Concordance of ictal findings on concurrently recording REMI® and traditional outpatient video-EEG studies
Abstract number :
3.46
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2025
Submission ID :
1451
Source :
www.aesnet.org
Presentation date :
12/8/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Rohith Nelakurthi, MD – Yale
Jayanth Tallapalli, – Yale University
Nikol Agadzhanian, MSc – Yale University, Yale School of Medicine
Luke whitmire, PhD – Epitel Inc.
Mark lehmkuhle, PhD – Epitel Inc.
Rationale: Ambulatory EEG (aEEG) is rapidly evolving, offering transformative potential for epilepsy monitoring. Innovations like the REMI® system provide ultra-long-term, chronic recording capabilities with a patient-friendly form factor, utilizing four sensors (behind the ears and on the forehead) to capture seizures. As part of the ongoing REMI-AMB EEG clinical trial (NCT06027749), this study aims to evaluate the clinical utility of the REMI® system by presenting our preliminary findings on the visual detection of ictal EEG patterns. Our objective is to directly compare these findings to those obtained from simultaneous traditional video aEEG studies for the first three days of the REMI ® monitoring.
Methods: An interim analysis of 19 patients was conducted. We first performed a blinded review of the aEEG concurrent REMI® recording to identify seizures. The traditional aEEG report was then used to identify and select only those patients with confirmed seizures. Each aEEG seizure was correlated with the REMI® tracing. If no correlation was found, an unblinded review of the REMI® data at the exact aEEG seizure timestamp was performed. All seizures were characterized by pattern, duration, and timing. Those without a REMI® correlate after unblinded review were annotated as missed.
Results: 6 patients had seizures concurrently captured on the aEEG and the REMI® system. Thirteen out of 23 (57%) seizures were unequivocally concordant with the aEEG as ictal patterns with typical spatiotemporal electrodiagnostic criteria. One seizure could not be reliably assessed due to a sensor dysfunction. The remaining 9 seizures were captured on aEEG but missed identification after the initial review of the REMI®. These REMI® EEG tracings showed changes (such as emergence of delta activity, or fast frequency activity) but did not fulfill the electrodiagnostic criteria of ictal pattern (spatiotemporal evolution) even after secondary review and revision. Most of these aEEG seizures were localized to the occipital lobe and hence the limitation in capturing definitive ictal EEG changes with limited spatial coverage. None of the seizures had definitive localizing concordance, keeping in mind the limited spatial coverage of REMI (e.g., patient 6 had right posterior quadrant, right occipital, maximal seizures with the REMI displaying temporal epileptiform activity). Ictal epileptiform patterns were congruent in 5/6 patients.
Conclusions: Initial results indicate that the REMI® system demonstrates an ability to record ictal events in a community setting for clinical review. To further evaluate the clinical utility of the REMI® system, it is necessary to collect data from a greater number of seizures across a broader patient population. This expanded dataset will help determine which seizure types—considering ictal patterns, localizations, and lateralizations—are most consistently observable with the REMI® system.
Funding: Epitel
Clinical Epilepsy