This is a multicenter home-based medical device intervention study, with prospective validation of the wearable seizure detection device (Nightwatch) and retrospective validation of remote sensors (video and audio detection) in children. The investigators will also perform a feasibility and utility analysis of Nightwatch.
Various remote and wearable sensor devices have become available for the detection of potentially dangerous seizures, with limited impact on epilepsy care so far. Both the investigator's remote and wearable seizure detection devices (SDDs) have been extensively tested and proven highly sensitive. Yet the home performance in children, an important target population, had been insufficiently studied. Objective: 1. To test the performance of the wearable SDD (Nightwatch) prospectively and the remote SDD (automated video and audio analysis) retrospectively in children in a family home setting. 2. To assess the feasibility, cost-effectiveness and cost-utility of Nightwatch in children. Study design: A multicenter home-based medical device intervention study with prospective validation of our wearable SDD. Study population: 60 children (ages 4-16 years) with refractory epilepsy (≥1 major nocturnal seizure per week) recruited from the outpatient clinics of one of the participating epilepsy centers (Stichting Epilepsie instellingen Nederland (SEIN), Academic Centre of Epileptology Kempenhaeghe (Kempenhaeghe), University Medical Center Utrecht (UMCU)). Intervention: Phase I: Two months of baseline (usual care); Phase 2: Two months of nocturnal seizure monitoring at home, using Nightwatch and the remote SDD. Main study parameters/endpoints: The diagnostic performance of Nightwatch and the remote SDD algorithms, i.e. sensitivity, positive predictive value, false alarm rate and % time with uninterrupted signal output. The investigators will evaluate feasibility of Nightwatch through surveys on quality of life, sleep, parental strain, interviews with parents/guardians and neurologists, and a value sensitive design group session. The investigators will also perform a cost-effectiveness and cost-utility analysis by medical consumption and costs questionnaires. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Implementing SDDs will not pose any direct or substantial risk. Study participation can be a burden though, due to impact of the devices on privacy, number of false alarms and time spent on the questionnaires and interviews. Application of the SDDs, however, might offer better insight into the actual number of nocturnal seizures in a child, change in medical management and facilitate appropriate interventions in major motor seizures. If reliable, SDDs may improve the night rest of both patient and parents/guardians.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
60
Nocturnal monitoring for 2 months with three different seizure detection devices.
Stichting Epilepsie Instellingen Nederland (SEIN)
Heemstede, Achterweg 5, Netherlands
Academic Center of Epileptology Kempenhaeghe
Heeze, Netherlands
University Medical Center Utrecht
Utrecht, Netherlands
Diagnostic performance Nightwatch - sensitivity
Performance of Nightwatch to detect major nocturnal motor seizures in children at home, measured prospectively by means of sensitivity.
Time frame: Monitoring period of 2 months per participant.
Diagnostic performance Nightwatch - positive predictive value
Performance of Nightwatch to detect major nocturnal motor seizures in children at home, measured prospectively by means of positive predictive value.
Time frame: Monitoring period of 2 months per participant.
Diagnostic performance Nightwatch - false alarm rate
Performance of Nightwatch to detect major nocturnal motor seizures in children at home, measured prospectively by means of false alarm rate.
Time frame: Monitoring period of 2 months per participant.
Diagnostic performance Nightwatch - % time with uninterrupted signal
Performance of Nightwatch to detect major nocturnal motor seizures in children at home, measured prospectively by means of % of time with uninterrupted signal output.
Time frame: Monitoring period of 2 months per participant.
Diagnostic performance of video and audio detection - sensitivity
Diagnostic performance of our remote seizure detection devices (video and audio) to detect major nocturnal motor seizures in children at home, measured retrospectively by means of sensitivity.
Time frame: Monitoring period of 2 months per participant.
Diagnostic performance of video and audio detection - positive predictive value
Diagnostic performance of our remote seizure detection devices (video, audio) to detect major nocturnal motor seizures in children at home, measured retrospectively by means of positive predictive value.
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Time frame: Monitoring period of 2 months per participant.
Diagnostic performance of video and audio detection - false alarm rate
Diagnostic performance of our remote seizure detection devices (video, audio) to detect major nocturnal motor seizures in children at home, measured retrospectively by means of false alarm rate.
Time frame: Monitoring period of 2 months per participant.
Diagnostic performance of video and audio detection - % time with uninterrupted signal output.
Diagnostic performance of our remote seizure detection devices (video, audio) to detect major nocturnal motor seizures in children at home, measured retrospectively by means of % time with uninterrupted signal output.
Time frame: Monitoring period of 2 months per participant.
Feasibility of Nightwatch will be examined in an interview with parents/guardians, focussing on different aspects of the device.
Feasibility of Nightwatch with a mixed methods approach focusing on Acceptability, Demand, Implementation, Practicality, Expansion, Limited-efficacy testing, impact of the SDD on parents/guardians with children (interview).
Time frame: 4 month period (2 months usual care + 2 months monitoring)
Feasibility of Nightwatch by means of Caregiver Strain Index (CSI).
Effect of Nightwatch on parental stress, with a stress questionnaire (CSI), containing 13 questions about stress with 'yes/no' answers. 11-13 tims 'yes' indicates high level of stress, 7-10 times 'yes' indicates medium level of stress and 0-6 times 'yes' means low level of stress.
Time frame: 4 month period (2 months usual care + 2 months monitoring)
Feasibility of Nightwatch by means of Pittsburgh Sleep Quality Index (PSQI).
Effect of Nightwatch on parental sleep with a sleep questionnaire (PSQI), containing 10 questions about sleep, with scales from 1-4 to indicate how often parents/guardians experience certain sleep problems.
Time frame: 4 month period (2 months usual care + 2 months monitoring)
Feasibility of Nightwatch by means of the Quality of Life questionnaire: EQ-5D-5L
Effect of Nightwatch on parental quality of life, with a QoL questionnaire (EQ-5D-5L), containing 5 questions about the person's health with a 1-5 scale indicating the severity of a certain health problem and a 0-100 rating scale of their health.
Time frame: 4 month period (2 months usual care + 2 months monitoring)
Cost-effectiveness analysis of Nightwatch
Economic evaluation from a societal prospective of Nightwatch involving a cost-effectiveness analysis (CEA).
Time frame: 4 month period (2 months usual care + 2 months monitoring)
Cost-utility analysis of Nightwatch
Economic evaluation from a societal prospective of Nightwatch involving a cost- a cost-utility analysis (CUA).
Time frame: 4 month period (2 months usual care + 2 months monitoring)