Wearable electroencephalography for ultra-long-term seizure monitoring: a systematic review and future prospects

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ABSTRACT

Introduction

Wearable electroencephalography (EEG) for objective seizure counting might transform the clinical management of epilepsy. Non-EEG modalities have been validated for the detection of convulsive seizures, but there is still an unmet need for the detection of non-convulsive seizures.

Areas covered

The main objective of this systematic review was to explore the current status on wearable surface- and subcutaneous EEG for long-term seizure monitoring in epilepsy. We included 17 studies and evaluated the progress on the field, including device specifications, intended populations, and main results on the published studies including diagnostic accuracy measures. Furthermore, we examine the hurdles for widespread clinical implementation. This systematic review and expert opinion both consults the PRISMA guidelines and reflects on the future perspectives of this emerging field.

Expert opinion

Wearable EEG for long-term seizure monitoring is an emerging field, with plenty of proposed devices and proof-of-concept clinical validation studies. The possible implications of these devices are immense including objective seizure counting and possibly forecasting. However, the true clinical value of the devices, including effects on patient important outcomes and clinical decision making is yet to be unveiled and large-scale clinical validation trials are called for.

KEYWORDS:

• Wearables
• seizure detection
• epilepsy
• surface EEG
• subcutaneous EEG
• systematic review

Article highlights

• Wearable EEG monitoring can provide objective measurements of seizure burden.

• Surface EEG-based options allow for flexible monitoring periods at the patient's discretion, e.g., providing objective measures of seizure activity during periods of high self-reported seizure counts.

• Subcutaneous EEG is invasive but provides an unobtrusive method for ultra-long-term monitoring (>1 month), allowing for measurements of cyclic seizure patterns and treatment efficacy.

• Studies on the clinical value and diagnostic accuracy of these devices show promising results.

• Patient experience plays a key role in the implementation of these methods.

Declaration of interest

T Kjaer consults for UNEEG medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The study was funded by the EU-Interreg program 5A as part of the NorDigHealth project and was supported by the Department of Neurology, Zealand University Hospital, Region Zealand, Denmark. The funders had no role in the preparation of this review.