Abstracts

Rationale: Alteration of consciousness (AOC) during seizures is a hallmark of epilepsy, leading to increased morbidity, mortality, and reduced quality of life. Assessment of AOC level is crucial for accurate diagnosis and management of people with epilepsy (PWE). However, current AOC testing during seizures has mainly been limited to hospital settings, and is further limited by a lack of standardization, sparse testing, delay to testing, poor interrater and test-retest reliability. The absence of a standardized AOC assessment tool for testing PWE in naturalistic environments has limited investigation of AOC mechanisms and its impact on patients. To address this clinical gap, we implement previously validated tools for automatic responsiveness testing in epilepsy (ARTiE) utilizing a mobile phone application and smartwatch.

Methods: The mobile ARTiE system was validated in the Epilepsy Video/EEG monitoring unit. Patient inclusion criteria were: (1) epilepsy diagnosis; (2) age 18 years or older; (3) ability to participate in behavioral tasks at baseline. The mobile ARTiE system (smart phone, watch & cloud) administers the behavioral assessment sequence and records verbal and motor responses. The wearable and mobile devices have bidirectional wireless connectivity allowing remote initiation of the assessment and data synchronization. Upon automated or visual seizure detection—remote server notification automatically launches testing that includes verbal questions and commands to test receptive and expressive language, orientation, motor praxis, and memory recall. The assessment adaptively increases the number of loops based on patient performance.

Results: Seven adult PWE were enrolled for testing with the mobile ARTiE system running on an Apple iPhone & iWatch. A total of 29 baseline (no seizure) automated triggered events were captured testing motor, memory, and orientation in PWE. All subjects achieved 100% (n=87/87) score for following motor command to tap the watch face on an auditory cue (“beep”). Memory registration testing was 100% (n=58/58) for randomly selected nouns. Orientation to self and time was 100% (n=29/29). Memory retrieval for two words presented by the watch was impaired with 3.4% (n=1) unable to recall either of the two nouns, 55.2% (n=16) able to recall one of the words, and 41.4% (n=12) able to recall both nouns. The subjects reported they enjoyed working with the technology and are interested in future studies in their home environment.

Conclusions: We describe a novel behavioral and electrophysiology platform for automated assessment of AOC during seizures. Preliminary results indicate that standardized behavioral responsiveness and AOC testing deployed prospectively utilizing a wearable and mobile health platform is feasible and can provide reliable ictal behavioral assessments. Future directions include collection of data during different types of seizures and assessment of AOC in real-world settings.

Funding: Please list any funding that was received in support of this abstract.: Supported by NIH Brain Initiative UG3-NS112826 Thalamic stimulation to prevent impaired consciousness in epilepsy (START PI: H. Blumenfeld).