Monitoring Antiseizure Medication Change Using Ultra Long-Term Electroencephalogram: A Multicenter Study

Area of Science:

• Neurology
• Epilepsy Research
• Biomedical Engineering

Background:

• Medication adjustments are frequent in treatment-resistant epilepsy, but lack strong evidence.
• Patient seizure diaries have limitations in accurately capturing seizure frequency.

Purpose of the Study:

• To evaluate if ultra long-term subcutaneous electroencephalogram (sqEEG) enhances seizure detection and treatment response assessment compared to traditional seizure diaries.
• To compare the efficacy of sqEEG versus diaries in identifying changes in seizure frequency following antiseizure medication adjustments.

Main Methods:

• A retrospective, multicenter cohort study involving adults with treatment-resistant epilepsy across 9 centers.
• Comparison of sqEEG seizure frequency with patient seizure diaries before and after medication dose changes over 7-, 14-, and 30-day periods.
• Utilized categorical analyses, mixed-effects models, and survival analyses to compare detection capabilities.

Main Results:

• SqEEG recorded 2.2 to 3.4 times more seizures than diaries (p < 0.01).
• Significant disagreements between sqEEG and diaries were observed at 7 and 14 days post-medication adjustment.
• SqEEG identified an earlier return to baseline seizure counts after dose reductions (7- and 14-day windows).

Conclusions:

• Ultra long-term sqEEG monitoring offers a more objective and sensitive measure of seizure frequency in treatment-resistant epilepsy compared to patient diaries.
• SqEEG facilitates earlier detection of treatment-related changes, particularly after medication dose reductions.
• Objective EEG monitoring holds significant potential for optimizing epilepsy treatment.