Rationale:
Absence seizures can be unnoticeable for patients and caregivers, and a significant proportion are not reported in seizure diaries, even when patients are specifically asked to do it. However, clinicians rely on these diaries to change antiseizure medications (ASM) in daily practice and to determine efficacy in clinical trials.
In this proof-of-concept study, we aimed to evaluate the utility of a two-channel electroencephalography (EEG) wearable device (WD), the Sensor Dot (Byteflies, Belgium), for tailoring the therapy in individuals with absence seizures, defined as a 3 Hz spike and wave discharge with a minimum duration of three seconds
.Methods:
The hospital ethical committee approved the study, and all participants signed the informed consent. Patients with confirmed, uncontrolled absence seizures or who had controlled seizures but side effects with their baseline treatment wore the SD at home for at least 24 hours before adjusting the ASM and then once weekly. They were asked to report their absences using an electronic seizure diary.
The first author marked all absences offline, considered the ground truth. This data helped the treating physician to adjust the treatment according to the patient’s ASM response. We compared the patient-reported absences with the ground truth.
Results:
Eleven patients (eight females, median age 22 years) participated in the study (Table 1) and were followed between one and ten months. The median duration of each weekly recording was 21 hours [IR (Interquartile range): 15-22]. All patients reported no absences, despite having a median of 11 [IQR 2-38] with a duration of up to 10 seconds. Six patients were rendered seizure-free after a few or multiple adjustments in the ASM. In other cases, the measurement results helped the treating physician to improve the treatments and to suspect a case of psychogenic non-epileptic seizures.
Conclusions:
A two-channel scalp EEG WD can be used to detect absence seizures at home during long-term follow-up. Moreover, it helped to tailor the treatment in all cases. However, seizure detection algorithms will be required to scale the WD use to ameliorate the workload. These findings need confirmation with a multicenter trial and independent evaluation. Finally, integrating this system into the patient’s electronic files would be mandatory in future case uses.
Funding:
The Flemish Agency for Innovation and Entrepreneurship (Vlaamse Agenstachap Innoveren & Ondernemen, VLAIO) supported this study with the grant
Interdisciplinar and Cooperative Research (ICON) – Personalized Medicine A19/TT/1549 (Plug' n Patch)
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