Abstracts

Rationale: The inaccuracies of seizure diarisation have been well documented and have important implications for patient management. We aimed to (1) understand how implantation of an ultra-long term EEG monitoring device might improve patient care by complimenting diarisation; and (2) identify and explore other potential clinical benefits of ultra-long term EEG monitoring for future study.


Methods: Semi-structured interviews were conducted with site principal investigators enrolling patients in the UMPIRE study at the completion of the study primary end point. In that study, patients were implanted with the Minder sub-scalp system permitting continuous EEG recordings in the community, concurrent with seizure / event diarisation. Individual case experiences were explored with a focus on changes to clinical management post implantation, clinician impression of patient experience and pitfalls identified during the study. The study protocol was approved by St Vincent’s Hospital Melbourne IRB (HREC158/19) and registered under the CTN (ACTRN12619001587190).

Results: Implanted patients were affected by various management issues and queries, the most common of which were: poor seizure awareness, events / symptoms for characterisation, dual diagnosis of epilepsy and FND, epilepsy lateralisation for pre-surgical planning and medication side effects. Investigators reported that with the additional information provided by the Minder system, management was able to be optimised in most cases. Examples of clinically meaningful Minder EEG findings included: identification of high seizure frequencies in cases where patients either had no seizure awareness or reported infrequent seizures; reclassification of events as either epileptic, FND or cardiac in aetiology; clarification of ictal symptoms and signs including those reported from observers; and confirmation of unilateral or bilateral ictal onset. Clinical outcomes from these findings included: optimisation of ASMs with either increasing or decreasing doses as appropriate; implementation of driving restrictions; referral for specialist treatment (eg: cardiology, psychiatry); improved accuracy of patient and observer seizure diarisation; and validation or exclusion of surgical candidacy. All investigators reported anecdotally that the device was well tolerated by most patients and there was often a sense of ‘empowerment’ or ‘control’ for patients after receiving objective seizure / event data. Pitfalls discovered included issues with correct device usage, ongoing device compliance, social circumstances and scalp thickness.


Conclusions: In current epilepsy practice, clinical decision making relies heavily on the accuracy of seizure diarisation. This preliminary case review confirmed that ultra-long term EEG recording from the implantable Minder sub-scalp system has the potential to improve patient outcomes in a number of clinical scenarios. Overall clinician impressions were that the device was well tolerated by patients and that it also made a meaningful difference to the epilepsy lived experience. Future research should focus on measuring long-term clinical outcomes.


Funding: Funding was provided by Epiminder Pty. Ltd.