Multimodal seizure detection: A review

Abstract

Summary A review is given on the combined use of multiple modalities in non electroencephalography (EEG)‐based detection of motor seizures in children and adults. A literature search of papers was done on multimodal seizure detection with extraction of data on type of modalities, study design and algorithm, sensitivity, false detection rate, and seizure types. Evidence of superiority was sought for using multiple instead of single modalities. Seven papers were found from 2010 to 2017, mostly using contact sensors such as accelerometers (n = 5), electromyography (n = 2), heart rate (n = 2), electrodermal activity (n = 1), and oximetry (n = 1). Remote sensors included video, radar, movement, and sound. All studies but one were in‐hospital, with video‐EEG as a gold standard. Algorithms were based on physiology and supervised machine learning, but did not always include a separate test dataset. Sensitivity ranged from 4% to 100% and false detection rate from 0.25 to 20 per 8 hours. Tonic–clonic seizure detection performed best. False detections tended to be restricted to a minority (16%‐30%) of patients. Use of multiple sensors increased sensitivity; false detections decreased in one study, but increased in another. These preliminary studies suggest that detection of tonic–clonic seizures might be feasible, but larger field studies are required under more rigorous design that precludes bias. Generic algorithms probably suffice for the majority of patients.

Wearable devices for sudden unexpected death in epilepsy prevention

“…These devices and their effectiveness are discussed in detail in other articles from this supplement. 12,51,52 Some evidence suggests that nocturnal supervision reduces the risk of SUDEP, 42,53 indirectly supporting the view that timely postictal intervention by a caregiver could counteract some of the mechanisms at stake in SUDEP, such as the prone position. Other indirect arguments pointing to the same conclusion have been derived from epilepsy monitoring unit (EMU) data.…”

“…Several commercially available wearable devices are providing reliable detection of GTCS with an associated alarm that can prompt immediate intervention from surrounding relatives or caregivers. These devices and their effectiveness are discussed in detail in other articles from this supplement …”

Detection of convulsive seizures using surface electromyography

“…Although the small‐scale studies reported an improved performance in the multimodal setting as compared to the unimodal one, the sensitivity and FAR of these multimodal TCS detectors was not superior to what the 2 large‐scale multicenter studies reported on the unimodal, EMG‐based devices. For a detailed review on multimodal seizure detection, the reader is referred to another paper of this supplement of Epilepsia …”

“…For a detailed review on multimodal seizure detection, the reader is referred to another paper of this supplement of Epilepsia. 33 We have found 2 patents corresponding to the commercially available EMG-based seizure-detection devices. 34,35 Our PubMed search identified 4 prospective studies on clinical validation of accelerometry-based, wearable devices using real-time detection of TCS.…”

Seizure detection and mobile health devices in epilepsy: Update and future developments

“…Conversely, 2 other field studies with high sensitivity are reported in this supplement: one using accelerometry showed a median sensitivity of 90% and a false alarm rate of only 0.1/d for GTCS detection, whereas another one using video‐only in a residential care setting reported 100% sensitivity and a median false alarm rate of 0.78 per night . Multimodal seizure detection is currently characterized by various sensing methods and highly variable sensitivity (4%‐100%) and rate of false alarms (0.25‐20 per 8 hours) …”