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Long-term home monitoring of people living with epilepsy cannot be achieved using the standard full-scalp electroencephalography (EEG) coupled with video. Wearable seizure detection devices, such as behind-the-ear EEG (bte-EEG), offer an unobtrusive method for ambulatory follow-up of this population. Combining bte-EEG with electrocardiography (ECG) can enhance automated seizure detection performance. However, such frameworks produce high false alarm rates, making visual review necessary. This study aimed to evaluate a semi-automated multimodal wearable seizure detection framework using bte-EEG and ECG. Using the SeizeIT1 dataset of 42 patients with focal epilepsy, an automated multimodal seizure detection algorithm was used to produce seizure alarms. Two reviewers evaluated the algorithm's detections twice: (1) using only bte-EEG data and (2) using bte-EEG, ECG, and heart rate signals. The readers achieved a mean sensitivity of 59.1% in the bte-EEG visual experiment, with a false detection rate of 6.5 false detections per day. Adding ECG resulted in a higher mean sensitivity (62.2%) and a largely reduced false detection rate (mean of 2.4 false detections per day), as well as an increased inter-rater agreement. The multimodal framework allows for efficient review time, making it beneficial for both clinicians and patients. [ABSTRACT FROM AUTHOR]

Objective: Wearable seizure detection devices could provide more reliable seizure documentation outside the hospital compared to seizure self‐reporting by patients, which is the current standard. Previously, during the SeizeIT1 project, we studied seizure detection based on behind‐the‐ear electroencephalography (EEG). However, the obtained sensitivities were too low for practical use, because not all seizures are associated with typical ictal EEG patterns. Therefore, in this paper, we aim to develop a multimodal automated seizure detection algorithm integrating behind‐the‐ear EEG and electrocardiography (ECG) for detecting focal seizures. In this framework, we quantified the added value of ECG to behind‐the‐ear EEG. Methods: This study analyzed three multicenter databases consisting of 135 patients having focal epilepsy and a total of 896 seizures. A patient‐specific multimodal automated seizure detection algorithm was developed using behind‐the‐ear/temporal EEG and single‐lead ECG. The EEG and ECG data were processed separately using machine learning methods. A late integration approach was applied for fusing those predictions. Results: The multimodal algorithm outperformed the EEG‐based algorithm in two of three databases, with an increase of 11% and 8% in sensitivity for the same false alarm rate. Significance: ECG can be of added value to an EEG‐based seizure detection algorithm using only behind‐the‐ear/temporal lobe electrodes for patients with focal epilepsy. [ABSTRACT FROM AUTHOR]

Objective: Seizure diaries kept by patients are unreliable. Automated electroencephalography (EEG)‐based seizure detection systems are a useful support tool to objectively detect and register seizures during long‐term video‐EEG recording. However, this standard full scalp‐EEG recording setup is of limited use outside the hospital, and a discreet, wearable device is needed for capturing seizures in the home setting. We are developing a wearable device that records EEG with behind‐the‐ear electrodes. In this study, we determined whether the recognition of ictal patterns using only behind‐the‐ear EEG channels is possible. Second, an automated seizure detection algorithm was developed using only those behind‐the‐ear EEG channels. Methods: Fifty‐four patients with a total of 182 seizures, mostly temporal lobe epilepsy (TLE), and 5284 hours of data, were recorded with a standard video‐EEG at University Hospital Leuven. In addition, extra behind‐the‐ear EEG channels were recorded. First, a neurologist was asked to annotate behind‐the‐ear EEG segments containing selected seizure and nonseizure fragments. Second, a data‐driven algorithm was developed using only behind‐the‐ear EEG. This algorithm was trained using data from other patients (patient‐independent model) or from the same patient (patient‐specific model). Results: The visual recognition study resulted in 65.7% sensitivity and 94.4% specificity. By using those seizure annotations, the automated algorithm obtained 64.1% sensitivity and 2.8 false‐positive detections (FPs)/24 hours with the patient‐independent model. The patient‐specific model achieved 69.1% sensitivity and 0.49 FPs/24 hours. Significance: Visual recognition of ictal EEG patterns using only behind‐the‐ear EEG is possible in a significant number of patients with TLE. A patient‐specific seizure detection algorithm using only behind‐the‐ear EEG was able to detect more seizures automatically than what patients typically report, with 0.49 FPs/24 hours. We conclude that a large number of refractory TLE patients can benefit from using this device. [ABSTRACT FROM AUTHOR]