Wheeler Lydia, Kremen Vaclav, Mersereau Cole, Ornelas Guillermo, Yadav Taruna, Cormier Devon, Derry Allyson, Duque Lopez Andrea, McQuown Kevin, Sladky Vladimir, Benjamin Christopher, Giacino Joseph, Worrell Gregory, Blumenfeld Hal
Department of Neurology, Bioelectronics Neurophysiology, and Engineering Lab, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic Graduate School of Biomedical Science, Mayo Clinic, Rochester, Minnesota, USA.
Epilepsia. 2025 Jan;66(1):104-116. doi: 10.1111/epi.18181. Epub 2024 Nov 19.
An accurate evaluation of behavioral responsiveness during and after seizures in people with epilepsy is critical for diagnosis and management. Current methods for assessing behavioral responsiveness are characterized by substantial variation, subjectivity, and limited reliability and reproducibility in ambulatory and epilepsy monitoring unit settings. In this study, we aimed to develop and implement a novel mobile platform for deployment of automated responsiveness testing in epilepsy-the ARTiE Watch-to facilitate standardized, objective assessments of behavioral responsiveness during and after seizures.
We prospectively recruited patients admitted to the epilepsy monitoring units for diagnostic evaluation and long-term video-electroencephalographic monitoring at Mayo Clinic and Yale New Haven Hospital. Participants wore the ARTiE Watch, a smartwatch paired with custom smartphone software integrated with cloud infrastructure allowing for remote activation of standardized assessment on the participants' smartwatches. The assessment consisted of 18 command prompts that test behavioral responsiveness across motor, language, and memory domains. Upon visually identifying an electrographic seizure during EMU monitoring, the BrainRISE platform was used to deploy the ARTiE Watch behavioral testing sequence. Responsiveness scoring was conducted on smartwatch files.
Eighteen of 56 participants had a total of 39 electrographic seizures assessed with the ARTiE Watch. The 18 subjects with ARTiE Watch-tested seizures had a total of 67 baseline (interictal) ARTiE Watch tests collected for analysis. The analysis showed distinct ARTiE Watch behavioral responsiveness phenotypes: (1) decreased responsiveness across all ARTiE Watch commands during seizure (ictal-postictal) periods compared (to baseline (p < .0001), (2) decreased responsiveness in bilateral tonic-clonic seizures compared to baseline (p < .0001) and compared to focal seizures (p < .0001), and (3) decreased responsiveness during focal impaired awareness seizures compared to baseline (p < .0001) and compared to focal aware seizures (p < .001).
ARTiE Watch behavioral testing deployed utilizing a mobile cloud-based platform is feasible and can provide standardized, objective behavioral responsiveness assessments during seizures.
准确评估癫痫患者发作期间及发作后的行为反应能力对于诊断和治疗至关重要。目前评估行为反应能力的方法存在显著差异、主观性强，且在动态和癫痫监测单元环境中的可靠性和可重复性有限。在本研究中，我们旨在开发并实施一种新型移动平台——用于癫痫自动反应性测试的ARTiE手表，以促进对癫痫发作期间及发作后的行为反应能力进行标准化、客观的评估。
我们前瞻性地招募了在梅奥诊所和耶鲁纽黑文医院癫痫监测单元接受诊断评估和长期视频脑电图监测的患者。参与者佩戴ARTiE手表，这是一款与定制智能手机软件配对的智能手表，该软件集成了云基础设施，可远程激活对参与者智能手表的标准化评估。评估包括18个指令提示，用于测试运动、语言和记忆领域的行为反应能力。在癫痫监测单元（EMU）监测过程中通过视觉识别出脑电图发作后，使用BrainRISE平台部署ARTiE手表行为测试序列。对智能手表文件进行反应能力评分。
56名参与者中有18名共有39次脑电图发作接受了ARTiE手表评估。接受ARTiE手表测试发作的18名受试者共收集了67次基线（发作间期）ARTiE手表测试用于分析。分析显示了ARTiE手表行为反应能力的不同表型：（1）与基线相比，发作期（发作期-发作后期）所有ARTiE手表指令的反应能力均下降（p < .0001）；（2）与基线相比，双侧强直阵挛发作的反应能力下降（p < .0001），与局灶性发作相比也下降（p < .0001）；（3）与基线相比，局灶性意识障碍发作期间的反应能力下降（p < .0001），与局灶性意识清醒发作相比也下降（p < .001）。
利用基于移动云的平台部署的ARTiE手表行为测试是可行的，并且可以在癫痫发作期间提供标准化、客观的行为反应能力评估。
