Detection of focal impaired awareness seizures using a biometric shirt

Abstract

Abstract Objective In recent years, seizure detection using wearable technology has gained significant attention in research. Most studies, however, have focused on detecting generalized or focal to bilateral tonic–clonic seizures. This study evaluates the feasibility of using a biometric shirt to detect focal impaired awareness seizures (FIAS) by monitoring respiratory, electrocardiography, and accelerometry signals. Methods Patients with epilepsy were recruited at the University of Montreal Hospital Center epilepsy monitoring unit. Seizures were annotated by epileptologists based on simultaneous video‐electroencephalographic recordings, blinded to the shirt data. Features were extracted from the respiratory, accelerometry, and electrocardiography signals using varying window sizes and steps. An XGBoost classifier was trained and tested using a nested leave‐one‐subject‐out cross‐validation. Post‐processing included a firing power regularization method to reduce false alarms. Results We recorded 113 FIAS from 27 patients who wore the shirt continuously for over 4750 hours. Using a firing power threshold of 0.65, we detected 71 seizures, resulting in a mean sensitivity of 66%, a 15% time in warning, and a false alarm rate (FAR) of 30 per 24 hours. A firing power threshold of 0.85 allowed us to reduce false alarms (8% time in warning, FAR of 21 per 24 hours) but resulted in a lower sensitivity of 57%. Performances varied across patients: sensitivity was high and FAR was low for some patients and vice versa for others, indicating variability in algorithm effectiveness across patients. Significance Our results demonstrate that detecting FIAS with a connected shirt could be feasible for certain patients, although the rate of false alarms remains an issue. Designing a personalized algorithm and selecting patients who exhibit significant physiological changes during seizures could make wearable‐based FIAS detection more viable in the near future. Plain Language Summary Novel mobile health technologies could transform epilepsy care by enabling continuous monitoring of seizures in everyday life. In this study, we used a biometric shirt to detect seizures with impaired awareness automatically. We used the shirt to measure breathing, heart activity, and movement in 27 patients with epilepsy in a hospital setting. Our algorithm detected up to two‐thirds of seizures correctly. However, the number of incorrect alarms remains relatively high, with variable performances between patients. While the technology showed potential, these challenges highlight the need for further improvements and personalized care plans.