Actigraphic Signatures of Disability in Adults with Epilepsy and Intellectual Disability
Abstract number :
1.083
Submission category :
2. Translational Research / 2C. Biomarkers
Year :
2023
Submission ID :
41
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Nandani Adhyapak, BS – Baylor College of Medicine
Pallavi KrishnaRao, BS, MS – Neurology – Baylor College of Medicine; Jessica Kamen, BS – Neurology – Baylor College of Medicine; Mark Abboud, BS – Neurology – Baylor College of Medicine; Vaishnav Krishnan, MDPhD FAES – Assistant Professor, Neurology, Baylor College of Medicine
Rationale: Wearable science in epilepsy has extensively focused on the problem of seizure prediction/detection. A more limited emphasis has been placed on digital measurements of the many comorbidities of epilepsy. Using wrist-worn accelerometers (“wrist actigraphy”), our laboratory recently demonstrated that certain features of rest-activity rhythm (RARs) may encode aspects of neuropsychiatric wellbeing in intellectually able, self-consenting adults with focal epilepsy. Here, we visualize RARs in PWE affected by varying degrees of intellectual disability (ID).
Methods: Study protocols were approved by the Baylor College of Medicine’s IRB (H-45654). Adults with epilepsy and ID were identified during routine clinic visits. Consenting caregivers were instructed to ensure that subjects wore an Actiwatch-2 device continuously on their nondominant wrist for at least ten days. Caregivers rated overall epilepsy severity (Global Assessment of Severity of Epilepsy, GASE) and completed psychometric assessments of adaptive function (ABAS-3, Adaptive Behavior Assessment System-3) and psychopathology (ABCL, Adult Behavior Checklist). Incomplete days of recording were removed. Accelerometry data (binned in 60s epochs) was utilized to measure RAR morphology and estimate “sleep” (defined as epochs of zero mobility lasting ≥4 minutes).
Results: From 32 subjects examined so far (median age 26, range 20-68, 53% female, 75% nonverbal), we collected a median recording duration of 10.5 days (range 6-20). Subjects were K-means clustered into three groups using ABAS-3 and ABCL parameters. Subjects in “cluster 1” (n=15) displayed the lowest scores of adaptive functioning and were almost exclusively nonverbal and non-ambulatory. “Cluster 2” (n = 9) subjects displayed the greatest burden of caregiver-reported behavioral problems and were mostly ambulatory but nonverbal. “Cluster 3” subjects displayed the highest scores of adaptive functioning and were mostly verbal and ambulatory. Averaged actograms for such clusters displayed unique morphologies that significantly deviated from the classically sigmoid pattern seen in generally healthy cohorts. When formally compared against actograms from age- and sex-matched community-dwelling intellectually able subjects without epilepsy, all three subject clusters displayed significantly lower amplitudes, higher intradaily variability and total sleep time. GASE scores were similar across all three groups, as were actigraphically determined estimates of total daily sleep.
Conclusions: These initial results suggest a potential role for wrist actigraphy as a biomarker of neuropsychiatric wellbeing in adults with epilepsy and ID. Longitudinal studies are essential to understand the value of actigraphy in objectively measuring the psychomotor impacts of antiseizure medications (or any psychoactive medication), the relationships between seizure tendency and sleep health, and whether behavioral modifications to the RAR (e.g., scheduled morning activities) in some patients may exert some neuropsychiatric benefit.
Funding: This work is supported by the Mike Hogg Foundation, NINDS K08NS110924, NINDS R01NS13199 and seed funding from the BCM Office of Research.
Translational Research