Developing an App to Detect Seizures

Andrew N. Wilner, MD


January 14, 2016

Editor's Note: Medscape contributor Dr Andrew Wilner recently spoke with Nathan E. Crone, MD, a professor of neurology at the Johns Hopkins Comprehensive Epilepsy Center in Baltimore, Maryland, about his work developing a smartphone and Apple Watch app that helps detect seizures. What follows is a transcript of their discussion.

Andrew N. Wilner, MD: Dr Crone, welcome. I recently read an article[1] discussing an app you're developing that may assist in seizure detection. Can you tell us about your app?

Nathan E. Crone, MD: Thank you very much. First, I want to mention that the app was co-developed with Gregory Krauss, MD, who is also in the epilepsy division at Johns Hopkins. We developed this app over the past several months to help patients participate in a research study to develop a future app to detect seizures using the Apple Watch and a paired iPhone.

Dr Wilner: Don't patients know when they have a seizure? Why do they need an app to tell them they had a seizure?

Dr Crone: Well, about 40% of patients know that they're having a seizure or that they're about to have a seizure, but a lot of patients don't have any warning. There are also patients who don't even realize that they've had a seizure, and we see those patients in clinic quite frequently.

Dr Wilner: I know that if you monitor patients, sometimes they'll have a seizure on video, and then when you ask them what they experienced during the seizure, they'll say, "Oh, I didn't have a seizure yet," but everyone else in the room knows they did.

Dr Crone: Exactly. It is important for patients to learn what is happening because, of course, it affects things like driving and other activities where they need to be aware.

Dr Wilner: Is this app going to help in seizure prediction or does it only tell you when you've already had a seizure?

Dr Crone: The future app will hopefully detect when you're having a seizure. Currently there is no detection built into the app. It is really designed to collect sensor data from the watch and from the iPhone to develop algorithms that we will then incorporate into a future app that will provide seizure detection.

As far as your original question about seizure prediction, that's been a tough nut to crack. Even with intracranial EEG, it's not easy to predict when someone will have a seizure. It all depends on how long in advance you want to predict the seizure.

Dr Wilner: So, this seizure detection app will give us an accurate seizure count? When the patient comes to his clinic visit every few months and you ask how many seizures he's had since the last visit, you will get a very accurate number and not just rely on the patient's memory?

Dr Crone: That's right. We hope that it will provide an accurate count of their seizures. It does require the patient to activate the app when they're feeling a seizure come on or to report a seizure after the fact. The patient does need to be aware that they have either had a seizure or that they are starting to have a seizure. Of course, some patients are aware that they are starting to have a seizure but then forget that they have had a seizure.

Dr Wilner: Does the watch store all of this information? Is that how it works?

Dr Crone: The app stores all of this information, and it's actually uploaded to a server where we have access to that data for research. Most of that data does not stay on the phone all the time. When the patient wants to look at their trends and see all the seizures that they've tracked, and also their medications, they can pull that information down onto their phone and look at it in nice graphs.

Dr Wilner: A lot of my patients are going to tell me that they can't afford an Apple Watch and an iPhone. Is this being developed for any other platform?

Dr Crone: Currently, we have not developed this for other platforms, but I believe that if we can use these sensors in the Apple Watch and the iPhone to do this, then that could be ported over to other devices and platforms in the future. We first want to test the algorithms in the best technology available.

Dr Wilner: If a patient wants to participate in this study, what should they do?

Dr Crone: It helps if they have an iPhone and an Apple Watch. Then they can go to the App Store and search for EpiWatch, and they can learn about the app and the study, because using the app is the same as participating in the study.

Once they download the app, they can read about the study. There is an electronic consenting guide that takes them through the consenting process, what to look forward to in the study, and what their participation would mean. Then they get to review all of that information and sign a consent form with their finger on the iPhone screen. They can get a copy of the consent form by email. Then they're ready to start using the app. It does require some special steps to make sure that the Apple Watch is set up correctly for working with the app. There is an icon that has to be set up on the Apple Watch screen so that they can get to it very quickly. All they have to do, once that is set up correctly, is raise their wrist, tap the icon, and start tracking a seizure.

Dr Wilner: This sounds like a great adventure. I look forward to speaking with you, maybe a year from now, when you have preliminary results from the study.

Dr Crone: That would be great. We are very excited.


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