Automatic Responsiveness Testing in Epilepsy with Wearable Technology: The ARTiE Watch

Objective

An accurate evaluation of behavioral responsiveness during and after seizures in people with epilepsy is critical for accurate 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 (EMU) 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.

Methods

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’ smartwatch. The assessment consisted of 18 command prompts which 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.

Results

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 (p<0.0001) to baseline, (2) decreased responsiveness in bilateral tonic-clonic seizures compared to baseline (p<0.0001) and compared (p<0.0001) to focal seizures, and (3) decreased responsiveness during focal impaired awareness seizures compared (p<0.0001) to baseline and compared (p<0.001) to focal aware seizures.

Significance

ARTiE Watch behavioral testing deployed utilizing a mobile cloud-based platform is feasible and can provide standardized, objective behavioral responsiveness assessments during seizures.

Key points

• cloud-based platform was used to deliver ARTiE Watch testing during interictal (baseline), ictal, and post-ictal periods in epilepsy monitoring unit participants.

• Watch behavioral responsiveness testing shows different behavioral responsiveness phenotypes for focal aware seizures (FAS), focal impaired aware seizures (FIAS), and bilateral tonic-clonic seizures (BTC).

• Watch behavioral responsiveness testing deployed utilizing a cloud-based platform provides reproducible, standardized, objective behavioral assessments.