Wearable devices for sudden unexpected death in epilepsy prevention

Abstract

Sudden unexpected death in epilepsy (SUDEP) is most often associated with the occurrence of generalized tonic-clonic seizures (GTCS), a seizure type that can now be detected with high sensitivity and specificity by wearable or bed devices. The recent development in such devices and their performance offer multiple opportunities to tackle SUDEP and its prevention. Reliable GTCS detection might help physicians optimize antiepileptic treatment, which could in turn reduce the risk of SUDEP. GTCS-triggered alarms can lead to immediate intervention by caregivers that are also likely to decrease the odd of SUDEP. The biosignals used to detect GTCS might provide novel SUDEP biomarkers, in particular, by informing on several important characteristics of the ictal and postictal periods (type of GTCS, duration of tonic phase, rotation in the prone position, presence and duration of postictal immobility and bradycardia, rise in electrodermal activity). Other biosensors not yet used for detecting GTCS might provide complementary information, such as the presence and intensity of ictal/postictal hypoxemia. The above biomarkers, if strongly predictive, could help identify patients at very high risk of SUDEP, enabling better assessment of individual risk, as well as selection of appropriate patients for clinical studies aiming at preventing SUDEP. The same biosignals could also be used as ancillary biomarkers to test the impact of various interventions before moving to highly challenging randomized controlled trials with SUDEP as a primary outcome.

Tonic electromyographic activity following bilateral tonic–clonic seizures is associated with periictal respiratory dysfunction and postictal generalized EEG suppression

“…Detection of postictal tonic electromyographic activity incorporated in a wearable device may be superior to simple detection of a GCS in predicting SUDEP risk. Integrating detection of PTEMG activity with periictal autonomic changes in a wearable device could be used to trigger warnings to caretakers that a potentially life‐threatening event has occurred, thereby allowing for timely cardiopulmonary resuscitation …”

“…Integrating detection of PTEMG activity with periictal autonomic changes in a wearable device could be used to trigger warnings to caretakers that a potentially life-threatening event has occurred, thereby allowing for timely cardiopulmonary resuscitation. 13…”

“…PGES is related to periictal respiratory distress, 10 and severe hypoxemia and hypercapnia occur with some GCS 11,12 and are likely implicated in SUDEP. 13 PTEMG activity may also, at least in part, be a consequence of seizure-associated hypoxemia. Acute hypoxia enhances corticospinal excitability.…”

Detection of convulsive seizures using surface electromyography

“…This contributes to social isolation and decreased quality of life. There is a well‐documented need for wearable seizure detection devices . Bilateral or generalized tonic–clonic seizures (TCS) may lead to injuries, and they constitute a primary risk factor for sudden unexpected death in epilepsy (SUDEP), especially when patients are unattended .…”

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

“…The development of mobile health and wearable technologies has recently boosted the field of seizure detection, in particular that of generalized tonic–clonic seizures (GTCS) using non–electroencephalography (EEG)‐based methods . Growing clinical interest in developing these methods stems from their potential to trigger alarms, prompt timely interventions, and possibly reduce the risk of sudden unexpected death in epilepsy (SUDEP) issues tackled in this supplement . By offering more objective seizure counting, seizure‐detection devices might also allow for better evaluation of the effectiveness of antiepileptic treatment, both in clinical practice and studies.…”