Philippa Karoly1,2, Daniel M Goldenholz3, Mark Cook1. 1. Department of Medicine, St Vincent's Hospital Melbourne. 2. Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia. 3. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: The estimation of seizure frequency is a cornerstone of clinical management of epilepsy and the evaluation of new therapies. Current estimation approaches are significantly limited by several factors. Comparing patient diaries and objective estimates (through both inpatient video-EEG monitoring of and long-term ambulatory EEG studies) reveal that patients document seizures inaccurately. So far, few practical alternative methods of estimation have been available. RECENT FINDINGS: We review the systems of counting currently utilized and their limitations, as well as the limitations imposed by problems defining clinical events. Alternative methodologies that permit the volatility of seizure rates to be accommodated, and possible alternative measures of brain excitability will be outlined. Recent developments in technologies around data capture, such as wearable and implantable devices, as well as significant advances in the ability to analyse the large data-sets supplied by these systems have provided a wealth of information. SUMMARY: There are now unprecedented opportunities to utilize and apply these insights in routine clinical management and assessment of therapies. The rapid adoption of long-term, wearable monitoring systems will permit major advances in our understanding of the natural history of epilepsy, and lead to more effective therapies and improved patient safety.
PURPOSE OF REVIEW: The estimation of seizure frequency is a cornerstone of clinical management of epilepsy and the evaluation of new therapies. Current estimation approaches are significantly limited by several factors. Comparing patient diaries and objective estimates (through both inpatient video-EEG monitoring of and long-term ambulatory EEG studies) reveal that patients document seizures inaccurately. So far, few practical alternative methods of estimation have been available. RECENT FINDINGS: We review the systems of counting currently utilized and their limitations, as well as the limitations imposed by problems defining clinical events. Alternative methodologies that permit the volatility of seizure rates to be accommodated, and possible alternative measures of brain excitability will be outlined. Recent developments in technologies around data capture, such as wearable and implantable devices, as well as significant advances in the ability to analyse the large data-sets supplied by these systems have provided a wealth of information. SUMMARY: There are now unprecedented opportunities to utilize and apply these insights in routine clinical management and assessment of therapies. The rapid adoption of long-term, wearable monitoring systems will permit major advances in our understanding of the natural history of epilepsy, and lead to more effective therapies and improved patient safety.
Authors: Marc G Leguia; Ralph G Andrzejak; Christian Rummel; Joline M Fan; Emily A Mirro; Thomas K Tcheng; Vikram R Rao; Maxime O Baud Journal: JAMA Neurol Date: 2021-04-01 Impact factor: 18.302
Authors: Pasquale Striano; Stéphane Auvin; Abigail Collins; Rita Horvath; Ingrid E Scheffer; Michal Tzadok; Ian Miller; Mary Kay Koenig; Adrian Lacy; Ronald Davis; Angela Garcia-Cazorla; Russell P Saneto; Melanie Brandabur; Susan Blair; Tony Koutsoukos; Darryl De Vivo Journal: Epilepsia Date: 2022-05-21 Impact factor: 6.740
Authors: Sharon Chiang; Daniel M Goldenholz; Robert Moss; Vikram R Rao; Zulfi Haneef; William H Theodore; Jonathan K Kleen; Jay Gavvala; Marina Vannucci; John M Stern Journal: Epilepsia Date: 2019-12-02 Impact factor: 6.740