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Böttcher S, Zabler N, Jackson M, Bruno E, Biondi A, Epitashvili N, Vieluf S, Dümpelmann M, Richardson MP, Brinkmann BH, Loddenkemper T, Schulze-Bonhage A. Effects of epileptic seizures on the quality of biosignals recorded from wearables. Epilepsia 2024. [PMID: 39373185 DOI: 10.1111/epi.18138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVE Wearable nonelectroencephalographic biosignal recordings captured from the wrist offer enormous potential for seizure monitoring. However, signal quality remains a challenging factor affecting data reliability. Models trained for seizure detection depend on the quality of recordings in peri-ictal periods in performing a feature-based separation of ictal periods from interictal periods. Thus, this study aims to investigate the effect of epileptic seizures on signal quality, ensuring accurate and reliable monitoring. METHODS This study assesses the signal quality of wearable data during peri-ictal phases of generalized tonic-clonic and focal to bilateral tonic-clonic seizures (TCS), focal motor seizures (FMS), and focal nonmotor seizures (FNMS). We evaluated accelerometer (ACC) activity and the signal quality of electrodermal activity (EDA) and blood volume pulse (BVP) data. Additionally, we analyzed the influence of peri-ictal movements as assessed by ACC (ACC activity) on signal quality and examined intraictal subphases of focal to bilateral TCS. RESULTS We analyzed 386 seizures from 111 individuals in three international epilepsy monitoring units. BVP signal quality and ACC activity levels differed between all seizure types. We found the largest decrease in BVP signal quality and increase in ACC activity when comparing the ictal phase to the pre- and postictal phases for TCS. Additionally, ACC activity was strongly negatively correlated with BVP signal quality for TCS and FMS, and weakly for FNMS. Intraictal analysis revealed that tonic and clonic subphases have the lowest BVP signal quality and the highest ACC activity. SIGNIFICANCE Motor elements of seizures significantly impair BVP signal quality, but do not have significant effect on EDA signal quality, as assessed by wrist-worn wearables. The results underscore the importance of signal quality assessment methods and careful selection of robust modalities to ensure reliable seizure detection. Future research is needed to explain whether seizure detection models' decisions are based on signal responses induced by physiological processes as opposed to artifacts.
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Affiliation(s)
- Sebastian Böttcher
- Epilepsy Center, University Medical Center-University of Freiburg, Freiburg, Germany
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
| | - Nicolas Zabler
- Epilepsy Center, University Medical Center-University of Freiburg, Freiburg, Germany
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elisa Bruno
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Andrea Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nino Epitashvili
- Epilepsy Center, University Medical Center-University of Freiburg, Freiburg, Germany
| | - Solveig Vieluf
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Matthias Dümpelmann
- Epilepsy Center, University Medical Center-University of Freiburg, Freiburg, Germany
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Benjamin H Brinkmann
- Department of Neurology and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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de Albuquerque LCP, Torres CM, Batista CEA, Cunha DRMDF, Bizzi JWJ, Bianchin MM. Measuring quality and safety of epilepsy monitoring units in Brazil: Adoption of quality indicators. Seizure 2024; 115:68-74. [PMID: 38218112 DOI: 10.1016/j.seizure.2023.12.021] [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: 05/10/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Drug-resistant epilepsy affects a substantial proportion (30-40 %) of patients with epilepsy, often necessitating video-electroencephalography (video-EEG) monitoring. In 2016, Sauro et al. introduced a set of measures aimed at improving the quality and safety indicators reported in video-EEG evaluations. This study aims to report our experience with the implementation of these measures. METHODS We analyzed video-EEG data regarding quality and safty from a period spanning January 2016 to January 2018, involving a total of 101 patients monitored in our video-EEG unit. RESULTS Among the patients included in the study, a definitive diagnosis was attainable for 92.1 %, with 36.6 % experiencing a change in diagnosis and 65.3 % undergoing a change in treatment as a result of the video-EEG evaluation. Additionally, the referral question was fully addressed in 60.4 % of admissions, and video-EEG was considered to be very useful or extremely useful in 66.4 % of cases. Adverse events were observed in 26.7 % of patients, with the most common being the progression of focal seizures to bilateral tonic-clonic seizures (11.9 %) and the occurrence of seizure clusters (5.9 %). CONCLUSION Our findings support the implementation of Sauro et al.'s set of measures, as they provide valuable criteria for improving the reporting of video-EEG quality and safety indicators. However, challenges may arise due to variations in terminology across studies and the lack of standardized criteria for defining essential questions in video-EEG evaluations. Further research utilizing these measures is necessary to enhance their effectiveness and encourage consistent reporting of results from epilepsy monitoring units.
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Affiliation(s)
- Leonardo Cordenonzi Pedroso de Albuquerque
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos n. 2.350, Porto Alegre, Brazil
| | - Carolina Machado Torres
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos n. 2.350, Porto Alegre, Brazil
| | | | | | | | - Marino Muxfeldt Bianchin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos n. 2.350, Porto Alegre, Brazil; Basic Research and Advanced Investigations in Neurosciences, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Castillo Rodriguez MDLA, Brandt A, Schulze-Bonhage A. Differentiation of subclinical and clinical electrographic events in long-term electroencephalographic recordings. Epilepsia 2023; 64 Suppl 4:S47-S58. [PMID: 36008142 DOI: 10.1111/epi.17401] [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: 02/18/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE With the advent of ultra-long-term recordings for monitoring of epilepsies, the interpretation of results of isolated electroencephalographic (EEG) recordings covering only selected brain regions attracts considerable interest. In this context, the question arises of whether detected ictal EEG patterns correspond to clinically manifest seizures or rather to purely electrographic events, that is, subclinical events. METHODS EEG patterns from 268 clinical seizures and 252 subclinical electrographic events from 50 patients undergoing video-EEG monitoring were analyzed. Features extracted included predominant frequency band, duration, association with rhythmic muscle artifacts, spatial extent, and propagation patterns. Classification using logistic regression was performed based on data from the whole dataset of 10-20 system EEG recordings and from a subset of two temporal electrode contacts. RESULTS Correct separation of clinically manifest and purely electrographic events based on 10-20 system EEG recordings was possible in up to 83.8% of events, depending on the combination of features included. Correct classification based on two-channel recordings was only slightly inferior, achieving 78.6% accuracy; 74.4% and 74.8%, respectively, of events could be correctly classified when using duration alone with either electrode set, although classification accuracies were lower for some subgroups of seizures, particularly focal aware seizures and epileptic arousals. SIGNIFICANCE A correct classification of subclinical versus clinical EEG events was possible in 74%-83% of events based on full EEG recordings, and in 74%-78% when considering only a subset of two electrodes, matching the channel number available from new implantable diagnostic devices. This is a promising outcome, suggesting that ultra-long-term low-channel EEG recordings may provide sufficient information for objective seizure diaries. Intraindividual optimization using high numbers of ictal events may further improve separation, provided that supervised learning with external validation is feasible.
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Affiliation(s)
| | - Armin Brandt
- Epilepsy Center, University Medical Center Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center Freiburg, Freiburg, Germany
- Spemann Graduate School of Biology and Medicine, Freiburg, Germany
- European Reference Network EpiCare, Freiburg, Germany
- NeuroModulBasic, Freiburg, Germany
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Beniczky S, Ryvlin P. Mobile health and digital technology in epilepsy: The dawn of a new era. Epilepsia 2023; 64 Suppl 4:S1-S3. [PMID: 37921045 DOI: 10.1111/epi.17813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Sándor Beniczky
- Department of Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University and Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
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Hirsch M, Novitskaya Y, Schulze‐Bonhage A. Value of ultralong-term subcutaneous EEG monitoring for treatment decisions in temporal lobe epilepsy: A case report. Epilepsia Open 2023; 8:1616-1621. [PMID: 37842739 PMCID: PMC10690663 DOI: 10.1002/epi4.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
Treatment decisions in epilepsy critically depend on information on the course of the disease, its severity and options for specific local interventions. We here report a patient with pharmaco-resistant non-lesional temporal lobe epilepsy with evidence for predominant right temporal epileptogenesis. While seizure frequency had been grossly underestimated for many years, ultralong-term monitoring with a subcutaneous EEG device revealed actual seizure frequency (66 over 11 months vs four patient-documented seizures), providing objective data on treatment efficacy and additional supportive lateralizing information that played a decisive role for the choice of surgical treatment, which had been rejected by the patient prior to this information.
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Affiliation(s)
- Martin Hirsch
- Epilepsy Center, University Medical CenterUniversity of FreiburgFreiburgGermany
- European Reference Network EpiCareBronFrance
| | - Yulia Novitskaya
- Epilepsy Center, University Medical CenterUniversity of FreiburgFreiburgGermany
- European Reference Network EpiCareBronFrance
| | - Andreas Schulze‐Bonhage
- Epilepsy Center, University Medical CenterUniversity of FreiburgFreiburgGermany
- European Reference Network EpiCareBronFrance
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Timpte K, Rosenkötter U, Honrath P, Weber Y, Wolking S, Heckelmann J. Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study. Front Neurol 2023; 14:1281652. [PMID: 37928154 PMCID: PMC10622959 DOI: 10.3389/fneur.2023.1281652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Paroxysmal seizure-like events can be a diagnostic challenge. Inpatient video-electroencephalography (EEG) monitoring (VEM) can be a valuable diagnostic tool, but recommendations for the minimal duration of VEM to confirm or rule out epilepsy are inconsistent. In this study, we aim to determine whether VEM of 48 or 72 h was superior to 24 h. Methods In this monocentric, retrospective study, we included 111 patients with paroxysmal, seizure-like events who underwent at least 72 h of VEM. Inclusion criteria were as follows: (1) Preliminary workup was inconclusive; (2) VEM admission occurred to confirm a diagnosis; (3) At discharge, the diagnosis of epilepsy was conclusively established. We analyzed the VEM recordings to determine the exact time point of the first occurrence of epileptic abnormalities (EAs; defined as interictal epileptiform discharges or electrographic seizures). Subgroup analyses were performed for epilepsy types and treatment status. Results In our study population, 69.4% (77/111) of patients displayed EAs during VEM. In this group, the first occurrence of EAs was observed within 24 h in 92.2% (71/77) of patients and within 24-72 h in 7.8% (6/77). There was no statistically significant difference in the incidence of EA between medicated and non-medicated patients or between focal, generalized epilepsies and epilepsies of unknown type. Of the 19 recorded spontaneous electroclinical seizures, 6 (31.6%) occurred after 24 h. Discussion A VEM of 24 h may be sufficient in the diagnostic workup of paroxysmal seizure-like events under most circumstances. Considering the few cases of first EA in the timeframe between 24 and 72 h, a prolonged VEM may be useful in cases with a high probability of epilepsy or where other strategies like sleep-EEG or ambulatory EEG show inconclusive results. Prolonged VEM increases the chance of recording spontaneous seizures. Our study also highlights a high share of subjects with epilepsy that do not exhibit EAs during 72 h of VEM.
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Affiliation(s)
| | | | | | | | - Stefan Wolking
- Department of Epileptology and Neurology, RWTH University Hospital Aachen, Aachen, Germany
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Schulze‐Bonhage A, Richardson MP, Brandt A, Zabler N, Dümpelmann M, San Antonio‐Arce V. Cyclical underreporting of seizures in patient-based seizure documentation. Ann Clin Transl Neurol 2023; 10:1863-1872. [PMID: 37608738 PMCID: PMC10578895 DOI: 10.1002/acn3.51880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Circadian and multidien cycles of seizure occurrence are increasingly discussed as to their biological underpinnings and in the context of seizure forecasting. This study analyzes if patient reported seizures provide valid data on such cyclical occurrence. METHODS We retrospectively studied if circadian cycles derived from patient-based reporting reflect the objective seizure documentation in 2003 patients undergoing in-patient video-EEG monitoring. RESULTS Only 24.1% of more than 29000 seizures documented were accompanied by patient notifications. There was cyclical underreporting of seizures with a maximum during nighttime, leading to significant deviations in the circadian distribution of seizures. Significant cyclical deviations were found for focal epilepsies originating from both, frontal and temporal lobes, and for different seizure types (in particular, focal unaware and focal to bilateral tonic-clonic seizures). INTERPRETATION Patient seizure diaries may reflect a cyclical reporting bias rather than the true circadian seizure distributions. Cyclical underreporting of seizures derived from patient-based reports alone may lead to suboptimal treatment schemes, to an underestimation of seizure-associated risks, and may pose problems for valid seizure forecasting. This finding strongly supports the use of objective measures to monitor cyclical distributions of seizures and for studies and treatment decisions based thereon.
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Affiliation(s)
- Andreas Schulze‐Bonhage
- Epilepsy CenterUniversity Medical Center, University of FreiburgFreiburgGermany
- European Reference Network EpiCARE
| | - Mark P. Richardson
- Division of NeuroscienceInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Armin Brandt
- Epilepsy CenterUniversity Medical Center, University of FreiburgFreiburgGermany
| | - Nicolas Zabler
- Epilepsy CenterUniversity Medical Center, University of FreiburgFreiburgGermany
| | - Matthias Dümpelmann
- Epilepsy CenterUniversity Medical Center, University of FreiburgFreiburgGermany
| | - Victoria San Antonio‐Arce
- Epilepsy CenterUniversity Medical Center, University of FreiburgFreiburgGermany
- European Reference Network EpiCARE
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Wong V, Hannon T, Fernandes KM, Freestone DR, Cook MJ, Nurse ES. Ambulatory video EEG extended to 10 days: A retrospective review of a large database of ictal events. Clin Neurophysiol 2023; 153:177-186. [PMID: 37453851 DOI: 10.1016/j.clinph.2023.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This work aims to determine the ambulatory video electroencephalography monitoring (AVEM) duration and number of captured seizures required to resolve different clinical questions, using a retrospective review of ictal recordings. METHODS Patients who underwent home-based AVEM had event data analyzed retrospectively. Studies were grouped by clinical indication: differential diagnosis, seizure type classification, or treatment assessment. The proportion of studies where the conclusion was changed after the first seizure was determined, as was the AVEM duration needed for at least 99% of studies to reach a diagnostic conclusion. RESULTS The referring clinical question was not answered entirely by the first event in 29.6% (n = 227) of studies. Diagnostic and classification indications required a minimum of 7 days for at least 99% of studies to be answered, whilst treatment-assessment required at least 6 days. CONCLUSIONS At least 7 days of monitoring, and potentially multiple events, are required to adequately answer these clinical questions in at least 99% of patients. The widely applied 72 h or single event recording cut-offs may be inadequate to adequately answer these three indications in a substantial proportion of patients. SIGNIFICANCE Extended duration of monitoring and capturing multiple events should be considered when attempting to capture seizures on video-EEG.
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Affiliation(s)
- Victoria Wong
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Timothy Hannon
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Kiran M Fernandes
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Dean R Freestone
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Victoria, Australia; Seer Medical, Melbourne 3000, Victoria, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Victoria, Australia; Seer Medical, Melbourne 3000, Victoria, Australia.
| | - Ewan S Nurse
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Victoria, Australia; Seer Medical, Melbourne 3000, Victoria, Australia
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Nurse ES, Perera T, Hannon T, Wong V, Fernandes KM, Cook MJ. Rates of event capture of home video EEG. Clin Neurophysiol 2023; 149:12-17. [PMID: 36867914 DOI: 10.1016/j.clinph.2023.02.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Recording electrographic and behavioral information during epileptic and other paroxysmal events is important during video electroencephalography (EEG) monitoring. This study was undertaken to measure the event capture rate of an home service operating across Australia using a shoulder-worn EEG device and telescopic pole-mounted camera. METHODS Neurologist reports were accessed retrospectively. Studies with confirmed events were identified and assessed for event capture by recording modality, whether events were reported or discovered, and physiological state. RESULTS 6,265 studies were identified, of which 2,788 (44.50%) had events. A total of 15,691 events were captured, of which 77.89% were reported. The EEG amplifier was active for 99.83% of events. The patient was in view of the camera for 94.90% of events. 84.89% of studies had all events on camera, and 2.65% had zero events on camera (mean = 93.66%, median = 100.00%). 84.42% of events from wakefulness were reported, compared to 54.27% from sleep. CONCLUSIONS Event capture was similar to previously reported rates from home studies, with higher capture rates on video. Most patients have all events captured on camera. SIGNIFICANCE Home monitoring is capable of high rates of event capture, and the use of wide-angle cameras allows for all events to be captured in the majority of studies.
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Affiliation(s)
- Ewan S Nurse
- Seer Medical, Melbourne 3000, Australia; Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Australia
| | | | - Timothy Hannon
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Australia
| | - Victoria Wong
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Australia
| | - Kiran M Fernandes
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Australia
| | - Mark J Cook
- Seer Medical, Melbourne 3000, Australia; Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville 3052, Australia.
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