Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Neurosciences, Tampere University Hospital, Tampere, Finland.
Department of Neurology, Rovaniemi Central Hospital, Rovaniemi, Finland.
Epilepsy Behav. 2022 Aug;133:108804. doi: 10.1016/j.yebeh.2022.108804. Epub 2022 Jun 23.
The aim of this study was to evaluate the clinical utility of a semi-automated hybrid video/audio-based epilepsy monitoring system (Nelli®) in a home setting.
In this retrospective study, 104 consecutive patients underwent Nelli-registration for an average of 29 days at their home. The seizure-related data obtained from the registration were assessed to investigate the utility of the Nelli-registration regarding clinical decision-making.
Of 104 patients, Nelli® hybrid system was able to recognize clinically relevant events in 83 (80%) patients: epileptic seizures in 67 (65%) and nonepileptic events in 16 (15%). A total of 2767 epileptic seizures of different seizure types were captured and identified. These seizures included not only tonic-clonic seizures but also other complex or simple motor seizures. For the outcomes regarding clinical decision-making, a need for a new therapeutic intervention was recognized in 54 (51.9%) patients based on the number and severity of seizures captured by Nelli-registration. In 12 (11.5%) patients, the need to change the treatment plan was excluded because no evidence of suspected epileptic seizures was found. Nelli-registration aided in confirming the therapeutic efficacy of modifications of antiseizure medications (ASMs) or neuromodulation therapies in 13 (12.5%) patients. Nelli-registration enabled to determine the change in seizure classification and facilitated to reach clear diagnostic conclusions in 11 (10.6%) patients. In 14 (13.5%) patients, there was no change in clinical outcome, as Nelli-registration was unable to infer any clinical decision either due to inconclusive results or lack of typical events. Seizures detected during Nelli-registration aided in decision-making for therapeutic interventions in 71 (68%) patients. Altogether, 44 (42%) patients had adjustment of ASMs, and in 9 (9%) patients, Nelli-registrations led to the change in the settings of vagus nerve stimulation (VNS) or deep brain stimulation (DBS) treatment. Additionally, 18 (17%) patients were referred to presurgical evaluation or established a baseline seizure frequency before surgical implantation for neuromodulation treatment with VNS or DBS, while 33 (32%) patients had no change in therapy. Nine patients (8.7%) were referred to video-EEG monitoring (VEM), as Nelli-recorded events highlighted the need for presurgical evaluation in 6 patients or further diagnostic evaluation in 3 patients.
This study confirms the clinical utility of the video/audio monitoring system Nelli® in home settings. Home monitoring with Nelli® hybrid system provides a new alternative for the assessment of frequency and type of epileptic seizures as well as for a recognition of nonepileptic events. Thus, Nelli-registration can facilitate the optimization of seizure monitoring and management in clinical practice, complementing existing methods such as VEM and ambulatory EEG recordings.
本研究旨在评估一种半自动混合视频/音频癫痫监测系统（Nelli®）在家中环境中的临床实用性。
在这项回顾性研究中，104 例连续患者在家中平均进行了 29 天的 Nelli 登记。评估从登记中获得的与癫痫发作相关的数据，以研究 Nelli 登记在临床决策方面的实用性。
在 104 例患者中，83 例（80%）患者的 Nelli®混合系统能够识别临床相关事件：67 例（65%）癫痫发作和 16 例（15%）非癫痫发作。总共捕获并识别了 2767 种不同类型的癫痫发作。这些发作不仅包括强直阵挛发作，还包括其他复杂或简单的运动性发作。根据 Nelli 登记捕获的癫痫发作的数量和严重程度，54 例（51.9%）患者需要新的治疗干预。由于未发现疑似癫痫发作的证据，12 例（11.5%）患者排除了改变治疗计划的需要。在 13 例（12.5%）患者中，Nelli 登记有助于确认抗癫痫药物（ASM）或神经调节治疗的治疗效果改变。在 11 例（10.6%）患者中，Nelli 登记确定了癫痫发作分类的变化，并有助于得出明确的诊断结论。在 14 例（13.5%）患者中，临床结果没有变化，因为 Nelli 登记由于结果不确定或缺乏典型事件，无法推断任何临床决策。在 71 例（68%）患者中，癫痫发作的检测有助于治疗干预决策。总共 44 例（42%）患者调整了 ASM，9 例（9%）患者因 Nelli 登记导致迷走神经刺激（VNS）或深部脑刺激（DBS）治疗设置发生变化。此外，18 例（17%）患者被转至术前评估，或在接受 VNS 或 DBS 神经调节治疗的手术植入前建立基线癫痫发作频率，而 33 例（32%）患者的治疗没有变化。9 例（8.7%）患者被转至视频-脑电图监测（VEM），因为 Nelli 记录的事件突出了 6 例患者需要术前评估，3 例患者需要进一步诊断评估。
本研究证实了视频/音频监测系统 Nelli®在家中环境中的临床实用性。Nelli 混合系统的家庭监测为评估癫痫发作的频率和类型以及识别非癫痫发作提供了新的选择。因此，Nelli 登记可以促进临床实践中癫痫发作监测和管理的优化，补充视频-脑电图监测（VEM）和动态脑电图记录等现有方法。
