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- Title
Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors.
- Authors
Onorati, Francesco; Regalia, Giulia; Caborni, Chiara; Migliorini, Matteo; Bender, Daniel; Poh, Ming ‐ Zher; Frazier, Cherise; Kovitch Thropp, Eliana; Mynatt, Elizabeth D.; Bidwell, Jonathan; Mai, Roberto; LaFrance, W. Curt; Blum, Andrew S.; Friedman, Daniel; Loddenkemper, Tobias; Mohammadpour ‐ Touserkani, Fatemeh; Reinsberger, Claus; Tognetti, Simone; Picard, Rosalind W.
- Abstract
Objective New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy ( SUDEP). They must be unobtrusive and automated, and provide false alarm rates (FARs) bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. Methods Hand-annotated video-electroencephalographic seizure events were collected from 69 patients at six clinical sites. Three different wristbands were used to record electrodermal activity ( EDA) and accelerometer ( ACM) signals, obtaining 5,928 h of data, including 55 convulsive epileptic seizures (six focal tonic-clonic seizures and 49 focal to bilateral tonic-clonic seizures) from 22 patients. Recordings were analyzed offline to train and test two new machine learning classifiers and a published classifier based on EDA and ACM. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. Results The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and an FAR of 0.2 events/day. No nocturnal seizures were missed. Most patients had <1 false alarm every 4 days, with an FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures), the FAR is up to 13 times lower than with the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median = 29.3 s, range = 14.8-151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of postictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. Significance The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behavior and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning.
- Subjects
SEIZURES diagnosis; EPILEPSY; DETECTORS; WEARABLE technology; ELECTROENCEPHALOGRAPHY; GALVANIC skin response; SUDDEN death prevention
- Publication
Epilepsia (Series 4), 2017, Vol 58, Issue 11, p1870
- ISSN
0013-9580
- Publication type
Article
- DOI
10.1111/epi.13899