July 11, 2023

Leading research shapes scientific discovery, clinical practice and patient experience of epilepsy

Seer reaches milestone 50th publication of peer-reviewed research

This month, Seer celebrates a milestone which is at the heart of what we do and why we exist. Founded in 2017, Seer was born out of research and clinical collaborations between the University of Melbourne and St Vincent’s Hospital Melbourne. Research forms the basis from which we are able to deliver the gold-standard in home-based diagnostic monitoring.

Seer’s research is influential across the spectrum of epilepsy care. Our research serves to advance global understanding of epilepsy, it provides scientific validation for the use of innovative technologies and patient care, and contributes breakthroughs that transform the patient experience for people living with epilepsy.

As we celebrate Seer’s milestone 50th peer-reviewed publication, we reflect on some of the major breakthroughs and biggest impacts of our research.

1. Changing diagnoses: the impact of video-EEG monitoring in informing epilepsy diagnosis and management

When doctors are unsure whether a person has epilepsy or another neurological disorder, video-EEG is the typical diagnostic tool employed. If epilepsy has already been diagnosed, video-EEG is also the go-to tool for classifying the type of seizures someone is experiencing, in order to inform an appropriate treatment plan.

In ‘Evaluating the Utility of Inpatient Video-EEG Monitoring’, a leading study published in 2004 and co-authored by Seer’s Chief Medical Officer, the effectiveness of inpatient video-EEG monitoring was evaluated, in order to determine how often the diagnosis and management of patients changed following this type of monitoring.

This study highlights the high utility of video-EEG monitoring in changing diagnoses and management plans. Video-EEG monitoring was thus cemented as a critical tool for improving accuracy of diagnoses and guiding appropriate management decisions for patients.

2. Video-EEG monitoring enhances diagnostic yield and efficacy of monitoring for patients with epilepsy

Ambulatory or at-home video-EEG monitoring, like the service provided by Seer, delivers a high diagnostic yield and is comparable to inpatient monitoring.

In a study published in Clinical Neurophysiology in February 2023, ambulatory monitoring was found to be an effective means of capturing seizure events. By adding video recordings to EEG monitoring, the diagnostic yield is further increased. In some cases, video recordings are more useful than EEG recordings to help establish an accurate diagnosis.

Confirming the clinical option and merit in providing home-based diagnostic monitoring for epilepsy, this study confirmed at-home monitoring can provide diagnostic information and event capture rates that are equivalent to those attained in traditional inpatient settings.

Not only does home-based monitoring increase access and levels of patient comfort during monitoring, it also offers a viable solution to minimise strain on hospital resources.

3. Prolonged monitoring maximises diagnostic efficacy

A study published in Clinical Neurophysiology in June 2023 confirmed that a monitoring duration of 6-7 days is optimal to capture events and reach diagnostic conclusions for most patients.

This study assessed the amount of time required to evaluate treatment or reach a conclusion on epilepsy diagnosis or seizure type classification with video-EEG monitoring. Collating data from more than 3000 patients, this study established that capturing one event with video-EEG monitoring was insufficient, and that in approximately 30% of cases, subsequent events captured during the same recording period changed the diagnosis. Additionally, the study found that almost 50% of patients were yet to have an answer to their clinical question after 1 day of monitoring.

Highlighting the importance of prolonged monitoring in maximising diagnostic efficacy and improving patient outcomes, this research revealed that for diagnostic and clinical indications, at least 7 days of monitoring was required to answer 99% of studies, whilst treatment-related conclusions required at least 6 days of monitoring.

4. Signals from off-the-shelf wearable devices can be used to determine personalised cycles of seizure risk

Published in Epilepsia in 2023, a collaborative study between Seer’s Research team and Neurology leaders at the Mayo Clinic demonstrates the ability to measure and identify long-term seizure cycles from signals obtained from wearable devices (Nicholas M. Gregg et. al).

Signals such as accelerometery, heart rate, heart rate variability, electrodermal activity, and skin temperature were recorded using the Empatica E4 device, and assessed to identify personalised long-term seizure cycle patterns. This demonstrates the possibility of using other commercially-available wearables (like a Fitbit) to capture similar data to recognise these cycles. In addition, when these signals are paired with the Seer app, they can be used to produce a personalised seizure cycle and risk profile.

Demonstrating that wearable technology can provide new insights into the study of biological rhythms in epilepsy, this study validates the use of wearables in seizure risk forecasting and opens up new pathways for further development.

5. Sleep and seizure risk in epilepsy: the importance of bed and wake times

Sleep duration, sleep deprivation, and the sleep-wake cycle are believed to influence epileptic activity and seizure risk. A Seer study published in Brain titled “Sleep and seizure risk in epilepsy: Bed and wake times are more important than sleep duration” presents evidence challenging the common understanding of the relationship between seizures and sleep in epilepsy.

The study involved 60 participants who wore a Fitbit smartwatch for at least 28 days and reported their seizure activity using the Seer mobile app. The analysis focused on various sleep features, including sleep duration, oversleeping, undersleeping, and sleep onset and offset times. Surprisingly, day-to-day changes in sleep duration had minimal impacts on seizure risk. Instead, shifts in normal sleeping times (i.e., routine bed and wake-times) were found to be more critical in predicting seizure risk the following day. Nocturnal seizures also significantly increased seizure risk in the following 48 hours.

This groundbreaking research not only sheds light on the complex relationship between sleep patterns and seizure risk, but also showcases the integration of the Seer app and Fitbit wearables as powerful tools for scientific outcomes. The study demonstrates the potential of wearables in identifying sleep-seizure associations, guiding clinical recommendations, and enhancing seizure forecasting algorithms. These advancements have significant implications for improving epilepsy management and patient care.

Regarding the milestone of publishing 50 peer-reviewed papers since Seer’s founding in 2017, Co-Founder and Chief Medical Officer Prof Mark Cook AO reflects:

It’s marvellous to be a part of an achievement like this, there aren’t many commercial operations doing research on this scale. Seer comes from a research background, and we are proud to be producing new research which not only improves outcomes for patients, but also improves processes within our operation, resulting in better outcomes for everyone.

Learn more about Seer’s research breakthroughs and this milestone achievement via the video below.

Explore Seer’s latest publications and learn more about Seer’s Research team here.