Wrist sensor reveals sympathetic hyperactivity and hypoventilation before probable SUDEP

Picard, Rosalind W.; Migliorini, Matteo; Caborni, Chiara; Onorati, Francesco; Regalia, Giulia; Friedman, Daniel; Devinsky, Orrin

doi:10.1212/wnl.0000000000004208

Cited by 59 publications

(42 citation statements)

References 8 publications

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“…Such information, gathered from wearable devices, would provide novel insights into the sequence of events resulting in SUDEP. For instance, an unusual fast rising and large postictal electrodermal response was observed in a patient who died of SUDEP while wearing an EDA‐based GTCS‐detecting wrist device …”

Section: Identifying Biomarkers and Mechanisms Of Sudepmentioning

confidence: 99%

“…For instance, an unusual fast rising and large postictal electrodermal response was observed in a patient who died of SUDEP while wearing an EDA-based GTCSdetecting wrist device. 23 Other potential risk factors of SUDEP that deserve to be investigated include postictal cardiorespiratory changes, in particular postictal bradycardia/asystole and hypoxemia, 24 and whether the patient is in a prone position, 25 all of which are easily captured by existing wrist-based or bed-attached sensors. [26][27][28] Connected T-shirts in development, with various thoracic sensors, can also capture electrocardiography (ECG) features of interest, such as QT length, heart rate variability, and T-wave alternans, but maybe at the price of some discomfort.…”

Section: And Mechanisms Of Sudepmentioning

confidence: 99%

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Wearable devices for sudden unexpected death in epilepsy prevention

et al. 2018

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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.

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Section: Identifying Biomarkers and Mechanisms Of Sudepmentioning

confidence: 99%

Section: And Mechanisms Of Sudepmentioning

confidence: 99%

Wearable devices for sudden unexpected death in epilepsy prevention

et al. 2018

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“…There are critical periods for detection and interventions during seizures. This is highlighted by the MORTEMUS study of SUDEP cases occurring during inpatient video‐EEG monitoring and by a recent case report of seizure detection and delayed intervention with SUDEP . Even in an inpatient study of respiratory and EEG patterns during tonic–clonic seizures, the median time for nurses to assist patients was 74 s .…”

Section: Timing Of Seizure Detection and Interventions: Benchmarks Dementioning

confidence: 99%

“…This is highlighted by the MORTEMUS study of SUDEP cases occurring during inpatient video-EEG monitoring and by a recent case report of seizure detection and delayed intervention with SUDEP. 37,42 Even in an inpatient study of respiratory and EEG patterns during tonic-clonic seizures, the median time for nurses to assist patients was 74 s. 38 The durations of tonic-clonic and postictal phases serve as benchmarks for seizure detection systems and for implementing effective caregiver interventions.…”

Section: Detection and Interventions: Benchmarks Determined By Duratimentioning

confidence: 99%

Strategies for non‐EEG seizure detection and timing for alerting and interventions with tonic–clonic seizures

et al. 2018

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Sudden unexpected death in epilepsy (SUDEP) is a common cause of death in epilepsy and frequently occurs following generalized tonic-clonic seizures (GTCS). Non-electroencephalography (EEG) seizure detection systems using mobile sensor devices permit caregivers to assist patients during seizures and may reduce risks for complications of seizures such as injuries and SUDEP. We review changes in accelerometry, electrodermal activity, and heart rate associated with tonic-clonic seizures and their use in detection systems, including multimodal detectors. We reviewed current and past publications reporting data on linkage between GTCS, post-ictal generalized EEG suppression (PGES), and ventilatory dysfunction. The timing and duration of postictal immobility and respiratory dysfunction associated with convulsions help identify which patients might benefit the most from seizure monitoring and from benchmarks for the timing of seizure detection, caregiver alerting, and interventions.

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“…However, each year the meeting takes on the unique character and specialization of the local venue; the BSN 2016 meeting in the University of California at San Francisco (UCSF) Mission Bay conference center focused on neuroscience applications including stress and behavior monitoring and chronic disease management. Keynote presentations highlighted the use of pattern analysis and "smart shoes" to manage Parkinson's disease [1], and bioengineering advances in detecting electrodermal activity at the wrist associated with epilepsy and psychologically stressful events [2]. One of the papers in this special issue addresses clinical gait analyses in multiple sclerosis, demonstrating how technology developments for one chronic disease model (Parkinson's) benefit management of other diseases.…”

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confidence: 99%