Ultra-long subscalp EEG monitoring at home in patients with drug resistant focal and generalized epilepsy
Abstract number :
1.213
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2025
Submission ID :
858
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Leonardo Affronte, MD – University of Modena and Reggio Emilia
Stefania Maffei, PhD – Modena Academic Hospital - AOU Modena
Mara Malerba, PhD – Modena Academic Hospital - AOU Modena
Giada Giovannini, PhD, MD – Modena Academic Hospital, Italy
Antonietta Coppola, MD – Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
Leonilda Bilo, MD – Neurology Unit - Epilepsy Center, AOU Federico II Napoli
Marina Trivisano, MD, PhD – Bambino Gesù Children's Hospital
Anna Vaudano, MD, PhD – University of modena and Reggio Emilia
Paolo Manganotti, MD – Neurology Unit, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste,
Nicola Specchio, MD, PhD, FRCP – Bambino Gesù Children’s Hospital, IRCCS, Member of the ERN EpiCARE; University Hospitals KU
Presenting Author: Stefano Meletti, PhD, MD – UNIMORE
Rationale: To evaluate the feasibility, tolerability, and clinical utility of ultra-long-term subcutaneous EEG (sqEEG) monitoring system in patients with drug-resistant focal and generalized epilepsy.
Methods: Patients affected by drug-resistant epilepsies require an accurate seizures’ counts in order to guide treatment monitoring and efficacy in real word setting. Patients underwent sqEEG implantation (UNEEG 24/7) in a prospective open interventional clinical trial (Eeg Monitoring In Rare Epilepsies - EMIRE; NCT06855901). Seizures were detected through caregivers’ reports, expert visual review (EVR, the gold standard), and automated seizure detection software (EpiSight). Device tolerability, signal quality, and impact on clinical management were assessed.
Results: Five patients (3 male) were implanted (mean age 40 years; mean epilepsy duration 25 years). 3 patients had focal onset seizures, 1 generalized tonic-clonic seizures; 1 a Lennox-Gastaut Syndrome. Median duration of sqEEG monitoring was 11 weeks. Overall, the patients’ usage of the device was 92% ranging from 89% to 94%). About 7500 hours of EEG signal were recorded.
No device-related adverse events occurred. Only a reversible itching on the site of implantation was reported by 1 subject. EEG signal quality was optimal through the recording time.
Overall, 40 seizures events were reported by patients, while 186 seizures events were detected by sqEEG recordings review by the EVR, meaning that about 80% of the seizures were unrecognized by patients/caregivers. Moreover, out of the 40 patients-reported events, 20 were not confirmed by the EVR as ictal events.
EpiSight detected 100 out of 181 seizures with an overall sensibility of 55%. Specificity was low 1,2 % (1472 false positive events).
There was a wide variability in Episight software performance across patients and seizure’s types. Sensibility ranged between 24% to 61%, Specificity ranged from 0,5 to 11,7%. Focusing on tonic-clonic seizures cross-patients’ sensibility was high (11 out of 14 tonic-clonic seizures were automatically detected; 78%). Episight detected 100% of TCS in 2 patients, 65% in a third patient.
Conclusions: sqEEG provides reliable long-term monitoring information in epilepsy patients, outperforming caregiver reporting and offering critical insights into seizure burden. These preliminary findings underscore that subcutaneous ultra-long EEG monitoring is safe and provides excellent quality EEG data. Improvements in automatic seizure detection algorhythm is however needed. SqEEG shows promises in improving seizure monitoring in complex epilepsies and in developmental and epileptic encephalopathies improving patient care.
References:
Duun‐Henriksen J, et al. A new era in electroencephalographic monitoring? Subscalp devices for ultra–long‐term recordings. Epilepsia. 2020;61(9):1805-1817.
Rubboli G, et al. Clinical utility of ultra long‐term subcutaneous electroencephalographic monitoring in drug‐resistant epilepsies: a “real world” pilot study. Epilepsia. 2024;65(11):3265-3278.
Funding: Project Code: PNRR-MR1-2022-12376491. By the Italian MoH.
Neurophysiology