Abstract Details

Title The FORESITE Study: FOREcasting Seizures to Initiate ThErapy – Technical Design, Hardware, and Algorithms

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-001

Objective For seizure forecasts to improve the lives of people with epilepsy, forecasts may be used to prompt medication administration to reduce seizure burden with minimal increase in medication dose.

Background Seizure forecasting has been demonstrated with intracranial EEG, wearable devices, and subscalp EEG. Our team is developing a seizure forecasting system based on subscalp EEG and wearable device signals operating via a smartphone and an associated microcontroller. Seizure alerts prompt administration of intranasal diazepam, with the goal of preventing seizures before they begin. Data is processed on an independent microcontroller (Particle Photon2) connected via Bluetooth to a subscalp EEG device (UNEEG SubQ, Allerod DK). Heart rate and actigraphy are recorded from a smartwatch. Forecasting algorithms run on the microcontroller, and recorded data is transmitted to the cloud. Push notifications are sent to the patient’s phone in response to seizure forecasts to prompt medication administration. Doses are logged on a smartphone seizure diary, and further alerts are suppressed once the dosage limit is reached. Detected seizures on EEG prompt cognitive testing on the smartwatch to test impaired consciousness.

Design/Methods Seizure forecasting algorithms use deep-learning LSTM neural network and multi-day cycle models of seizure risk. Given the benzodiazepine’s half-life (49.2h), circadian seizure risk patterns are not helpful, and multi-day cycles are necessary. Seizure forecasting algorithms were tested on 7 ultra-long-term SubQ EEG recordings from King’s College London. Subcutaneous EEG, annotations, and wearable signals are displayed in a cloud data dashboard.

Results A 2-class CNN-biLSTM seizure detection algorithm trained on a combined dataset of subcutaneous EEG and scalp EEG data produced an AUROC of 0.959 and AUPRC of 0.485 with positive sample fraction of 0.00021. Multi-day cycle seizure forecasting models achieve over 80% sensitivity with false alarms occurring on fewer than half of days in four of 7 patients.

Conclusions Seizure forecasting to guide medication is feasible.

Authors/Disclosures
Benjamin H. Brinkmann, PhD (Mayo Clinic) PRESENTER	Dr. Brinkmann has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Dr. Brinkmann has stock in Cadence Neuroscience. The institution of Dr. Brinkmann has received research support from Epilepsy Foundation of America. The institution of Dr. Brinkmann has received research support from National Institutes of Health. The institution of Dr. Brinkmann has received research support from National Institutes of Health. The institution of Dr. Brinkmann has received research support from UNEEG A/S. The institution of Dr. Brinkmann has received research support from Seer Medical Pty. The institution of Dr. Brinkmann has received research support from Neurelis Inc. Dr. Brinkmann has received intellectual property interests from a discovery or technology relating to health care.
Richard Cui, PhD	Dr. Cui has nothing to disclose.
Jordan Clark	Mr. Clark has nothing to disclose.
Mona Nasseri	Dr. Nasseri has nothing to disclose.
Pedro Viana, MD, PhD	Dr. Viana has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UNEEG MEDICAL.
Vaclav Kremen (Mayo Clinic)	Vaclav Kremen has nothing to disclose.
Jonas Duun-Henriksen, PhD	Dr. Duun-Henriksen has received personal compensation for serving as an employee of UNEEG medical.
Kevin McQuown	Mr. McQuown has nothing to disclose.
Rachel Stirling, PhD	Dr. Stirling has received personal compensation for serving as an employee of Seer Medical.
Vladimir Sladky, PhD student	Mr. Sladky has nothing to disclose.
Philippa J. Karoly, PhD	An immediate family member of Dr. Karoly has received personal compensation for serving as an employee of Seer Medical. An immediate family member of Dr. Karoly has stock in Seer Medical . The institution of Dr. Karoly has received research support from Australian government National Health and Medical Research Council . Dr. Karoly has received research support from Australian government department of industry science and resources .
Enrique Carrazana (Neurelis, Inc.)	Enrique Carrazana has received personal compensation for serving as an employee of Neurelis. Enrique Carrazana has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Hawaii-Biotech, CND Life Sciences, Apex Labs. Enrique Carrazana has stock in Neurelis, CND, Apex.
Andreas Schulze-Bonhage (Universitaetsklinikum Freiburg)	Andreas Schulze-Bonhage has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BIAL, GW. Andreas Schulze-Bonhage has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for BIAL, GW, EISAI, UCB.
Mark Richardson, MD, MRCP (Institute of Psychiatry)	The institution of Dr. Richardson has received research support from Medical Research Council UK. The institution of Dr. Richardson has received research support from Epilepsy Research UK. The institution of Dr. Richardson has received research support from GW Pharma. The institution of Dr. Richardson has received research support from European Commission. The institution of Dr. Richardson has received research support from Autifony Therapeutics . The institution of Dr. Richardson has received research support from Epilepsy Foundation of America . Dr. Richardson has received intellectual property interests from a discovery or technology relating to health care.
Gregory A. Worrell, MD (Mayo Clinic College of Medicine)	Dr. Worrell has received stock or an ownership interest from NeuroOne Inc.. Dr. Worrell has received stock or an ownership interest from Cadence Neuroscience Inc. The institution of Dr. Worrell has received research support from NIH. The institution of Dr. Worrell has received research support from Medtronic Inc.. The institution of Dr. Worrell has received research support from Neuropace Inc,. The institution of Dr. Worrell has received research support from Epilepsy Foundation of America. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care.

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