Multimodal nocturnal seizure detection in a residential care setting: a long-term prospective trial

Johan Arends, Roland D. Thijs, Thea Gutter, Constantin Ungureanu, Pierre Cluitmans, Johannes van Dijk, Judith van Andel, Francis Tan, Al de Weerd, Ben Vledder, Wytske Hofstra, Richard Lazeron, Ghislaine van Thiel, Kit C.B. Roes, Frans Leijten

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3 Citations (Scopus)

Abstract

OBJECTIVE: To develop and prospectively evaluate a method of epileptic seizure detection combining heart rate and movement. METHODS: In this multicenter, in-home, prospective, video-controlled cohort study, nocturnal seizures were detected by heart rate (photoplethysmography) or movement (3-D accelerometry) in persons with epilepsy and intellectual disability. Participants with >1 monthly major seizure wore a bracelet (Nightwatch) on the upper arm at night for 2 to 3 months. Major seizures were tonic-clonic, generalized tonic >30 seconds, hyperkinetic, or others, including clusters (>30 minutes) of short myoclonic/tonic seizures. The video of all events (alarms, nurse diaries) and 10% completely screened nights were reviewed to classify major (needing an alarm), minor (needing no alarm), or no seizure. Reliability was tested by interobserver agreement. We determined device performance, compared it to a bed sensor (Emfit), and evaluated the caregivers' user experience. RESULTS: Twenty-eight of 34 admitted participants (1,826 nights, 809 major seizures) completed the study. Interobserver agreement (major/no major seizures) was 0.77 (95% confidence interval [CI] 0.65-0.89). Median sensitivity per participant amounted to 86% (95% CI 77%-93%); the false-negative alarm rate was 0.03 per night (95% CI 0.01-0.05); and the positive predictive value was 49% (95% CI 33%-64%). The multimodal sensor showed a better sensitivity than the bed sensor (n = 14, median difference 58%, 95% CI 39%-80%, p < 0.001). The caregivers' questionnaire (n = 33) indicated good sensor acceptance and usability according to 28 and 27 participants, respectively. CONCLUSION: Combining heart rate and movement resulted in reliable detection of a broad range of nocturnal seizures.

LanguageEnglish
Pagese2010-e2019
Number of pages11
JournalNeurology
Volume91
Issue number21
DOIs
StatePublished - 20 Nov 2018

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Seizures
Confidence Intervals
Heart Rate
Caregivers
Epilepsy
Photoplethysmography
Accelerometry
Disabled Persons
Intellectual Disability
Arm
Cohort Studies
Nurses
Equipment and Supplies

Cite this

Arends, Johan ; Thijs, Roland D. ; Gutter, Thea ; Ungureanu, Constantin ; Cluitmans, Pierre ; van Dijk, Johannes ; van Andel, Judith ; Tan, Francis ; de Weerd, Al ; Vledder, Ben ; Hofstra, Wytske ; Lazeron, Richard ; van Thiel, Ghislaine ; Roes, Kit C.B. ; Leijten, Frans. / Multimodal nocturnal seizure detection in a residential care setting : a long-term prospective trial. In: Neurology. 2018 ; Vol. 91, No. 21. pp. e2010-e2019
@article{bbb29ec90d754c97907af8d898718679,
title = "Multimodal nocturnal seizure detection in a residential care setting: a long-term prospective trial",
abstract = "OBJECTIVE: To develop and prospectively evaluate a method of epileptic seizure detection combining heart rate and movement. METHODS: In this multicenter, in-home, prospective, video-controlled cohort study, nocturnal seizures were detected by heart rate (photoplethysmography) or movement (3-D accelerometry) in persons with epilepsy and intellectual disability. Participants with >1 monthly major seizure wore a bracelet (Nightwatch) on the upper arm at night for 2 to 3 months. Major seizures were tonic-clonic, generalized tonic >30 seconds, hyperkinetic, or others, including clusters (>30 minutes) of short myoclonic/tonic seizures. The video of all events (alarms, nurse diaries) and 10{\%} completely screened nights were reviewed to classify major (needing an alarm), minor (needing no alarm), or no seizure. Reliability was tested by interobserver agreement. We determined device performance, compared it to a bed sensor (Emfit), and evaluated the caregivers' user experience. RESULTS: Twenty-eight of 34 admitted participants (1,826 nights, 809 major seizures) completed the study. Interobserver agreement (major/no major seizures) was 0.77 (95{\%} confidence interval [CI] 0.65-0.89). Median sensitivity per participant amounted to 86{\%} (95{\%} CI 77{\%}-93{\%}); the false-negative alarm rate was 0.03 per night (95{\%} CI 0.01-0.05); and the positive predictive value was 49{\%} (95{\%} CI 33{\%}-64{\%}). The multimodal sensor showed a better sensitivity than the bed sensor (n = 14, median difference 58{\%}, 95{\%} CI 39{\%}-80{\%}, p < 0.001). The caregivers' questionnaire (n = 33) indicated good sensor acceptance and usability according to 28 and 27 participants, respectively. CONCLUSION: Combining heart rate and movement resulted in reliable detection of a broad range of nocturnal seizures.",
author = "Johan Arends and Thijs, {Roland D.} and Thea Gutter and Constantin Ungureanu and Pierre Cluitmans and {van Dijk}, Johannes and {van Andel}, Judith and Francis Tan and {de Weerd}, Al and Ben Vledder and Wytske Hofstra and Richard Lazeron and {van Thiel}, Ghislaine and Roes, {Kit C.B.} and Frans Leijten",
year = "2018",
month = "11",
day = "20",
doi = "10.1212/WNL.0000000000006545",
language = "English",
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pages = "e2010--e2019",
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Arends, J, Thijs, RD, Gutter, T, Ungureanu, C, Cluitmans, P, van Dijk, J, van Andel, J, Tan, F, de Weerd, A, Vledder, B, Hofstra, W, Lazeron, R, van Thiel, G, Roes, KCB & Leijten, F 2018, 'Multimodal nocturnal seizure detection in a residential care setting: a long-term prospective trial' Neurology, vol. 91, no. 21, pp. e2010-e2019. DOI: 10.1212/WNL.0000000000006545

Multimodal nocturnal seizure detection in a residential care setting : a long-term prospective trial. / Arends, Johan; Thijs, Roland D.; Gutter, Thea; Ungureanu, Constantin; Cluitmans, Pierre; van Dijk, Johannes; van Andel, Judith; Tan, Francis; de Weerd, Al; Vledder, Ben; Hofstra, Wytske; Lazeron, Richard; van Thiel, Ghislaine; Roes, Kit C.B.; Leijten, Frans.

In: Neurology, Vol. 91, No. 21, 20.11.2018, p. e2010-e2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Multimodal nocturnal seizure detection in a residential care setting

T2 - Neurology

AU - Arends,Johan

AU - Thijs,Roland D.

AU - Gutter,Thea

AU - Ungureanu,Constantin

AU - Cluitmans,Pierre

AU - van Dijk,Johannes

AU - van Andel,Judith

AU - Tan,Francis

AU - de Weerd,Al

AU - Vledder,Ben

AU - Hofstra,Wytske

AU - Lazeron,Richard

AU - van Thiel,Ghislaine

AU - Roes,Kit C.B.

AU - Leijten,Frans

PY - 2018/11/20

Y1 - 2018/11/20

N2 - OBJECTIVE: To develop and prospectively evaluate a method of epileptic seizure detection combining heart rate and movement. METHODS: In this multicenter, in-home, prospective, video-controlled cohort study, nocturnal seizures were detected by heart rate (photoplethysmography) or movement (3-D accelerometry) in persons with epilepsy and intellectual disability. Participants with >1 monthly major seizure wore a bracelet (Nightwatch) on the upper arm at night for 2 to 3 months. Major seizures were tonic-clonic, generalized tonic >30 seconds, hyperkinetic, or others, including clusters (>30 minutes) of short myoclonic/tonic seizures. The video of all events (alarms, nurse diaries) and 10% completely screened nights were reviewed to classify major (needing an alarm), minor (needing no alarm), or no seizure. Reliability was tested by interobserver agreement. We determined device performance, compared it to a bed sensor (Emfit), and evaluated the caregivers' user experience. RESULTS: Twenty-eight of 34 admitted participants (1,826 nights, 809 major seizures) completed the study. Interobserver agreement (major/no major seizures) was 0.77 (95% confidence interval [CI] 0.65-0.89). Median sensitivity per participant amounted to 86% (95% CI 77%-93%); the false-negative alarm rate was 0.03 per night (95% CI 0.01-0.05); and the positive predictive value was 49% (95% CI 33%-64%). The multimodal sensor showed a better sensitivity than the bed sensor (n = 14, median difference 58%, 95% CI 39%-80%, p < 0.001). The caregivers' questionnaire (n = 33) indicated good sensor acceptance and usability according to 28 and 27 participants, respectively. CONCLUSION: Combining heart rate and movement resulted in reliable detection of a broad range of nocturnal seizures.

AB - OBJECTIVE: To develop and prospectively evaluate a method of epileptic seizure detection combining heart rate and movement. METHODS: In this multicenter, in-home, prospective, video-controlled cohort study, nocturnal seizures were detected by heart rate (photoplethysmography) or movement (3-D accelerometry) in persons with epilepsy and intellectual disability. Participants with >1 monthly major seizure wore a bracelet (Nightwatch) on the upper arm at night for 2 to 3 months. Major seizures were tonic-clonic, generalized tonic >30 seconds, hyperkinetic, or others, including clusters (>30 minutes) of short myoclonic/tonic seizures. The video of all events (alarms, nurse diaries) and 10% completely screened nights were reviewed to classify major (needing an alarm), minor (needing no alarm), or no seizure. Reliability was tested by interobserver agreement. We determined device performance, compared it to a bed sensor (Emfit), and evaluated the caregivers' user experience. RESULTS: Twenty-eight of 34 admitted participants (1,826 nights, 809 major seizures) completed the study. Interobserver agreement (major/no major seizures) was 0.77 (95% confidence interval [CI] 0.65-0.89). Median sensitivity per participant amounted to 86% (95% CI 77%-93%); the false-negative alarm rate was 0.03 per night (95% CI 0.01-0.05); and the positive predictive value was 49% (95% CI 33%-64%). The multimodal sensor showed a better sensitivity than the bed sensor (n = 14, median difference 58%, 95% CI 39%-80%, p < 0.001). The caregivers' questionnaire (n = 33) indicated good sensor acceptance and usability according to 28 and 27 participants, respectively. CONCLUSION: Combining heart rate and movement resulted in reliable detection of a broad range of nocturnal seizures.

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U2 - 10.1212/WNL.0000000000006545

DO - 10.1212/WNL.0000000000006545

M3 - Article

VL - 91

SP - e2010-e2019

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 21

ER -