at home. PURPOSE The study, assessed through a mixed methods design, the direct experiences of people with epilepsy independently using a non-invasive monitoring system (EEG@HOME) for an extended duration of 6 months, at home. We aimed to investigate factors affecting engagement, gather qualitative insights, and provide recommendations for future home epilepsy monitoring systems. MATERIALS AND METHODS Adults with epilepsy independently were trained to use a wearable dry EEG system, a wrist-worn device, and a smartphone app for seizure tracking and behaviour monitoring for 6 months at home. Monthly acceptability questionnaires (PSSUQ, SUS) and semi-structured interviews were conducted to explore participant experience. Adherence with the procedure, acceptability scores and systematic thematic analysis of the interviews, focusing on the experience with the procedure, motivation and benefits and opinion about the procedure were assessed. RESULTS Twelve people with epilepsy took part into the study for an average of 193.8 days (range 61 to 312) with a likelihood of using the system at six months of 83 %. The e-diary and the smartwatch were highly acceptable and preferred to a wearable EEG system (PSSUQ score of 1.9, 1.9, 2.4). Participants showed an acceptable level of adherence with all solutions (Average usage of 63 %, 66 %, 92 %) reporting more difficulties using the EEG twice a day and remembering to complete the daily behavioural questionnaires. Clear information and training, continuous remote support, perceived direct and indirect benefits and the possibility to have a flexible, tailored to daily routine monitoring were defined as key factors to ensure compliance with long-term monitoring systems. CONCLUSIONS EEG@HOME study demonstrated people with epilepsy' interest and ability in active health monitoring using new technologies. Remote training and support enable independent home use of new non-invasive technologies, but to ensure long term acceptability and usability systems will require to be integrated into patients' routines, include healthcare providers, and offer continuous support and personalized feedback.
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Affiliation(s)
- Andrea Biondi
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - Sara K Simblett
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Pedro F Viana
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Petroula Laiou
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Anna M G Fiori
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ewan Nurse
- Seer Medical Inc, Melbourne, VIC, Australia; Department of Medicine, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Deb K Pal
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Mark P Richardson
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
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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.
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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
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Andrzejak RG, Zaveri HP, Schulze‐Bonhage A, Leguia MG, Stacey WC, Richardson MP, Kuhlmann L, Lehnertz K. Seizure forecasting: Where do we stand? Epilepsia 2023; 64 Suppl 3:S62-S71. [PMID: 36780237 PMCID: PMC10423299 DOI: 10.1111/epi.17546] [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: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/14/2023]
Abstract
A lot of mileage has been made recently on the long and winding road toward seizure forecasting. Here we briefly review some selected milestones passed along the way, which were discussed at the International Conference for Technology and Analysis of Seizures-ICTALS 2022-convened at the University of Bern, Switzerland. Major impetus was gained recently from wearable and implantable devices that record not only electroencephalography, but also data on motor behavior, acoustic signals, and various signals of the autonomic nervous system. This multimodal monitoring can be performed for ultralong timescales covering months or years. Accordingly, features and metrics extracted from these data now assess seizure dynamics with a greater degree of completeness. Most prominently, this has allowed the confirmation of the long-suspected cyclical nature of interictal epileptiform activity, seizure risk, and seizures. The timescales cover daily, multi-day, and yearly cycles. Progress has also been fueled by approaches originating from the interdisciplinary field of network science. Considering epilepsy as a large-scale network disorder yielded novel perspectives on the pre-ictal dynamics of the evolving epileptic brain. In addition to discrete predictions that a seizure will take place in a specified prediction horizon, the community broadened the scope to probabilistic forecasts of a seizure risk evolving continuously in time. This shift of gears triggered the incorporation of additional metrics to quantify the performance of forecasting algorithms, which should be compared to the chance performance of constrained stochastic null models. An imminent task of utmost importance is to find optimal ways to communicate the output of seizure-forecasting algorithms to patients, caretakers, and clinicians, so that they can have socioeconomic impact and improve patients' well-being.
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Grants
- NIH NS109062 NIH HHS
- MR/N026063/1 Medical Research Council
- R01 NS109062 NINDS NIH HHS
- R01 NS094399 NINDS NIH HHS
- NIH NS094399 NIH HHS
- Medical Research Council Centre for Neurodevelopmental Disorders
- National Health and Medical Research Council
- National Institutes of Health
- University of Bern, the Inselspital, University Hospital Bern, the Alliance for Epilepsy Research, the Swiss National Science Foundation, UCB, FHC, the Wyss Center for bio‐ and neuro‐engineering, the American Epilepsy Society (AES), the CURE epilepsy Foundation, Ripple neuro, Sintetica, DIXI medical, UNEEG medical and NeuroPace.
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Affiliation(s)
- Ralph G. Andrzejak
- Department of Information and Communication TechnologiesUniversitat Pompeu FabraBarcelonaSpain
| | | | - Andreas Schulze‐Bonhage
- Epilepsy Center, NeurocenterUniversity Medical Center, University of FreiburgFreiburgGermany
| | - Marc G. Leguia
- Department of Information and Communication TechnologiesUniversitat Pompeu FabraBarcelonaSpain
| | - William C. Stacey
- Department of Neurology, Department of Biomedical EngineeringBioInterfaces Institute, University of MichiganAnn ArborMichiganUSA
- Division of NeurologyVA Ann Arbor Medical CenterAnn ArborMichiganUSA
| | - Mark P. Richardson
- School of NeuroscienceInstitute of Psychiatry Psychology and Neuroscience, King's College LondonLondonUK
| | - Levin Kuhlmann
- Department of Data Science and AI, Faculty of Information TechnologyMonash UniversityClaytonVictoriaAustralia
| | - Klaus Lehnertz
- Department of EpileptologyUniversity of Bonn Medical CentreBonnGermany
- Helmholtz Institute for Radiation and Nuclear PhysicsUniversity of BonnBonnGermany
- Interdisciplinary Center for Complex SystemsUniversity of BonnBonnGermany
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6
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Xiong W, Stirling RE, Payne DE, Nurse ES, Kameneva T, Cook MJ, Viana PF, Richardson MP, Brinkmann BH, Freestone DR, Karoly PJ. Forecasting seizure likelihood from cycles of self-reported events and heart rate: a prospective pilot study. EBioMedicine 2023; 93:104656. [PMID: 37331164 PMCID: PMC10300292 DOI: 10.1016/j.ebiom.2023.104656] [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: 08/18/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Seizure risk forecasting could reduce injuries and even deaths in people with epilepsy. There is great interest in using non-invasive wearable devices to generate forecasts of seizure risk. Forecasts based on cycles of epileptic activity, seizure times or heart rate have provided promising forecasting results. This study validates a forecasting method using multimodal cycles recorded from wearable devices. METHOD Seizure and heart rate cycles were extracted from 13 participants. The mean period of heart rate data from a smartwatch was 562 days, with a mean of 125 self-reported seizures from a smartphone app. The relationship between seizure onset time and phases of seizure and heart rate cycles was investigated. An additive regression model was used to project heart rate cycles. The results of forecasts using seizure cycles, heart rate cycles, and a combination of both were compared. Forecasting performance was evaluated in 6 of 13 participants in a prospective setting, using long-term data collected after algorithms were developed. FINDINGS The results showed that the best forecasts achieved a mean area under the receiver-operating characteristic curve (AUC) of 0.73 for 9/13 participants showing performance above chance during retrospective validation. Subject-specific forecasts evaluated with prospective data showed a mean AUC of 0.77 with 4/6 participants showing performance above chance. INTERPRETATION The results of this study demonstrate that cycles detected from multimodal data can be combined within a single, scalable seizure risk forecasting algorithm to provide robust performance. The presented forecasting method enabled seizure risk to be estimated for an arbitrary future period and could be generalised across a range of data types. In contrast to earlier work, the current study evaluated forecasts prospectively, in subjects blinded to their seizure risk outputs, representing a critical step towards clinical applications. FUNDING This study was funded by an Australian Government National Health & Medical Research Council and BioMedTech Horizons grant. The study also received support from the Epilepsy Foundation of America's 'My Seizure Gauge' grant.
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Affiliation(s)
- Wenjuan Xiong
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Rachel E Stirling
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia; Seer Medical, Melbourne, Australia
| | | | - Ewan S Nurse
- Seer Medical, Melbourne, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Tatiana Kameneva
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia; Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
| | - Mark J Cook
- Seer Medical, Melbourne, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia; Graeme Clark Institute, The University of Melbourne, Melbourne, Australia
| | - Pedro F Viana
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Epilepsy, King's College Hospital NHS Foundation Trust, London, UK; Centro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Epilepsy, King's College Hospital NHS Foundation Trust, London, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Benjamin H Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Mayo Clinic, Rochester, MN, USA
| | | | - Philippa J Karoly
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia; Graeme Clark Institute, The University of Melbourne, Melbourne, Australia.
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7
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Wang ET, Chiang S, Cleboski S, Rao VR, Vannucci M, Haneef Z. Seizure count forecasting to aid diagnostic testing in epilepsy. Epilepsia 2022; 63:3156-3167. [PMID: 36149301 PMCID: PMC11025604 DOI: 10.1111/epi.17415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Epilepsy monitoring unit (EMU) admissions are critical for presurgical evaluation of drug-resistant epilepsy but may be nondiagnostic if an insufficient number of seizures are recorded. Seizure forecasting algorithms have shown promise for estimating the likelihood of seizures as a binary event in individual patients, but methods to predict how many seizures will occur remain elusive. Such methods could increase the diagnostic yield of EMU admissions and help patients mitigate seizure-related morbidity. Here, we evaluated the performance of a state-space method that uses prior seizure count data to predict future counts. METHODS A Bayesian negative-binomial dynamic linear model (DLM) was developed to forecast daily electrographic seizure counts in 19 patients implanted with a responsive neurostimulation (RNS) device. Holdout validation was used to evaluate performance in predicting the number of electrographic seizures for forecast horizons ranging 1-7 days ahead. RESULTS One-day-ahead prediction of the number of electrographic seizures using a negative-binomial DLM resulted in improvement over chance in 73.1% of time segments compared to a random chance forecaster and remained >50% for forecast horizons of up to 7 days. Superior performance (mean error = .99) was obtained in predicting the number of electrographic seizures in the next day compared to three traditional methods for count forecasting (integer-valued generalized autoregressive conditional heteroskedasticity model or INGARCH, 1.10; Croston, 1.06; generalized linear autoregressive moving average model or GLARMA, 2.00). Number of electrographic seizures in the preceding day and laterality of electrographic pattern detections had highest predictive value, with greater number of electrographic seizures and RNS magnet swipes in the preceding day associated with a higher number of electrographic seizures the next day. SIGNIFICANCE This study demonstrates that DLMs can predict the number of electrographic seizures a patient will experience days in advance with above chance accuracy. This study represents an important step toward the translation of seizure forecasting methods into the optimization of EMU admissions.
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Affiliation(s)
- Emily T. Wang
- Department of Statistics, Rice University, Houston, Texas, USA
| | - Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Vikram R. Rao
- Department of Statistics, Rice University, Houston, Texas, USA
| | - Marina Vannucci
- Department of Statistics, Rice University, Houston, Texas, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
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8
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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.
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Ilyas A, Hoffman C, Vakilna Y, Chaliyeduth S, Muhlhofer W, Riley KO, Dabaghian Y, Lhatoo SD, Pati S. Forecasting Seizure Clusters from Chronic Ambulatory Electrocorticography. Epilepsia 2022; 63:e106-e111. [PMID: 35751497 DOI: 10.1111/epi.17347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
Seizure clusters are seizures that occur in rapid succession during periods of heightened seizure risk and are associated with substantial morbidity and sudden unexpected death in epilepsy. The objective of this feasibility study is to evaluate the performance of a novel seizure cluster forecasting algorithm. Chronic ambulatory electrocorticography recorded over an average of 38 months in 10 subjects with drug-resistant epilepsies was analyzed pseudoprospectively by dividing data into training (first 85%) and validation periods. For each subject, the probability of seizure clustering, derived from the Kolmogorov-Smirnov statistic using a novel algorithm, was forecasted in the validation period using individualized autoregressive models that were optimized from training data. The primary outcome of this study was the mean absolute scaled error (MASE) of 1-day horizon forecasts. From 10 subjects, 394±142 (mean±SD) ECoG-based seizure events were extracted for analysis, representing a span of 38±27 months of recording. MASE across all subjects were 0.74±0.09, 0.78±0.09, and 0.83±0.07 at 0.5-, 1-, and 2-day horizons. The feasibility study demonstrates that seizure clusters are quasiperiodic and can be forecasted to clinically meaningful horizons. Pending validation in larger cohorts, the forecasting approach described herein may herald chronotherapy during imminent heightened seizure vulnerability.
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Affiliation(s)
- Adeel Ilyas
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL.,Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA.,Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Clarissa Hoffman
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Neurology, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Yash Vakilna
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Neurology, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | | | - Wolfgang Muhlhofer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Kristen O Riley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Yuri Dabaghian
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Neurology, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Samden D Lhatoo
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Neurology, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Sandipan Pati
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Neurology, McGovern Medical School at UT Health Houston, Houston, TX, USA
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10
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Sivathamboo S, Nhu D, Piccenna L, Yang A, Antonic-Baker A, Vishwanath S, Todaro M, Yap LW, Kuhlmann L, Cheng W, O'Brien TJ, Lannin NA, Kwan P. Preferences and User Experiences of Wearable Devices in Epilepsy: A Systematic Review and Mixed-Methods Synthesis. Neurology 2022; 99:e1380-e1392. [PMID: 35705497 DOI: 10.1212/wnl.0000000000200794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/12/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To examine the preferences and user experiences of people with epilepsy and caregivers regarding automated wearable seizure detection devices. METHODS We performed a mixed-methods systematic review. We searched electronic databases for original peer-reviewed publications between January 1, 2000, and May 26, 2021. Key search terms included "epilepsy", "seizure", "wearable", and "non-invasive". We performed a descriptive and a qualitative thematic analysis of the studies included according to the technology acceptance model. Full texts of the discussion sections were further analyzed to identify word frequency and word mapping. RESULTS Twenty-two observational studies were identified. Collectively, they comprised responses from 3299 participants including patients with epilepsy, caregivers and healthcare workers. Sixteen studies examined user preferences, five examined user experiences, and one examined both experiences and preferences. Important preferences for wearables included improving care, cost, accuracy, and design. Patients desired real-time detection with a latency of ≤15 minutes from seizure occurrence, along with high sensitivity (≥90%) and low false-alarm rates. Device related costs were a major factor for device acceptance, where device costs of <$300 USD and a monthly subscription fee of <$20 USD were preferred. Despite being a major driver of wearable-based technologies, sudden unexpected death in epilepsy (SUDEP) was rarely discussed. Among studies evaluating user experiences, there was a greater acceptance towards wristwatches. Thematic coding analysis showed that attitudes towards device use, and perceived usefulness were reported consistently. Word mapping identified 'specificity', 'cost', and 'battery' as key single terms, and 'battery life', 'insurance coverage', 'prediction/detection quality', and the effect of devices on 'daily life' as key bigrams. DISCUSSION User acceptance of wearable technology for seizure detection was strongly influenced by accuracy, design, comfort, and cost. Our findings emphasise the need for standardised and validated tools to comprehensively examine preferences and user experiences of wearable devices in this population, using the themes identified in this study. Greater efforts to incorporate perspectives and user experiences in developing wearables for seizure detection, particularly in community-based settings are needed. PROSPERO REGISTRATION CRD42020193565.
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Affiliation(s)
- Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australi
| | - Duong Nhu
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Clayton, 3800, Victoria, Australia
| | - Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia
| | - Anthony Yang
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia
| | - Swarna Vishwanath
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia
| | - Marian Todaro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australi
| | - Lim Wei Yap
- Department of Chemical and Biological Engineering, Monash University, Clayton, 3800, Victoria, Australi
| | - Levin Kuhlmann
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Clayton, 3800, Victoria, Australia
| | - Wenlong Cheng
- Department of Chemical and Biological Engineering, Monash University, Clayton, 3800, Victoria, Australi
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australi
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Alfred Health (Allied Health Directorate), Melbourne, 3004, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia .,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australi
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11
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Naganur V, Sivathamboo S, Chen Z, Kusmakar S, Antonic-Baker A, O'Brien TJ, Kwan P. Automated seizure detection with non-invasive wearable devices: A systematic review and meta-analysis. Epilepsia 2022; 63:1930-1941. [PMID: 35545836 PMCID: PMC9545631 DOI: 10.1111/epi.17297] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
Objective This study was undertaken to review the reported performance of noninvasive wearable devices in detecting epileptic seizures and psychogenic nonepileptic seizures (PNES). Methods We conducted a systematic review and meta‐analysis of studies reported up to November 15, 2021. We included studies that used video‐electroencephalographic (EEG) monitoring as the gold standard to determine the sensitivity and false alarm rate (FAR) of noninvasive wearables for automated seizure detection. Results Twenty‐eight studies met the criteria for the systematic review, of which 23 were eligible for meta‐analysis. These studies (1269 patients in total, median recording time = 52.9 h per patient) investigated devices for tonic–clonic seizures using wrist‐worn and/or ankle‐worn devices to measure three‐dimensional accelerometry (15 studies), and/or wearable surface devices to measure electromyography (eight studies). The mean sensitivity for detecting tonic–clonic seizures was .91 (95% confidence interval [CI] = .85–.96, I2 = 83.8%); sensitivity was similar between the wrist‐worn (.93) and surface devices (.90). The overall FAR was 2.1/24 h (95% CI = 1.7–2.6, I2 = 99.7%); FAR was higher in wrist‐worn (2.5/24 h) than in wearable surface devices (.96/24 h). Three of the 23 studies also detected PNES; the mean sensitivity and FAR from these studies were 62.9% and .79/24 h, respectively. Four studies detected both focal and tonic–clonic seizures, and one study detected focal seizures only; the sensitivities ranged from 31.1% to 93.1% in these studies. Significance Reported noninvasive wearable devices had high sensitivity but relatively high FARs in detecting tonic–clonic seizures during limited recording time in a video‐EEG setting. Future studies should focus on reducing FAR, detection of other seizure types and PNES, and longer recording in the community.
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Affiliation(s)
- Vaidehi Naganur
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Chronic Disease and Ageing, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia
| | - Shitanshu Kusmakar
- Department of Electrical and Electronic Engineering, The University of Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, 3004, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital), The University of Melbourne, 3000, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, 3000, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, 3004, Victoria, Australia
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12
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Nielsen JM, Rades D, Kjaer TW. Wearable electroencephalography for ultra-long-term seizure monitoring: a systematic review and future prospects. Expert Rev Med Devices 2021; 18:57-67. [PMID: 34836477 DOI: 10.1080/17434440.2021.2012152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION : Wearable electroencephalography (EEG) for objective seizure counting might transform the clinical management of epilepsy. Non-EEG modalities have been validated for the detection of convulsive seizures, but there is still an unmet need for the detection of non-convulsive seizures. AREAS COVERED : The main objective of this systematic review was to explore the current status on wearable surface- and subcutaneous EEG for long-term seizure monitoring in epilepsy. We included 17 studies and evaluated the progress on the field, including device specifications, intended populations, and main results on the published studies including diagnostic accuracy measures. Furthermore, we examine the hurdles for widespread clinical implementation. This systematic review and expert opinion both consults the PRISMA guidelines and reflects on the future perspectives of this emerging field. EXPERT OPINION : Wearable EEG for long-term seizure monitoring is an emerging field, with plenty of proposed devices and proof-of-concept clinical validation studies. The possible implications of these devices are immense including objective seizure counting and possibly forecasting. However, the true clinical value of the devices, including effects on patient important outcomes and clinical decision making is yet to be unveiled and large-scale clinical validation trials are called for.
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Affiliation(s)
- Jonas Munch Nielsen
- Department of Neurology, Zealand University Hospital, Region Sjælland. Vestermarksvej 11, 4000 Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Troels Wesenberg Kjaer
- Department of Neurology, Zealand University Hospital, Region Sjælland. Vestermarksvej 11, 4000 Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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13
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Hubbard I, Beniczky S, Ryvlin P. The Challenging Path to Developing a Mobile Health Device for Epilepsy: The Current Landscape and Where We Go From Here. Front Neurol 2021; 12:740743. [PMID: 34659099 PMCID: PMC8517120 DOI: 10.3389/fneur.2021.740743] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Seizure detection, and more recently seizure forecasting, represent important avenues of clinical development in epilepsy, promoted by progress in wearable devices and mobile health (mHealth), which might help optimizing seizure control and prevention of seizure-related mortality and morbidity in persons with epilepsy. Yet, very long-term continuous monitoring of seizure-sensitive biosignals in the ambulatory setting presents a number of challenges. We herein provide an overview of these challenges and current technological landscape of mHealth devices for seizure detection. Specifically, we display, which types of sensor modalities and analytical methods are available, and give insight into current clinical practice guidelines, main outcomes of clinical validation studies, and discuss how to evaluate device performance at point-of-care facilities. We then address pitfalls which may arise in patient compliance and the need to design solutions adapted to user experience.
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Affiliation(s)
- Ilona Hubbard
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland
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14
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Grzeskowiak CL, Dumanis SB. Seizure Forecasting: Patient and Caregiver Perspectives. Front Neurol 2021; 12:717428. [PMID: 34616352 PMCID: PMC8488220 DOI: 10.3389/fneur.2021.717428] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Accurate seizure forecasting is emerging as a near-term possibility due to recent advancements in machine learning and EEG technology improvements. Large-scale data curation and new data element collection through consumer wearables and digital health tools such as longitudinal seizure diary data has uncovered new possibilities for personalized algorithm development that may be used to predict the likelihood of future seizures. The Epilepsy Foundation recognized the unmet need for development in seizure forecasting following a 2016 survey where an overwhelming majority of respondents across all seizure types and frequencies reported that unpredictability of seizures had the strongest impact on their life while living with or caring for someone living with epilepsy. In early 2021, the Epilepsy Foundation conducted an updated survey among those living with epilepsies and/or their caregivers to better understand the use-cases that best suit the needs of our community as seizure forecast research advances. These results will provide researchers with insight into user-acceptance of using a forecasting tool and incorporation into their daily life. Ultimately, this input from people living with epilepsy and caregivers will provide timely feedback on what the community needs are and ensure researchers and companies first and foremost consider these needs in seizure forecasting tools/product development.
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Affiliation(s)
- Caitlin L. Grzeskowiak
- Epilepsy Foundation of America, Greater Landover, MD, United States
- *Correspondence: Caitlin L. Grzeskowiak
| | - Sonya B. Dumanis
- Epilepsy Foundation of America, Greater Landover, MD, United States
- Coalition for Aligning Science, Chevy Chase, MD, United States
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15
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Stirling RE, Maturana MI, Karoly PJ, Nurse ES, McCutcheon K, Grayden DB, Ringo SG, Heasman JM, Hoare RJ, Lai A, D'Souza W, Seneviratne U, Seiderer L, McLean KJ, Bulluss KJ, Murphy M, Brinkmann BH, Richardson MP, Freestone DR, Cook MJ. Seizure Forecasting Using a Novel Sub-Scalp Ultra-Long Term EEG Monitoring System. Front Neurol 2021; 12:713794. [PMID: 34497578 PMCID: PMC8419461 DOI: 10.3389/fneur.2021.713794] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder®), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilizing cycles in EA and previous seizure times. The procedures and devices were well-tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as visually confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88), which is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.
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Affiliation(s)
- Rachel E. Stirling
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Matias I. Maturana
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Philippa J. Karoly
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Ewan S. Nurse
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | - David B. Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | - John M. Heasman
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
- Cochlear Limited, Sydney, NSW, Australia
| | | | - Alan Lai
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Wendyl D'Souza
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Udaya Seneviratne
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Linda Seiderer
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Karen J. McLean
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Kristian J. Bulluss
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michael Murphy
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Mark J. Cook
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
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16
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Stirling RE, Grayden DB, D'Souza W, Cook MJ, Nurse E, Freestone DR, Payne DE, Brinkmann BH, Pal Attia T, Viana PF, Richardson MP, Karoly PJ. Forecasting Seizure Likelihood With Wearable Technology. Front Neurol 2021; 12:704060. [PMID: 34335457 PMCID: PMC8320020 DOI: 10.3389/fneur.2021.704060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/17/2021] [Indexed: 12/11/2022] Open
Abstract
The unpredictability of epileptic seizures exposes people with epilepsy to potential physical harm, restricts day-to-day activities, and impacts mental well-being. Accurate seizure forecasters would reduce the uncertainty associated with seizures but need to be feasible and accessible in the long-term. Wearable devices are perfect candidates to develop non-invasive, accessible forecasts but are yet to be investigated in long-term studies. We hypothesized that machine learning models could utilize heart rate as a biomarker for well-established cycles of seizures and epileptic activity, in addition to other wearable signals, to forecast high and low risk seizure periods. This feasibility study tracked participants' (n = 11) heart rates, sleep, and step counts using wearable smartwatches and seizure occurrence using smartphone seizure diaries for at least 6 months (mean = 14.6 months, SD = 3.8 months). Eligible participants had a diagnosis of refractory epilepsy and reported at least 20 seizures (mean = 135, SD = 123) during the recording period. An ensembled machine learning and neural network model estimated seizure risk either daily or hourly, with retraining occurring on a weekly basis as additional data was collected. Performance was evaluated retrospectively against a rate-matched random forecast using the area under the receiver operating curve. A pseudo-prospective evaluation was also conducted on a held-out dataset. Of the 11 participants, seizures were predicted above chance in all (100%) participants using an hourly forecast and in ten (91%) participants using a daily forecast. The average time spent in high risk (prediction time) before a seizure occurred was 37 min in the hourly forecast and 3 days in the daily forecast. Cyclic features added the most predictive value to the forecasts, particularly circadian and multiday heart rate cycles. Wearable devices can be used to produce patient-specific seizure forecasts, particularly when biomarkers of seizure and epileptic activity cycles are utilized.
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Affiliation(s)
- Rachel E. Stirling
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - David B. Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J. Cook
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Ewan Nurse
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Seer Medical, Melbourne, VIC, Australia
| | | | - Daniel E. Payne
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Tal Pal Attia
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Pedro F. Viana
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philippa J. Karoly
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
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17
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Brinkmann BH, Karoly PJ, Nurse ES, Dumanis SB, Nasseri M, Viana PF, Schulze-Bonhage A, Freestone DR, Worrell G, Richardson MP, Cook MJ. Seizure Diaries and Forecasting With Wearables: Epilepsy Monitoring Outside the Clinic. Front Neurol 2021; 12:690404. [PMID: 34326807 PMCID: PMC8315760 DOI: 10.3389/fneur.2021.690404] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
It is a major challenge in clinical epilepsy to diagnose and treat a disease characterized by infrequent seizures based on patient or caregiver reports and limited duration clinical testing. The poor reliability of self-reported seizure diaries for many people with epilepsy is well-established, but these records remain necessary in clinical care and therapeutic studies. A number of wearable devices have emerged, which may be capable of detecting seizures, recording seizure data, and alerting caregivers. Developments in non-invasive wearable sensors to measure accelerometry, photoplethysmography (PPG), electrodermal activity (EDA), electromyography (EMG), and other signals outside of the traditional clinical environment may be able to identify seizure-related changes. Non-invasive scalp electroencephalography (EEG) and minimally invasive subscalp EEG may allow direct measurement of seizure activity. However, significant network and computational infrastructure is needed for continuous, secure transmission of data. The large volume of data acquired by these devices necessitates computer-assisted review and detection to reduce the burden on human reviewers. Furthermore, user acceptability of such devices must be a paramount consideration to ensure adherence with long-term device use. Such devices can identify tonic–clonic seizures, but identification of other seizure semiologies with non-EEG wearables is an ongoing challenge. Identification of electrographic seizures with subscalp EEG systems has recently been demonstrated over long (>6 month) durations, and this shows promise for accurate, objective seizure records. While the ability to detect and forecast seizures from ambulatory intracranial EEG is established, invasive devices may not be acceptable for many individuals with epilepsy. Recent studies show promising results for probabilistic forecasts of seizure risk from long-term wearable devices and electronic diaries of self-reported seizures. There may also be predictive value in individuals' symptoms, mood, and cognitive performance. However, seizure forecasting requires perpetual use of a device for monitoring, increasing the importance of the system's acceptability to users. Furthermore, long-term studies with concurrent EEG confirmation are lacking currently. This review describes the current evidence and challenges in the use of minimally and non-invasive devices for long-term epilepsy monitoring, the essential components in remote monitoring systems, and explores the feasibility to detect and forecast impending seizures via long-term use of these systems.
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Affiliation(s)
| | - Philippa J Karoly
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Ewan S Nurse
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia.,Seer Medical, Melbourne, VIC, Australia
| | | | - Mona Nasseri
- Department of Neurology, Mayo Foundation, Rochester, MN, United States.,School of Engineering, University of North Florida, Jacksonville, FL, United States
| | - Pedro F Viana
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Greg Worrell
- Department of Neurology, Mayo Foundation, Rochester, MN, United States
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mark J Cook
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
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18
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Janse S, Janssen E, Huwig T, Basu Roy U, Ferris A, Presley CJ, Bridges JFP. Line of therapy and patient preferences regarding lung cancer treatment: a discrete-choice experiment. Curr Med Res Opin 2021; 37:643-653. [PMID: 33571024 DOI: 10.1080/03007995.2021.1888707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A growing literature on patient preferences informs decisions in research, regulatory science, and value assessment, but few studies have explored how preferences vary across patients with differing treatment experience. We sought to quantify patient preferences for the benefits and risks of lung cancer treatment and test how preferences differed by line of therapy (LOT). METHODS Preferences were elicited using a discrete choice experiment (DCE) following rigorous patient and stakeholder engagement. The DCE spanned five attributes (each with three levels): progression-free survival (PFS), short-term side effects, long-term side effects, risk of developing late-onset side effects, and mode of administration (MOA) - each defined across 3 relevant levels. A D-efficient design was used to generate 3 survey blocks of 9 paired-profile choice tasks each and respondents were asked which profile they preferred and then if they preferred to have no treatment (opt-out). A mixed logit model, controlling for opt-out, was used to estimate preferences. Preferences and trade-offs between PFS and other attributes were compared across two groups: those receiving ≤1 LOT and those receiving ≥2 LOT. RESULTS Of the 466 participants, 42% received ≤1 LOT and 58% received ≥2 LOT. Stated preferences differed between the groups overall (p<.001) and specifically for 18 months of PFS (p<.001), moderate short-term side effects (p<.001), no long-term side effects (p=.03), and 30% chance of late-onset side effects (p=.02). Those receiving differing amounts of LOT were willing to trade different amounts of PFS to change from moderate to mild short-term side effects (p<.001), moderate to no (p<.001) and mild to no (p<.001) long-term side effects. There were also differing amounts of tradeoff acceptable between the groups for a 10% decrease in risk of late-onset side effects (p=.016), a decrease in MOA from infusion every 3 weeks to pills taken daily at any time (p=.005) and from pills taken daily without food to pills taken daily at any time (p<.001). CONCLUSION We demonstrate differences in preferences based on experience with LOT, suggesting that patient treatment experience may have an impact on their preferences. As patient preference data become an important component of treatment decision making, preference differences should be considered when recommending therapies at different stages in the treatment journey. Understanding patient preferences regarding treatment decisions is essential to informing shared decision-making and ensuring treatment plans are consistent with patients' goals.
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Affiliation(s)
- Sarah Janse
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ellen Janssen
- Center for Medical Technology Policy (CMTP), Baltimore, MD, USA
| | - Tanya Huwig
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Proix T, Truccolo W, Leguia MG, Tcheng TK, King-Stephens D, Rao VR, Baud MO. Forecasting seizure risk in adults with focal epilepsy: a development and validation study. Lancet Neurol 2020; 20:127-135. [PMID: 33341149 DOI: 10.1016/s1474-4422(20)30396-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with epilepsy are burdened with the apparent unpredictability of seizures. In the past decade, converging evidence from studies using chronic EEG (cEEG) revealed that epileptic brain activity shows robust cycles, operating over hours (circadian) and days (multidien). We hypothesised that these cycles can be leveraged to estimate future seizure probability, and we tested the feasibility of forecasting seizures days in advance. METHODS We did a feasibility study in distinct development and validation cohorts, involving retrospective analysis of cEEG data recorded with an implanted device in adults (age ≥18 years) with drug-resistant focal epilepsy followed at 35 centres across the USA between Jan 19, 2004, and May 18, 2018. Patients were required to have had 20 or more electrographic seizures (development cohort) or self-reported seizures (validation cohort). In all patients, the device recorded interictal epileptiform activity (IEA; ≥6 months of continuous hourly data), the fluctuations in which helped estimate varying seizure risk. Point process statistical models trained on initial portions of each patient's cEEG data (both cohorts) generated forecasts of seizure probability that were tested on subsequent unseen seizure data and evaluated against surrogate time-series. The primary outcome was the percentage of patients with forecasts showing improvement over chance (IoC). FINDINGS We screened 72 and 256 patients, and included 18 and 157 patients in the development and validation cohorts, respectively. Models incorporating information about multidien IEA cycles alone generated daily seizure forecasts for the next calendar day with IoC in 15 (83%) patients in the development cohort and 103 (66%) patients in the validation cohort. The forecasting horizon could be extended up to 3 days while maintaining IoC in two (11%) of 18 patients and 61 (39%) of 157 patients. Forecasts with a shorter horizon of 1 h, possible only for electrographic seizures in the development cohort, showed IoC in all 18 (100%) patients. INTERPRETATION This study shows that seizure probability can be forecasted days in advance by leveraging multidien IEA cycles recorded with an implanted device. This study will serve as a basis for prospective clinical trials to establish how people with epilepsy might benefit from seizure forecasting over long horizons. FUNDING None. VIDEO ABSTRACT.
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Affiliation(s)
- Timothée Proix
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neuroscience, Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Wilson Truccolo
- Department of Neuroscience, Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Marc G Leguia
- Sleep-Wake-Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Maxime O Baud
- Sleep-Wake-Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland.
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20
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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.
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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
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21
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Goldenholz DM, Goldenholz SR, Romero J, Moss R, Sun H, Westover B. Development and Validation of Forecasting Next Reported Seizure Using e-Diaries. Ann Neurol 2020; 88:588-595. [PMID: 32567720 DOI: 10.1002/ana.25812] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE There are no validated methods for predicting the timing of seizures. Using machine learning, we sought to forecast 24-hour risk of self-reported seizure from e-diaries. METHODS Data from 5,419 patients on SeizureTracker.com (including seizure count, type, and duration) were split into training (3,806 patients/1,665,215 patient-days) and testing (1,613 patients/549,588 patient-days) sets with no overlapping patients. An artificial intelligence (AI) program, consisting of recurrent networks followed by a multilayer perceptron ("deep learning" model), was trained to produce risk forecasts. Forecasts were made from a sliding window of 3-month diary history for each day of each patient's diary. After training, the model parameters were held constant and the testing set was scored. A rate-matched random (RMR) forecast was compared to the AI. Comparisons were made using the area under the receiver operating characteristic curve (AUC), a measure of binary discrimination performance, and the Brier score, a measure of forecast calibration. The Brier skill score (BSS) measured the improvement of the AI Brier score compared to the benchmark RMR Brier score. Confidence intervals (CIs) on performance statistics were obtained via bootstrapping. RESULTS The AUC was 0.86 (95% CI = 0.85-0.88) for AI and 0.83 (95% CI = 0.81-0.85) for RMR, favoring AI (p < 0.001). Overall (all patients combined), BSS was 0.27 (95% CI = 0.23-0.31), also favoring AI (p < 0.001). INTERPRETATION The AI produced a valid forecast superior to a chance forecaster, and provided meaningful forecasts in the majority of patients. Future studies will be needed to quantify the clinical value of these forecasts for patients. ANN NEUROL 2020;88:588-595.
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Affiliation(s)
- Daniel M Goldenholz
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Shira R Goldenholz
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Juan Romero
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Rob Moss
- Seizure Tracker, Springfield, Virginia, USA
| | - Haoqi Sun
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brandon Westover
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Rheims S. Wearable devices for seizure detection: Is it time to translate into our clinical practice? Rev Neurol (Paris) 2020; 176:480-484. [PMID: 32359805 DOI: 10.1016/j.neurol.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/24/2022]
Abstract
With the exponential development of mobile health technologies over the past ten years, there has been a growing interest in the potential applications in the field of epilepsy, and specifically for seizure detection. Better detection of seizures is probably one of the best ways to improve patient safety. Overall, we are observing an exponential increase in the number of non-EEG based seizure detection systems and a progressive homogenization of their evaluation procedures. Most importantly, the properties of these devices for detection of tonic-clonic seizures are now very interesting, both in terms of sensitivity and in terms of false-alarm rates. Accordingly, we might expect that these be used in clinical practice in the near future, especially in patients at high risk of seizure-related injuries or sudden unexpected death in epilepsy (SUDEP).
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Affiliation(s)
- S Rheims
- Department of functional neurology and epileptology, hospices civils de Lyon, university of Lyon, Lyon, France; Inserm U1028/CNRS UMR 5292, Lyon's neuroscience research center, Lyon, France; Epilepsy institute, Lyon, France.
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23
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Chiang S, Moss R, Patel AD, Rao VR. Seizure detection devices and health-related quality of life: A patient- and caregiver-centered evaluation. Epilepsy Behav 2020; 105:106963. [PMID: 32092459 DOI: 10.1016/j.yebeh.2020.106963] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/01/2020] [Accepted: 02/02/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The unpredictability of epilepsy has a severe impact on health-related quality of life (HR-QOL) for people with epilepsy. Seizure detection devices have the potential to improve HR-QOL by improving seizure safety, reducing caregiver hypervigilance, and reducing seizure anxiety. Emerging data have led to an improved understanding of characteristics that promote acceptability of detection devices for people with epilepsy and caregivers. However, whether usage of seizure detection devices is associated with clinically meaningful improvement in anxiety and HR-QOL remains poorly understood. METHODS We analyzed cross-sectional survey data collected first-hand from 371 people with epilepsy and caregivers on seizure detection device and HR-QOL using an enriched population of electronic seizure diary users. Metrics related to quality of life and anxiety reduction were compared between users and nonusers of seizure detection devices. RESULTS Compared with nonusers of seizure detection devices, device users were significantly more likely to have been impacted by epilepsy in multiple HR-QOL domains, including anxiety, mood, emotional regulation/aggression, speech/language, sleep quality, social life, activities of daily living, independence, and education/academic potential. The majority (80.2%) of people using seizure detection devices experienced moderate or greater anxiety reduction from seizure detection device usage, while 11.1% reported that detection devices did not help at all with anxiety. Despite potential benefit, seizure detection devices were used only by a minority (21.8%) of people with epilepsy surveyed, and usage tended to be skewed toward younger patient age, higher income, and caregivers. There was no significant difference in overall HR-QOL between users and nonusers. CONCLUSIONS Seizure detection devices provide moderate or greater anxiety reduction among the majority of people with epilepsy and their caregivers, but current translatability into improvements in overall HR-QOL may be limited. Affordability and technological support are potential barriers to maximizing benefit equally among the epilepsy community. These considerations may be useful to help guide future device development and inform patient-clinician discussions on device usage and HR-QOL.
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Affiliation(s)
- Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Robert Moss
- Seizure Tracker™ LLC, Springfield, VA, United States of America
| | - Anup D Patel
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, United States of America; Prior Health Sciences Library, Ohio State University, Columbus, OH, United States of America
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States of America
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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
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25
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Dumanis SB, Dixon-Salazar T. Incorporating the regulatory science of patient input for the epilepsy community. Epilepsy Behav 2020; 103:106313. [PMID: 31653604 DOI: 10.1016/j.yebeh.2019.05.010] [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: 05/02/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022]
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