Status epilepticus prevention, ambulatory monitoring, early seizure detection and prediction in at-risk patients

Abstract

Purpose: Status epilepticus is an often apparently randomly occurring, life-threatening medical emergency which affects the quality of life in patients with epilepsy and their families. The purpose of this review is to summarize information on ambulatory seizure detection, seizure prediction, and status epilepticus prevention.

Method: Narrative review.

Results: Seizure detection devices are currently under investigation with regards to utility and feasibility in the detection of isolated seizures, mainly in adult patients with generalized tonic-clonic seizures, in long-term epilepsy monitoring units, and occasionally in the outpatient setting. Detection modalities include accelerometry, electrocardiogram, electrodermal activity, electroencephalogram, mattress sensors, surface electromyography, video detection systems, gyroscope, peripheral temperature, photoplethysmography, and respiratory sensors, among others. Initial detection results are promising, and improve even further, when several modalities are combined. Some portable devices have already been U.S. FDA approved to detect specific seizures. Improved seizure prediction may be attainable in the future given that epileptic seizure occurrence follows complex patient-specific non-random patterns. The combination of multimodal monitoring devices, big data sets, and machine learning may enhance patient-specific detection and predictive algorithms. The integration of these technological advances and novel approaches into closed-loop warning and treatment systems in the ambulatory setting may help detect seizures sooner, and tentatively prevent status epilepticus in the future.

Conclusions: Ambulatory monitoring systems are being developed to improve seizure detection and the quality of life in patients with epilepsy and their families.

Keywords: Automated seizure detection; Closed-loop systems; Epilepsy; Machine learning; Seizure detection sensors; Status epilepticus.