Abstracts

Rationale: Several wearable, at-home epilepsy devices have been developed within the last decade to improve at-home management of epilepsy.¹ Unfortunately, many devices currently available do not capture electroencephalogram (EEG) data but rather use heart rate change and EMG signal to detect seizures. Therefore, these devices are limited to the detection of seizures with major motor features, such as generalized tonic-clonic seizures.¹ To address this issue, we designed a behind-the-ear seizure-detection device known as BrainSD capable of detecting ictal EEG with a limited number of scalp contacts. This will enable the BrainSD to detect both generalized and focal seizures regardless of motor involvement.

Methods: We recruited 33 patients who were admitted to the Epilepsy Monitoring Unit (EMU) at UT Southwestern Clements University Hospital for seizure characterization or pre-surgical evaluation from August 2021 to May 2022. After consent, the subject wore the BrainSD device and standard 21-channel scalp-EEG with video recording simultaneously. The earpieces and attached electrode sensors were secured behind the patient’s ears. The sensing circuit was paired via Bluetooth to a tablet so that all information could be stored and viewed in real-time by the researchers. All data were then compared to video-EEG to confirm adequate detection of any seizures that occurred.

Results: In total, 14 seizures occurred across the 33 patients wearing the BrainSD device, with 11 of these seizures captured by the device. Of the 11 seizures captured, all 11 were focal in onset, with 3 of the seizures becoming bilateral tonic-clonic and 1 seizure being of subclinical status. Of the 3 seizures not captured by the device, 2 were regional right temporal seizures and 1 was a regional left frontotemporal seizure. All 3 of these missed seizures occurred during the early phases of the study due to an encryption issue with the tablet used to receive and store data. The issue has been resolved and the device has not missed a seizure since. In addition to seizure-detection, we also analyzed the device’s comfort, with the device being worn for an average of 42 hours. When asked if the device was comfortable, 50% of responding participants agreed, 23.3% strongly agreed, and 10% were neutral. Only one patient withdrew due to discomfort.

Conclusions: Our behind-the-ear device was capable of capturing generalized and focal seizures, and even captured a seizure of subclinical presentation. This reinforces the hypothesis that BrainSD is capable of detecting a wide variety of seizure-types using EEG and does not depend on the presence of major motor features, unlike most current wearable epilepsy devices. Future studies are needed to better fine-tune the BrainSD device and ensure that sensitivity and comfort are maximized for users._x000D_ _x000D_ Reference:_x000D_ 1. Bruno E, Viana PF, Sperling MR, Richardson MP. Seizure detection at home: Do devices on the market match the needs of people living with epilepsy and their caregivers? Epilepsia. 2020;61(Suppl 1):S11-S24. doi: 10.1111/epi.16521

Funding: University of Texas at Arlington