Seizure detection at home: Do devices on the market match the needs of people living with epilepsy and their caregivers?

Abstract

In patients with epilepsy, the potential to prevent seizure‐related injuries and to improve the unreliability of seizure self‐report have fostered the development and marketing of numerous seizure detection devices for home use. Understanding the requirements of users (patients and caregivers) is essential to improve adherence and mitigate barriers to the long‐term use of such devices. Here we reviewed the evidence on the needs and preferences of users and provided an overview of currently marketed devices for seizure detection (medically approved or with published evidence for their performance). We then compared devices with known needs. Seizure‐detection devices are expected to improve safety and clinical and self‐management, and to provide reassurance to users. Key factors affecting a device’s usability relate to its design (attractive appearance, low visibility, low intrusiveness), comfort of use, confidentiality of recorded data, and timely support from both technical and clinical ends. High detection sensitivity and low false alarm rates are paramount. Currently marketed devices are focused primarily on the recording of non–electroencephalography (EEG) signals associated with tonic‐clonic seizures, whereas the detection of focal seizures without major motor features remains a clear evidence gap. Moreover, there is paucity of evidence coming from real‐life settings. A joint effort of clinical and nonclinical experts, patients, and caregivers is required to ensure an optimal level of acceptability and usability, which are key aspects for a successful continuous monitoring aimed at seizure detection at home.

Telehealth in pediatric epilepsy care: A rapid transition during the COVID-19 pandemic

“…Efforts should be made to understand the context of how seizures are counted particularly given changes in childcare and school settings. Medical devices have the potential to assist by continuously detecting seizures in real time or close to real time and inform treatment decisions [ 22 ]. A number of devices have been developed to detect seizures or track seizure frequencies [ 23 , 24 ].…”

“…There are no devices on the market that currently meets this standard particularly for focal seizures. However, in the context of a clinical visit, the clinician needs to know whether there has been objective evidence of a change in seizure occurrence rate, which requires only that a change in seizure rate can be reliably detected rather than accurately detecting every event without false alarms [ 22 ]. At this point, there remain key evidence gaps in the use of seizure detection devices for clinical management purposes.…”

230 days of ultra long‐term subcutaneous EEG: seizure cycle analysis and comparison to patient diary

“…There is an ongoing search for technological solutions to provide remote, continuous and long‐term measurements of biosignals related to seizure occurrence or propensity. Key requirements for these devices are that they are reliable and acceptable by users 4 . Currently marketed seizure detection devices are restricted to the detection of convulsive seizures 4 …”

“…Key requirements for these devices are that they are reliable and acceptable by users 4 . Currently marketed seizure detection devices are restricted to the detection of convulsive seizures 4 …”

Seizure detection and mobile health devices in epilepsy: Recent developments and future perspectives

“…This supplement tackles several of the above issues, including the physicians’ and patients’ assessment of current seizure detection and wearable devices, 1,2 with a specific focus on video‐based automated detection of nocturnal motor seizures 3 and home video‐EEG telemetry 4 . The supplement also addresses the issues of quantifying GTCS severity 5,6 and detecting the various forms of focal seizures, 7,8 with emphasis on heart rate variability 5,7 …”