Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

癫痫 癫痫发作 警报 医学 脑电图 听力学 心理学 计算机科学 物理医学与康复 麻醉 神经科学 材料科学 复合材料
作者
Francesco Onorati,Giulia Regalia,Chiara Caborni,Matteo Migliorini,Daniel E. Bender,Ming‐Zher Poh,Cherise Frazier,Eliana Kovitch Thropp,Elizabeth D. Mynatt,Jonathan Bidwell,Roberto Mai,W. Curt LaFrance,Andrew S. Blum,Daniel Friedman,Tobias Loddenkemper,Fatemeh Mohammadpour,Claus Reinsberger,Simone Tognetti,Rosalind W. Picard
出处
期刊:Epilepsia [Wiley]
卷期号:58 (11): 1870-1879 被引量:180
标识
DOI:10.1111/epi.13899
摘要

Summary 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.
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