@article{bf1cf4ac0dd84680ba8b24210c515949,
title = "Seizure Forecasting Using a Novel Sub-Scalp Ultra-Long Term EEG Monitoring System",
abstract = "Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder{\textregistered}), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilizing cycles in EA and previous seizure times. The procedures and devices were well-tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as visually confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88), which is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.",
keywords = "epilepsy, implantable device, seizure, seizure cycles, seizure forecasting, sub scalp",
author = "Stirling, {Rachel E.} and Maturana, {Matias I.} and Karoly, {Philippa J.} and Nurse, {Ewan S.} and Kate McCutcheon and Grayden, {David B.} and Ringo, {Steven G.} and Heasman, {John M.} and Hoare, {Rohan J.} and Alan Lai and Wendyl D'Souza and Udaya Seneviratne and Linda Seiderer and McLean, {Karen J.} and Bulluss, {Kristian J.} and Michael Murphy and Brinkmann, {Benjamin H.} and Richardson, {Mark P.} and Freestone, {Dean R.} and Cook, {Mark J.}",
note = "Funding Information: MR had a research collaboration with UNEEG medical and has been a member of their advisory board. MR was supported by the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and by the Medical Research Centre for Neurodevelopmental Disorders (MR/N026063/1). BB had a financial interest in Cadence Neurosciences Inc., and has received non-financial research support (devices for a study) from Medtronic Inc. AL acknowledges support from the Victorian Medical Research Acceleration Fund. This project was supported by the My Seizure Gauge grant from the Epilepsy Foundation of America. Funding Information: Funding. MR had a research collaboration with UNEEG medical and has been a member of their advisory board. MR was supported by the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and by the Medical Research Centre for Neurodevelopmental Disorders (MR/N026063/1). BB had a financial interest in Cadence Neurosciences Inc., and has received non-financial research support (devices for a study) from Medtronic Inc. AL acknowledges support from the Victorian Medical Research Acceleration Fund. This project was supported by the My Seizure Gauge grant from the Epilepsy Foundation of America. Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Stirling, Maturana, Karoly, Nurse, McCutcheon, Grayden, Ringo, Heasman, Hoare, Lai, D'Souza, Seneviratne, Seiderer, McLean, Bulluss, Murphy, Brinkmann, Richardson, Freestone and Cook. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = aug,
day = "23",
doi = "10.3389/fneur.2021.713794",
language = "English",
volume = "12",
journal = "Frontiers in Neurology",
issn = "1664-2295",
publisher = "Frontiers Media SA",
}