Wearable non-EEG sensors for seizure detection

Background: In recent years, wearable devices applied to seizure detection have progressively become available. The goal of this thesis was to provide insight into the role of wearable non-EEG seizure detection devices in epilepsy, with a specific focus on two aspects often disregarded by the current literature: focal onset seizures and patients' direct experiences. Methods: This thesis makes use of methods that can be grouped into four major categories: qualitative data (online survey, focus group); review and analysis of the literature (including narrative review of the literature, systematic review, meta-analysis, meta-regression); experimental study (digital semiology of focal seizures with motor manifestations; acceptability of the device; assessment of seizure-related risk); quantitative data analysis. Results: The results are summarised in 6 main points: 1. People with epilepsy, their caregivers and healthcare providers are interested in the use of preferably small, commonly used, multimodal wearable devices to acquire information in the attempt to mitigate seizure unpredictability; 2. Current devices do not exactly match patients' needs and mainly focus on tonic-clonic seizure detection; 3. Wearable devices should incorporate HR signals to early detect focal onset seizures; 4. Focal onset seizures with motor manifestations exhibit a common digital semiology and evolution pattern characterized by early cardiac manifestations followed by motor phenomena and final electrodermal activity response; 5. Patients acceptability of wearable devices is good as well as self-management; 6. Wearable devices can help at identifying potentially life-threating post-ictal states such as prolonged immobility. Conclusion: We anticipate that focal onset seizure detection will open new avenues to improve both the safety and treatment of people with epilepsy, with our imagination being the only limiting factor.