Seizure forecasting using minimally invasive, ultra‐long‐term subcutaneous electroencephalography: Individualized intrapatient models

Abstract

ObjectiveOne of the most disabling aspects of living with chronic epilepsy is the unpredictability of seizures. Cumulative research in the past decades has advanced our understanding of the dynamics of seizure risk. Technological advances have recently made it possible to record pertinent biological signals, including electroencephalogram (EEG), continuously. We aimed to assess whether patient‐specific seizure forecasting is possible using remote, minimally invasive ultra‐long‐term subcutaneous EEG.MethodsWe analyzed a two‐center cohort of ultra‐long‐term subcutaneous EEG recordings, including six patients with drug‐resistant focal epilepsy monitored for 46–230 days with median 18 h/day of recorded data, totaling >11 000 h of EEG. Total electrographic seizures identified by visual review ranged from 12 to 36 per patient. Three candidate subject‐specific long short‐term memory network deep learning classifiers were trained offline and pseudoprospectively on preictal (1 h before) and interictal (>1 day from seizures) EEG segments. Performance was assessed relative to a random predictor. Periodicity of the final forecasts was also investigated with autocorrelation.ResultsDepending on each architecture, significant forecasting performance was achieved in three to five of six patients, with overall mean area under the receiver operating characteristic curve of .65–.74. Significant forecasts showed sensitivity ranging from 64% to 80% and time in warning from 10.9% to 44.4%. Overall, the output of the forecasts closely followed patient‐specific circadian patterns of seizure occurrence.SignificanceThis study demonstrates proof‐of‐principle for the possibility of subject‐specific seizure forecasting using a minimally invasive subcutaneous EEG device capable of ultra‐long‐term at‐home recordings. These results are encouraging for the development of a prospective seizure forecasting trial with minimally invasive EEG.

Multimodal wearable sensors inform cycles of seizure risk

“…Even if multimodal wrist-worn devices are unable to attain the performance of a brain implant, the ease of implementation, lower cost, broad applicability, and patient preference for a wrist-worn form factor 49 make this a critical area of study. Finally, future efforts should assess the utility of combining wearable and minimally invasive sub-cutaneous EEG 70 or intracranial EEG recordings. 69 This work provides evidence that long timescale cycles in noninvasive measures of human physiology are common in epilepsy, and that for many individuals, seizures occur at preferred phases of these cycles.…”

“…Even if multimodal wrist-worn devices are unable to attain the performance of a brain implant, the ease of implementation, lower cost, broad applicability, and patient preference for a wrist-worn form factor 49 make this a critical area of study. Finally, future efforts should assess the utility of combining wearable and minimally invasive sub-cutaneous EEG 70 or intracranial EEG recordings. 69…”

Medicom Conference Report EAN 2022

“…• Annual reproductive counselling for women of childbearing age: 46% • Anxiety and depression screening: 55% • Risk advice on Sudden Unexpected Death in Epilepsy (SUDEP): 14% • In children: timely IV-benzodiazepine in status: 33% of available information in an increasingly complex era. Prof. Barbara Tettenborn (Cantonal Hospital St. Gallen, Switzerland) identified the main advantages as well as limitations of e-learning in neurology [5]. Though easily available and accessible, it often presents an abundance of information, which is not peerreviewed.…”

“…Results of an open-label study with 263 migraine patients suggested that sTMS may be an effective, well-tolerated treatment option for migraine prevention [4]. A very recently published open-label study suggests that sTMS may be an effective, well-tolerated treatment option for the long-term prevention of difficult-to-treat, high-frequency episodic migraine and chronic migraine [5]. After 3 months, 93/153 (60%) analysed patients were responders.…”

“…Reasons to do this include long disease duration, lack of relapses and of MRI activity, progression to secondaryprogressive MS (SPMS) with very slow progression, safety issues, and access-related issues [4]. There are legitimate arguments for and against continuing DMT [5]. Prof. Magyari cited a study that identified a subset of patients with a high likelihood to stay relapse-free after discontinuing DMT: age >45 years at discontinuation, absence of relapses for ≥4 years on DMT before discontinuation, and absence of contrast-enhancing lesions [6].…”