Abstracts

Rationale: Because patient and caregiver reports of seizures are unreliable, there is a critical need for improved accuracy and reliability of tracking seizures. Both clinical management of epilepsy and current anti-convulsant and epilepsy device trials rely on paper diaries with self-reported seizure frequency as the primary outcome. This is the first study addressing the feasibility of detecting and recording convulsive seizures through a biosensor to an online seizure database.Methods: This prospective trial was conducted in the video EEG (vEEG) Epilepsy Monitoring Unit. Epilepsy patients wore a wristwatch accelerometer (SmartWatch, SmartMonitor©) that detected and transmitted events via Wi-Fi to a bedside electronic tablet with an online portal. The watch recorded the date, time, audio, duration, frequency and amplitude of convulsive events. Events logged by the watch were compared to vEEG to determine device sensitivity and specificity to detect and record convulsions to an online database.Results: Twenty-one patients were enrolled, 41 epileptic seizures were recorded on vEEG: 10 convulsive and 31 non-convulsive. The watch captured 8/10 convulsive seizures. One patient was not wearing the watch at the time of convulsion. Of the remaining 9 convulsions, watch sensitivity was 88.9% (8/9): one short duration myoclonic seizure was not detected. Watch audio recordings demonstrated seizure activity in 7/9 (77.8%). The watch recorded 77 false positives and 38 patient-initiated cancellations (49% specificity). False positives were easily explained on vEEG as non-epileptic repetitive movements such as teeth brushing. Patients and caregivers reported 5/41 (12.2% sensitivity) seizures but zero seizures were recorded on paper logs.Conclusions: Through a biosensor, automatic detection and recording of tonic clonic seizures to an online database is feasible and should be employed in for clinical decision making and future clinical drug and device trials to improve accuracy of seizure counts and characteristics.