Wearables bei Epilepsien

Zusammenfassung

Epileptische Anfälle führen zu verschiedensten körperlichen Symptomen, die je nach Art und Ausprägung mit geeigneten Geräten gemessen werden und als Surrogatmarker epileptischer Anfälle dienen können. Dominierende motorische Symptome können mit Beschleunigungssensoren oder elektromyografisch erfasst werden. Bei fokalen Anfällen mit fehlender oder geringer motorischer Beteiligung können autonome Phänomene wie Änderungen der Herzrate, Atmung und des elektrischen Hautwiderstandes per Elektrokardiografie, Photopletysmografie und Hautsensoren gemessen werden. Die in den heutigen Wearables integrierten Sensoren können diese Körpersignale messen und zur automatisierten Anfallserkennung nutzbar machen. In dieser Übersichtsarbeit werden verschiedene Sensortechnologien, Wearables und deren Anwendung zur automatisierten Erkennung epileptischer Anfälle vorgestellt, Gütekriterien zur Einschätzung mobiler Gesundheitstechnologien diskutiert und klinisch geprüfte Systeme zusammengefasst.

Abstract

Epileptic seizures cause a wide spectrum of physical symptoms, which can be measured by appropriate devices and serve as surrogate markers of epileptic activity. Predominant motor symptoms can be assessed using accelerometry or electromyography sensors. In focal seizures without or with minor motor symptoms only, autonomic phenomena such as alterations of heart rate, breathing and skin conductance can be measured by electrocardiography, photopletysmography or skin electrodes. The sensors commonly integrated in wearables can assess these body signals and contribute to seizure detection. In this review, sensor technologies, wearables and their application in automated seizure detection devices are presented, performance metrics of mobile health technologies are discussed and clinically validated detection systems are summarised.

Schlüsselwörter

Mobile Gesundheitstechnologien - Anfallsdetektion - Wearables - Telemedizin - epileptische Anfälle

Key words

Mobile health technologies - seizure detection - wearables - telemedicine - epileptic seizures

Publication History

Article published online:
23 February 2021

• Literatur

• 1 Pensel MC, Nass RD, Taubøll E. et al. Prevention of sudden unexpected death in epilepsy: current status and future perspectives. Expert Rev Neurother 2020; 20: 497-508 DOI: 10.1080/14737175.2020.1754195.
• 2 Mackay M, Mahlaba H, Gavillet E. et al. Seizure self-prediction: Myth or missed opportunity?. Seizure 2017; 51: 180-185 DOI: 10.1016/j.seizure.2017.08.011.
• 3 Hoppe C, Poepel A, Elger CE. Epilepsy: accuracy of patient seizure counts. Arch Neurol 2007; 64: 1595-1599 doi: 10.1001/archneur.64.11.1595
• 4 Shegog R, Braverman L, Hixson JD. Digital and technological opportunities in epilepsy: Toward a digital ecosystem for enhanced epilepsy management. Epilepsy Behav 2020; 102: 106663 DOI: 10.1016/j.yebeh.2019.106663.
• 5 Hoppe C, Feldmann M, Blachut B. et al. Novel techniques for automated seizure registration: Patientsʼ wants and needs. Epilepsy Behav 2015; 52 (Pt A) 1-7 DOI: 10.1016/j.yebeh.2015.08.006.
• 6 Bruno E, Biondi A, Böttcher S. et al. Day and night comfort and stability on the body of four wearable devices for seizure detection: A direct user-experience. Epilepsy Behav 2020; 112: 107478 DOI: 10.1016/j.yebeh.2020.107478.
• 7 Tatum WO, Hirsch LJ, Gelfand MA. et al. Assessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures. JAMA Neurol 2020; 77: 593-600 DOI: 10.1001/jamaneurol.2019.4785.
• 8 Li P, Benezeth Y, Macwan R. et al. Video-Based Pulse Rate Variability Measurement Using Periodic Variance Maximization and Adaptive Two-Window Peak Detection. Sensors (Basel) 2020; 20: 2752 DOI: 10.3390/s20102752.
• 9 Au Yong HM, Minato E, Paul E. et al. Can seizure-related heart rate differentiate epileptic from psychogenic nonepileptic seizures?. Epilepsy Behav 2020; 112: 107353 DOI: 10.1016/j.yebeh.2020.107353.
• 10 Beniczky S, Karoly P, Nurse E, Ryvlin P, Cook M. Machine learning and wearable devices of the future. Epilepsia, im Druck DOI: 10.1111/epi.16555.
• 11 Goldenholz DM, Moss R, Jost DA. et al. Common data elements for epilepsy mobile health systems. Epilepsia 2018; 59: 1020-1026 DOI: 10.1111/epi.14066.
• 12 Beniczky S, Ryvlin P. Standards for testing and clinical validation of seizure detection devices. Epilepsia 2018; 59 (Suppl 1): 9-13 DOI: 10.1111/epi.14049.
• 13 Bidwell J, Khuwatsamrit T, Askew B. et al. Seizure reporting technologies for epilepsy treatment: A review of clinical information needs and supporting technologies. Seizure 2015; 32: 109-117 DOI: 10.1016/j.seizure.2015.09.006.
• 14 Nasseri M, Nurse E, Glasstetter M. et al. Signal quality and patient experience with wearable devices for epilepsy management. Epilepsia 2020; 61 (Suppl 1): S25-S35 DOI: 10.1111/epi.16527.
• 15 Narechania AP, Garić II, Sen-Gupta I. et al. Assessment of a quasi-piezoelectric mattress monitor as a detection system for generalized convulsions. Epilepsy Behav 2013; 28: 172-176 DOI: 10.1016/j.yebeh.2013.04.017.
• 16 van Westrhenen A, Petkov G, Kalitzin SN. et al. Automated video-based detection of nocturnal motor seizures in children. Epilepsia 2020; 61 (Suppl 1): S36-S40 DOI: 10.1111/epi.16504.
• 17 Beniczky S, Conradsen I, Moldovan M. et al. Automated differentiation between epileptic and nonepileptic convulsive seizures. Ann Neurol 2015; 77: 348-351 DOI: 10.1002/ana.24338.
• 18 Beniczky S, Conradsen I, Pressler R. et al. Quantitative analysis of surface electromyography: Biomarkers for convulsive seizures. Clin Neurophysiol 2016; 127: 2900-2907 DOI: 10.1016/j.clinph.2016.04.017.
• 19 Beniczky S, Polster T, Kjaer TW. et al. Detection of generalized tonic-clonic seizures by a wireless wrist accelerometer: a prospective, multicenter study. Epilepsia 2013; 54: e58-e61 DOI: 10.1111/epi.12120.
• 20 Beniczky S, Conradsen I, Henning O. et al. Automated real-time detection of tonic-clonic seizures using a wearable EMG device. Neurology 2018; 90: e428-e434 DOI: 10.1212/WNL.0000000000004893.
• 21 Halford JJ, Sperling MR, Nair DR. et al. Detection of generalized tonic-clonic seizures using surface electromyographic monitoring. Epilepsia 2017; 58: 1861-1869 DOI: 10.1111/epi.13897.
• 22 Conradsen I, Wolf P, Sams T. et al. Patterns of muscle activation during generalized tonic and tonic-clonic epileptic seizures. Epilepsia 2011; 52: 2125-2132 DOI: 10.1111/j.1528-1167.2011.03286.x.
• 23 Nijsen TM, Aarts RM, Arends JB. et al. Automated detection of tonic seizures using 3-D accelerometry. 4th European Conference of the International Federation for Medical and Biological Engineering IFMBE Proceedings 2008; 22: 188-191 DOI: 10.1007/978-3-540-89208-3_47.
• 24 Dalton A, Patel S, Chowdhury AR. et al. Development of a body sensor network to detect motor patterns of epileptic seizures. IEEE Trans Biomed Eng 2012; 59: 3204-3211 DOI: 10.1109/TBME.2012.2204990.
• 25 Van de Vel A, Cuppens K, Bonroy B. et al. Long-term home monitoring of hypermotor seizures by patient-worn accelerometers. Epilepsy Behav 2013; 26: 118-125 DOI: 10.1016/j.yebeh.2012.10.006.
• 26 Baumgartner C, Lurger S, Leutmezer F. Autonomic symptoms during epileptic seizures. Epileptic Disord 2001; 3: 103-116
• 27 Bateman LM, Li CS, Seyal M. Ictal hypoxemia in localization-related epilepsy: analysis of incidence, severity and risk factors. Brain 2008; 131 (Pt12) 3239-3245 DOI: 10.1093/brain/awn277.
• 28 Surges R, Scott CA, Walker MC. Enhanced QT shortening and persistent tachycardia after generalized seizures. Neurology 2010; 74: 421-426 doi: 10.1212/WNL.0b013e3181ccc706
• 29 Poh MZ, Loddenkemper T, Reinsberger C. et al. Autonomic changes with seizures correlate with postictal EEG suppression. Neurology 2012; 78: 1868-1876 DOI: 10.1212/WNL.0b013e318258f7f1.
• 30 Eggleston KS, Olin BD, Fisher RS. Ictal tachycardia: the head-heart connection. Seizure 2014; 23: 496-505 DOI: 10.1016/j.seizure.2014.02.012.
• 31 Ryvlin P, Cammoun L, Hubbard I. et al. Noninvasive detection of focal seizures in ambulatory patients. Epilepsia, im Druck DOI: 10.1111/epi.16538.
• 32 Leutmezer F, Schernthaner C, Lurger S. et al. Electrocardiographic changes at the onset of epileptic seizures. Epilepsia 2003; 44: 348-354 DOI: 10.1046/j.1528-1157.2003.34702.x.
• 33 Surges R, Jordan A, Elger CE. Ictal modulation of cardiac repolarization, but not of heart rate, is lateralized in mesial temporal lobe epilepsy. PLoS One 2013; 8: e64765 DOI: 10.1371/journal.pone.0064765.
• 34 Jordan A, Bausch M, Surges R. Semi-automatic quantification of seizure-related effects on heart activity. Epilepsy Res 2019; 157: 106187 DOI: 10.1016/j.eplepsyres.2019.106187.
• 35 Jordan A, Bausch M, Surges R. Modulation of ictal heart rate is individually lateralized in temporal lobe epilepsy. Clin Neurophysiol 2020; 131: 2932-2933 DOI: 10.1016/j.clinph.2020.08.019.
• 36 Jeppesen J, Fuglsang-Frederiksen A, Johansen P. et al. Seizure detection based on heart rate variability using a wearable electrocardiography device. Epilepsia 2019; 60: 2105-2113 DOI: 10.1111/epi.16343.
• 37 Jeppesen J, Fuglsang-Frederiksen A, Johansen P. et al. Seizure detection using heart rate variability: A prospective validation study. Epilepsia 2020; 61 (Suppl 1): S41-S46 DOI: 10.1111/epi.16511.
• 38 van Andel J, Ungureanu C, Aarts R. et al. Using photoplethysmography in heart rate monitoring of patients with epilepsy. Epilepsy Behav 2015; 45: 142-145 DOI: 10.1016/j.yebeh.2015.02.018.
• 39 Vandecasteele K, De Cooman T, Gu Y. et al. Automated Epileptic Seizure Detection Based on Wearable ECG and PPG in a Hospital Environment. Sensors (Basel) 2017; 17: 2338 DOI: 10.3390/s17102338.
• 40 Hampel KG, Jahanbekam A, Elger CE. et al. Seizure-related modulation of systemic arterial blood pressure in focal epilepsy. Epilepsia 2016; 57: 1709-1718 DOI: 10.1111/epi.13504.
• 41 Zhang Q, Zhou D, Zeng X. Highly wearable cuff-less blood pressure and heart rate monitoring with single-arm electrocardiogram and photoplethysmogram signals. Biomed Eng Online 2017; 16: 23 doi: 10.1186/s12938-017-0317-z
• 42 Onorati F, Regalia G, Caborni C. et al. Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors. Epilepsia 2017; 58: 1870-1879 DOI: 10.1111/epi.13899.
• 43 Goldenholz DM, Kuhn A, Austermuehle A. et al. Long-term monitoring of cardiorespiratory patterns in drug-resistant epilepsy. Epilepsia 2017; 58: 77-84 DOI: 10.1111/epi.13606.
• 44 Calandra-Buonaura G, Toschi N, Provini F. et al. Physiologic autonomic arousal heralds motor manifestations of seizures in nocturnal frontal lobe epilepsy: implications for pathophysiology. Sleep Med 2012; 13: 252-262 DOI: 10.1016/j.sleep.2011.11.007.
• 45 Ghiasi S, Greco A, Barbieri R. et al. Assessing Autonomic Function from Electrodermal Activity and Heart Rate Variability During Cold-Pressor Test and Emotional Challenge. Sci Rep 2020; 10: 5406 DOI: 10.1038/s41598-020-62225-2.
• 46 Baumgartner C, Koren JP. Seizure detection using scalp-EEG. Epilepsia 2018; 59 (Suppl 1): 14-22 DOI: 10.1111/epi.14052.
• 47 Titgemeyer Y, Surges R, Altenmüller DM. et al. Can commercially available wearable EEG devices be used for diagnostic purposes?. An explorative pilot study. Epilepsy Behav 2020; 103 (Pt A) 106507 DOI: 10.1016/j.yebeh.2019.106507.
• 48 Vandecasteele K, De Cooman T, Dan J. et al. Visual seizure annotation and automated seizure detection using behind-the-ear electroencephalographic channels. Epilepsia 2020; 61: 766-775 DOI: 10.1111/epi.16470.
• 49 Zibrandtsen IC, Kidmose P, Christensen CB. et al. Ear-EEG detects ictal and interictal abnormalities in focal and generalized epilepsy – A comparison with scalp EEG monitoring. Clin Neurophysiol 2017; 128: 2454-2461 DOI: 10.1016/j.clinph.2017.09.115.
• 50 Weisdorf S, Duun-Henriksen J, Kjeldsen MJ. et al. Ultra-long-term subcutaneous home monitoring of epilepsy-490 days of EEG from nine patients. Epilepsia 2019; 60: 2204-2214 DOI: 10.1111/epi.16360.
• 51 Meisel C, El Atrache R, Jackson M. et al. Machine learning from wristband sensor data for wearable, noninvasive seizure forecasting. Epilepsia 2020; 61: 2653-2666 DOI: 10.1111/epi.16719.
• 52 Rao VR, G. Leguia M, Tcheng TK. et al. Cues for seizure timing. Epilepsia, im Druck DOI: 10.1111/epi.16611.
• 53 Duun-Henriksen J, Baud M, Richardson MP. et al. A new era in electroencephalographic monitoring? Subscalp devices for ultra-long-term recordings. Epilepsia 2020; 61: 1805-1817 DOI: 10.1111/epi.16630.
• 54 Baud MO, Rao VR. Gauging seizure risk. Neurology 2018; 91: 967-973 doi: 10.1212/WNL.0000000000006548
• 55 Ramgopal S, Thome-Souza S, Loddenkemper T. Chronopharmacology of anti-convulsive therapy. Curr Neurol Neurosci Rep 2013; 13: 339 doi: 10.1007/s11910-013-0339-2
• 56 Potruch A, Khoury ST, Ilan Y. The role of chronobiology in drug-resistance epilepsy: The potential use of a variability and chronotherapy-based individualized platform for improving the response to anti-seizure drugs. Seizure 2020; 80: 201-211 doi: 10.1016/j.seizure.2020.06.032
• 57 Karoly PJ, Ung H, Grayden DB. et al. The circadian profile of epilepsy improves seizure forecasting. Brain 2017; 140: 2169-2182 DOI: 10.1093/brain/awx173.
• 58 Beniczky S, Wiebe S, Jeppesen J. et al (im Druck) Automated seizure detection using wearable devices: a guideline of the International League against Epilepsy und International Federation of Clinical Neurophysiology.
• 59 Thompson ME, Langer J, Kinfe M. Seizure detection watch improves quality of life for adolescents and their families. Epilepsy Behav 2019; 98 (PtA) 188-194 DOI: 10.1016/j.yebeh.2019.07.028.
• 60 De Cooman T, Varon C, Van de Vel A. et al. Adaptive nocturnal seizure detection using heart rate and low-complexity novelty detection. Seizure 2018; 59: 48-53 DOI: 10.1016/j.seizure.2018.04.020.
• 61 De Cooman T, Vandecasteele K, Varon C. et al. Personalizing Heart Rate-Based Seizure Detection Using Supervised SVM Transfer Learning. Front Neurol 2020; 11: 145 DOI: 10.3389/fneur.2020.00145.
• 62 Arends J, Thijs RD, Gutter T. et al. Multimodal nocturnal seizure detection in a residential care setting: A long-term prospective trial. Neurology 2018; 91: e2010-e2019 DOI: 10.1212/WNL.0000000000006545.
• 63 Boon P, Vonck K, van Rijckevorsel K. et al. A prospective, multicenter study of cardiac-based seizure detection to activate vagus nerve stimulation. Seizure 2015; 32: 52-61 DOI: 10.1016/j.seizure.2015.08.011.
• 64 Nair DR, Laxer KD, Weber PB. et al. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology 2020; 95: e1244-e1256 DOI: 10.1212/WNL.0000000000010154.
• 65 Meritam P, Ryvlin P, Beniczky S. User-based evaluation of applicability and usability of a wearable accelerometer device for detecting bilateral tonic-clonic seizures: A field study. Epilepsia 2018; 59 (Suppl 1): 48-52 DOI: 10.1111/epi.14051.