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Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors
Author(s) -
Onorati Francesco,
Regalia Giulia,
Caborni Chiara,
Migliorini Matteo,
Bender Daniel,
Poh MingZher,
Frazier Cherise,
Kovitch Thropp Eliana,
Mynatt Elizabeth D.,
Bidwell Jonathan,
Mai Roberto,
LaFrance W. Curt,
Blum Andrew S.,
Friedman Daniel,
Loddenkemper Tobias,
MohammadpourTouserkani Fatemeh,
Reinsberger Claus,
Tognetti Simone,
Picard Rosalind W.
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13899
Subject(s) - epilepsy , epileptic seizure , alarm , medicine , electroencephalography , audiology , psychology , computer science , physical medicine and rehabilitation , anesthesia , neuroscience , materials science , composite material
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.