Abstracts

Rationale: Long-term EEG studies often require patients and their families to visit clinics for setup, log seizures on paper, and return for EEG removal and clinician review. While effective, traditional methods are limited by high cost, time demands, and impracticality of in-clinic visits; need for specialized personnel for setup; and poor patient tolerance of wired systems. Wearable EEG, AI-driven seizure detection, online seizure diaries, and telemedicine offer new ways to improve access, feasibility, and comfort of EEG monitoring for pediatric patients. We aimed to assess the feasibility of remote, wireless EEG monitoring with automated seizure detection, digital seizure reporting, and epileptologist-led EEG review.

Methods: We prospectively enrolled pediatric epilepsy patients aged 6+, remotely, from a Level-4 Epilepsy Center (Jan 2025). Participants were mailed a wireless EEG system (REMI^TM Epitel Inc., Salt Lake City, UT) and enrolled in an online seizure diary (Seizure Tracker, Springfield, VA). Patients wore four wireless sensors, two on the forehead and two behind the ears, for 1–5 days (Figure 1). With virtual guidance from a research coordinator, patients or caregivers set up the EEG sensors and reported suspected seizures via a handheld device or the online diary. An automated algorithm (REMI Vigilenz^TM AI for Event Detection) screened EEG data and marked discrete potential electrographic seizures for an epileptologist to review via Persyst Mobile. The system was then mailed back to BCH for reuse through pre-paid mailers. Participants were later invited to complete an online comfort survey.

Results: We enrolled three pediatric patients (2 females; mean age: 10) from Massachusetts (n=2) and Maine (n=1). Patients wore sensors for 1, 4, and 5 days, respectively, and all reported events via handheld device or online diary. Across all patients, 28 events were reported: Patient 1 reported 20 (all via the device), Patient 2 reported 5, and Patient 3 reported 3. Upon EEG review, no electrographic seizures were identified. Two of the three patients completed the comfort survey; both rated the sensors as comfortable, reported no sleep disruption, and said they would be willing to wear the EEG sensors again. No adverse events occurred.

Conclusions: Remote use of the wireless EEG system proved feasible and well-tolerated by our patients. Caregivers were able to set up the system at home independently and comfortably report events using a handheld medical device or an online diary. Given the limitations of traditional EEG monitoring, patient-friendly wearable EEG systems may solve for challenges such as access and EEG equity. These systems allow for seizure assessment without requiring patients to travel to specialized clinics, a significant barrier for many. Ongoing research will further evaluate the quality of EEG recordings, seizure detection accuracy, and the potential for expanded remote use of these EEG sensors in a larger cohort.

Funding: This research was supported by NIH grant 1U44 NS121562 and research funding from Epitel. TL is part of pending/approved patents relating to epilepsy diagnosis, seizure detection, and seizure prediction. VM, MF, and ML have financial interests in Epitel.