title: Non-EEG based ambulatory seizure detection designed for home use: What is available and how will it influence epilepsy care?
abstract: OBJECTIVE
  This study aimed to (1) evaluate available systems and algorithms for ambulatory automatic seizure detection and (2) discuss benefits and disadvantages of seizure detection in epilepsy care.
  
  
  METHODS
  PubMed and EMBASE were searched up to November 2014, using variations and synonyms of search terms "seizure prediction" OR "seizure detection" OR "seizures" AND "alarm".
  
  
  RESULTS
  Seventeen studies evaluated performance of devices and algorithms to detect seizures in a clinical setting. Algorithms detecting generalized tonic-clonic seizures (GTCSs) had varying sensitivities (11% to 100%) and false alarm rates (0.2-4/24 h). For other seizure types, detection rates were low, or devices produced many false alarms. Five studies externally validated the performance of four different devices for the detection of GTCSs. Two devices were promising in both children and adults: a mattress-based nocturnal seizure detector (sensitivity: 84.6% and 100%; false alarm rate: not reported) and a wrist-based detector (sensitivity: 89.7%; false alarm rate: 0.2/24 h).
  
  
  CONCLUSIONS
  Detection of seizure types other than GTCSs is currently unreliable. Two detection devices for GTCSs provided promising results when externally validated in a clinical setting. However, these devices need to be evaluated in the home setting in order to establish their true value. Automatic seizure detection may help prevent sudden unexpected death in epilepsy or status epilepticus, provided the alarm is followed by an effective intervention. Accurate seizure detection may improve the quality of life (QoL) of subjects and caregivers by decreasing burden of seizure monitoring and may facilitate diagnostic monitoring in the home setting. Possible risks are occurrence of alarm fatigue and invasion of privacy. Moreover, an unexpectedly high seizure frequency might be detected for which there are no treatment options. We propose that future studies monitor benefits and disadvantages of seizure detection systems with particular emphasis on QoL, comfort, and privacy of subjects and impact of false alarms.
authors.affiliation: University Medical Centre Utrecht, Department of Clinical Neurophysiology, Utrecht, The Netherlands. Electronic address: judithvanandel@gmail.com.
authors.forename: Judith
authors.initials: J
authors.lastname: van Andel
authors.affiliation: Stichting Epilepsie Instellingen Nederland SEIN, Department of Clinical Neurophysiology, Heemstede, The Netherlands; Leiden University Medical Centre, Department of Neurology, Leiden, The Netherlands.
authors.forename: Roland D
authors.initials: RD
authors.lastname: Thijs
authors.affiliation: Stichting Epilepsie Instellingen Nederland SEIN, Department of Clinical Neurophysiology, Zwolle, The Netherlands.
authors.forename: Al
authors.initials: A
authors.lastname: de Weerd
authors.affiliation: Academic Centre for Epileptology Kempenhaeghe, Department of Clinical Neurophysiology, Heeze, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Arends
authors.affiliation: University Medical Centre Utrecht, Department of Clinical Neurophysiology, Utrecht, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Leijten
mesh_terms: D000328:Adult; D000465:Algorithms; D002648:Child; D003645:Death, Sudden / Q000517:prevention & control*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D011788:Quality of Life; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology; D013226:Status Epilepticus
keywords: Seizure detection