Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
Epilepsia. 2020 Nov;61 Suppl 1:S11-S24. doi: 10.1111/epi.16521. Epub 2020 May 9.
In patients with epilepsy, the potential to prevent seizure-related injuries and to improve the unreliability of seizure self-report have fostered the development and marketing of numerous seizure detection devices for home use. Understanding the requirements of users (patients and caregivers) is essential to improve adherence and mitigate barriers to the long-term use of such devices. Here we reviewed the evidence on the needs and preferences of users and provided an overview of currently marketed devices for seizure detection (medically approved or with published evidence for their performance). We then compared devices with known needs. Seizure-detection devices are expected to improve safety and clinical and self-management, and to provide reassurance to users. Key factors affecting a device's usability relate to its design (attractive appearance, low visibility, low intrusiveness), comfort of use, confidentiality of recorded data, and timely support from both technical and clinical ends. High detection sensitivity and low false alarm rates are paramount. Currently marketed devices are focused primarily on the recording of non-electroencephalography (EEG) signals associated with tonic-clonic seizures, whereas the detection of focal seizures without major motor features remains a clear evidence gap. Moreover, there is paucity of evidence coming from real-life settings. A joint effort of clinical and nonclinical experts, patients, and caregivers is required to ensure an optimal level of acceptability and usability, which are key aspects for a successful continuous monitoring aimed at seizure detection at home.
在癫痫患者中，预防与癫痫发作相关的损伤和提高癫痫发作自我报告的可靠性，促进了许多用于家庭使用的癫痫检测设备的开发和营销。了解用户（患者和护理人员）的需求对于提高依从性和减轻长期使用此类设备的障碍至关重要。在这里，我们回顾了用户需求和偏好的证据，并概述了目前市场上用于癫痫检测的设备（经医学批准或具有性能的已发表证据）。然后，我们将设备与已知需求进行了比较。癫痫检测设备有望提高安全性和临床及自我管理水平，并使用户感到安心。影响设备可用性的关键因素与其设计（外观吸引人、低可见度、低侵入性）、使用舒适度、记录数据的保密性以及技术和临床方面的及时支持有关。高检测灵敏度和低误报率至关重要。目前市场上的设备主要侧重于记录与强直-阵挛性癫痫发作相关的非脑电图（EEG）信号，而对于没有主要运动特征的局灶性癫痫发作的检测仍然存在明显的证据空白。此外，来自现实生活环境的证据也很少。需要临床和非临床专家、患者和护理人员共同努力，以确保达到可接受性和可用性的最佳水平，这是在家中进行成功连续监测以检测癫痫发作的关键方面。
