Proposed clinical practice guideline for automated seizure detection using wearable devices

A joint EEG Task Force from the ILAE and the International Federation of Clinical Neurophysiology (IFCN) has developed a proposed clinical practice guideline for automated seizure detection using wearable devices. The ILAE guideline process requires obtaining feedback and comments from its members on the proposed guideline. These comments from our international community will be reviewed by the working group before finalizing the guideline.

Please read the draft of the clinical practice guideline on automated seizure detection using wearable devices and provide your comments. Please send your comments to Deb Flower, who will post them to this web page as they become available.

The manuscript will be open for comments for 30 days, until July 31, 2020. All comments will be placed on the League's website as they are received and will include the name of each writer. At the end of that time, the comments will remain public. The working group will review the comments and will make appropriate changes.

Thank you for your help in this important effort of the ILAE and IFCN.


Comments

6 July 2020

Thank you for an interesting guideline. The guideline focuses almost exclusively on devices measuring peripheral effects secondary to abnormal brain activity (like muscle activity), while a number of EEG devices that measure brain activity directly is on the market or on the way to market.

Our article, "A new era in EEG monitoring? Sub-scalp devices for ultra long-term recordings" was just accepted in Epilepsia. You can see more at https://brain-professor.com/EEG.html

The authors are:
Duun-Henriksen, Jonas; UNEEG medical, Epilepsy Science
Baud, Maxime; Hopitaux Universitaires de Geneve Departement des Neurosciences Cliniques, Neurology
Richardson, Mark; King’s College London, Department of Clinical Neuroscience
Cook, Mark; University of Melbourne, Medicine;
Kouvas, George; Wyss Center for Bio and Neuroengineering, CTO
Heasman, John; Cochlear Ltd, Epi-Minder
Friedman, Daniel; NYU Langone Health, Department of Neurology
Peltola, Jukka; Tampere University, Faculty of Medicine and Health Technology; Tampere University Hospital, Neurology
Zibrandtsen, Ivan; Zealand University Hospital Roskilde, Center of Neurophysiology
Kjaer, Troels W; Zealand University Hospital Roskilde, Department of Neurology

Sincerely yours
Troels Wesenberg Kjaer


30 June 2020

This is a well written guideline addressing two clinical questions “Can automated devices accurately detect GTCS/ FBTCS? Can automated devices detect impaired awareness seizures without GTCS?

28 studies were included, but only 3 phase III trials contribute to the recommendations for GTCS/ FBTCS, while for seizures without TCS 8 phase II studies were used.

Analysis of false alarm rate and device deficiency times could have been added to the scope of the review and all studies, including Phase II could have been utilized for the above outcomes even if they were considered at risk of bias for efficacy or effectiveness.

You may consider adding the following study "Automated Video-Based Detection of Nocturnal Motor Seizures in Children" by. Anouk van Westrhenen et al. Epilepsia. 2020 May.

In TABLE 4: The questions asked are pertinent, but the answers for the two questions viz. “Values and preferences” and “Wise use of resources” are not based on the evidence generated in this review.

Non wrist worn Wearable technologies (which can incorporate EEGs) including vests and caps are likely to be available in near future, with increased detection rate of seizures with fewer false negatives.

Sridharan Ramaratnam


29 June 2020

I think the article is timely and should be published ASAP. MY one comment for the authors to consider:

Our metric for therapy success, whether medical or otherwise, seizure diaries, has not evolved for several thousand years, and all of our current methods to approve medicines are based on these diaries. IS there a role of automatic devices in monitoring if ASDs actually work in patients with epilepsy and if the devices should be used in approving new medications and therapies. This comment also applies to surgery and devices used to augment epilepsy like VNS DBS and Neuropace.

Gary Mathern


26 June 2020

I'm a family caregiver and, in our non-profit organization, we are looking for seizure detection devices since 2008. We are buying and testing the devices in real-life conditions, first by family and then by the persons suffering of epilepsy. Our conclusions are quite different from those published, for daily-life but quite similar for nights. Reason : all validations are made in EEG (or video-EEG) conditions, which is important to be sure that the event detected (or not detected) is a seizure, but ... it is not real life. In real life, on non-epileptic people, the false alarms are high ! I think that it must be the 1st test, as we are sure that all alarms on non-epileptic people are false alarms. Example of false alarms : brush teeth, bicycle, masturbation, clean a table, electrical rasor, etc.

The second point that must not be forgoten is that a high percentage of persons having frequent seizures, specially GTCS, have intellectual disability, maybe also autistic troubles or other troubles. So, an evaluation of the robustness and acceptability of the device is mandatory. 2 examples : The EMFIT matress is fully OK for these people : no need to wear it, no impact on their way to go to bed. . The device named smartwach is a nightmare : vibration on the arm at each detection (unacceptable of most of these persons, no way to disable this), need to have a smartphone very near of the smartwatch (on the pocket or something like), guess how long will it take before it will be broken (due to a seizure falling or to the person's troubles). The device named nighwatch is OK for disabled people, if they accept it (robust, easy to wear, no vibration, etc).

I would like to read studies with 1/false alarm on no-epileptic people in real life conditions and 2/robustness and acceptability of the device (and mandatory tools around) by a disabled person. But I've never found something on that 2 points. These two points must be noted in this paper. From our point of view we are far from devices usable during ordinsry life, but some devices are OK for GTCS detection during sleeping-time, if they are "long-enough" (eg. 10s min for EMFIT)

Françoise Thomas-Vialettes


22 June 2020

Good evening Professor Sándor,

I have gone through the draft of Automated Seizure detection using wearable devices.

Very well written.

Best wishes
Man Mohan Mehndiratta