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Multicenter Study
. 2022 Sep;7(3):406-413.
doi: 10.1002/epi4.12618. Epub 2022 Jul 21.

Multimodal nocturnal seizure detection: Do we need to adapt algorithms for children?

Richard H C Lazeron  1 , Roland D Thijs  2 , Johan Arends  1 , Thea Gutter  2 , Pierre Cluitmans  1 , Johannes Van Dijk  1 , Francis I Y Tan  1 , Wytske Hofstra  2 , Claire E H M Donjacour  2 , Frans Leijten  3 ; Dutch Tele-Epilepsy Consortium
Affiliations
Multicenter Study

Multimodal nocturnal seizure detection: Do we need to adapt algorithms for children?

Richard H C Lazeron et al. Epilepsia Open. 2022 Sep.

Abstract

Objective: To assess the performance of a multimodal seizure detection device, first tested in adults (sensitivity 86%, PPV 49%), in a pediatric cohort living at home or residential care.

Methods: In this multicenter, prospective, video-controlled cohort-study, nocturnal seizures were detected by heartrate and movement changes in children with epilepsy and intellectual disability. Participants with a history of >1 monthly major motor seizure wore Nightwatch bracelet at night for 3 months. Major seizures were defined as tonic-clonic, generalized tonic >30 s, hyperkinetic, or clusters (>30 min) of short myoclonic or tonic seizures. The video of all events (alarms and nurse diaries) and about 10% of whole nights were reviewed to classify major seizures, and minor or no seizures.

Results: Twenty-three participants with focal or generalized epilepsy and nightly motor seizures were evaluated during 1511 nights, with 1710 major seizures. First 1014 nights, 4189 alarms occurred with average of 1.44/h, showing average sensitivity of 79.9% (median 75.4%) with mean PPV of 26.7% (median 11.1%) and false alarm rate of 0.2/hour. Over 90% of false alarms in children was due to heart rate (HR) part of the detection algorithm. To improve this rate, an adaptation was made such that the alarm was only triggered when the wearer was in horizontal position. For the remaining 497 nights, this was tested prospectively, 384 major seizures occurred. This resulted in mean PPV of 55.5% (median 58.1%) and a false alarm rate 0.08/h while maintaining a comparable mean sensitivity of 79.4% (median 93.2%).

Significance: Seizure detection devices that are used in bed which depend on heartrate and movement show similar sensitivity in children and adults. However, children do show general higher false alarm rate, mostly triggered while awake. By correcting for body position, the false alarms can be limited to a level that comes close to that in adults.

Keywords: Nightwatch; nightly; nocturnal; seizure; seizure detection; seizure detection epilepsy.

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Conflict of interest statement

Neither of the authors has any conflict of interest to disclose. The authors are part of the Dutch TeleEpilepsy Consortium, which has an agreement with LivAssured that future profits from its commercial device NightWatch will result in research donations from LivAssured to the consortium. No one from the TeleEpilepsy consortium, including the authors, has any direct financial links with LivAssured, or holds shares. The authors confirm that they have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

FIGURE 1
FIGURE 1
The Nightwatch bracelet
See this image and copyright information in PMC

References

    1. Harden C, Tomson T, Gloss D, Buchhalter J, JHelen C, Donner E, et al. Practice guideline summary: sudden unexpected death in epilepsy incidence rates and risk factors: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of neurology and the American Epilepsy Society. Neurology. 2017;88(17):1674–80. - PubMed
    1. Loscher W, Schmidt D. Modern antiepileptic drug development has failed to deliver: ways out of the current dilemma. Epilepsia. 2011;52(4):657–78. - PubMed
    1. Sveinsson O, Andersson T, Mattsson P, Carlsson S, Tomson T. Clinical risk factors in SUDEP: a nationwide population‐based case‐control study. Neurology. 2020;94(4):e419–29. - PMC - PubMed
    1. Lamberts RJ, Thijs RD, Laffan A, Langan Y, Sander JW. Sudden unexpected death in epilepsy: people with nocturnal seizures may be at highest risk. Epilepsia. 2012;53(2):253–7. - PubMed
    1. van der Lende M, Hesdorffer DC, Sander JW, Thijs RD. Nocturnal supervision and SUDEP risk at different epilepsy care settings. Neurology. 2018;91(16):e1508–18. - PubMed

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