Critical evaluation of four different seizure detection systems tested on one patient with focal and generalized tonic and clonic seizures.

For long-term home monitoring of epileptic seizures, the measurement of extracerebral body signals such as abnormal movement is often easier and less obtrusive than monitoring intracerebral brain waves with electroencephalography (EEG). Non-EEG devices are commercially available but with little scientifically valid information and no consensus on which system works for which seizure type or patient. We evaluated four systems based on efficiency, comfort, and user-friendliness and compared them in one patient suffering from focal epilepsy with secondary generalization. The Emfit mat, Epi-Care device, and Epi-Care Free bracelet are commercially available alarm systems, while the VARIA (Video, Accelerometry, and Radar-Induced Activity recording) device is being developed by our team and requires offline analysis for seizure detection and does so by presenting the 5% or 10% (patient-specific) most abnormal movement events, irrespective of the number of seizures per night. As we chose to mimic the home situation, we did not record EEG and compared our results to the seizures reported by experienced staff that were monitoring the patient on a semicontinuous basis. This resulted in a sensitivity (sens) of 78% and false detection rate (FDR) of 0.55 per night for Emfit, sens 40% and FDR 0.41 for Epi-Care, sens 41% and FDR 0.05 for Epi-Care Free, and sens 56% and FDR 20.33 for VARIA. Good results were obtained by some of the devices, even though, as expected, nongeneralized and nonrhythmic motor seizures (involving the head only, having a tonic phase, or manifesting mainly as sound) were often missed. The Emfit mat was chosen for our patient, also based on user-friendliness (few setup steps), comfort (contactless), and possibility to adjust patient-specific settings. When in need of a seizure detection system for a patient, a thorough individual search is still required, which suggests the need for a database or overview including results of clinical trials describing the patient and their seizure types.