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• W4366241051 abstract "Epilepsy is operationally defined by the International League Against Epilepsy (ILAE) based on probability of seizure recurrence (https://www.ilae.org/guidelines/definition-and-classification/definition-of-epilepsy-2014). It is, however, essentially a chronic condition that often includes protracted impairments of brain function in addition to seizures, potentially impacting cognition, sensory and motor processing, and mental health (the ILAE suggests calling epilepsy a disease). Still, current diagnosis, monitoring, and treatment decisions very much rely on occasional several minutes-long recordings of electroencephalography (EEG) to characterize discrete bouts of ‘excessive’ electrical activity in neuronal networks that disrupt ongoing cortical activity, whether or not they directly cause seizures. The short and episodic nature of the recordings may constitute a limitation to their effectiveness. This could be addressed by the advent of wearable technology, particularly sensor networks of wireless miniature EEG units, opening the possibility of long-term EEG monitoring in daily life conditions.1 Several such devices are in active development. A number of technical issues are yet to be resolved to allow prolonged wearability in a variety of everyday situations. These issues include minimal need for user interaction, electrode impedance stability, appropriate signal amplification, memory capacity, lower power consumption, and efficient signal processing algorithms. Ambulatory EEG typically does not include video recording, and artefacts related to variations in electrode impedance, the environment, free movements, and muscle activity pose special challenges to the validity of the recordings. But long-term out-of-clinic EEG increases the probability of registering epileptiform events and provides more opportunities to distinguish between epileptic and non-epileptic events. These developments might thus better inform diagnosis and decision-making for treatment or even allow extemporaneous intervention. Continuous monitoring might additionally help reduce the risk of sudden unexpected death in epilepsy, by alerting the patient or carers to the need for immediate medical, potentially life-saving intervention.2 It may also enable better characterization of distinctive temporal patterns over hours, months, or even years – known as seizure chronotypes – which should lead to better understanding of the condition as well as more accurate forecasting of seizure recurrence.3 Long-term recordings encompassing life activities also provide insights into features of brain states when individuals with epilepsy are not having seizures.4 Brain states can be approached using various EEG signal processing methods that focus on frequency and/or time domain analysis. For example, coherence measures reflect sharing of electrophysiological information across different brain regions. Entropy measures of the apparently random information contained in EEG signals also appear to be promising, including from a neurodevelopmental perspective.5 The rapid development of machine learning will likely improve the speed and relevance of the large amounts of data to be processed. This progress can be anticipated to lead to a more comprehensive understanding of brain functioning in individuals with epilepsy, how this impacts activity and participation, and how such functioning is modulated by personal and environmental factors. Hopefully, it may thus bring about clinical improvement to patients. However, ethical attention will be required to avoid inappropriate surveillance of individuals, for example continuing monitoring is likely unnecessary. In managing the data, it will be necessary to protect the privacy and confidentiality of patients and their personal information. It is also important to avoid the risk of excessive normalization based on the incorrect assumption that it is better for an individual to have recorded values within the normative range. The involved technologies are both disruptive and potentially transformative, and call for specific attention to the tension between technology and human relationships. Moreover, we will have to address disparities in access to technology and diagnostic services, including socioeconomic and geographic barriers, to ensure that all patients have equitable access to care." @default.
• W4366241051 created "2023-04-20" @default.
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• W4366241051 date "2023-04-18" @default.
• W4366241051 modified "2023-10-12" @default.
• W4366241051 title "Epilepsy is a continuing disease" @default.
• W4366241051 cites W4294669032 @default.
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• W4366241051 doi "https://doi.org/10.1111/dmcn.15625" @default.
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