Clinical utility of a video/audio-based epilepsy monitoring system Nelli

Objective: The aim of this study was to evaluate the clinical utility of a semi-automated hybrid video/ audio-based epilepsy monitoring system (Nelli (R)) in a home setting.Methods: In this retrospective study, 104 consecutive patients underwent Nelli-registration for an aver-age of 29 days at their home. The seizure-related data obtained from the registration were assessed to investigate the utility of the Nelli-registration regarding clinical decision-making.Results: Of 104 patients, Nelli (R) hybrid system was able to recognize clinically relevant events in 83 (80%) patients: epileptic seizures in 67 (65%) and nonepileptic events in 16 (15%). A total of 2767 epileptic sei-zures of different seizure types were captured and identified. These seizures included not only tonic-clonic seizures but also other complex or simple motor seizures.For the outcomes regarding clinical decision-making, a need for a new therapeutic intervention was recognized in 54 (51.9%) patients based on the number and severity of seizures captured by Nelli-registration. In 12 (11.5%) patients, the need to change the treatment plan was excluded because no evi-dence of suspected epileptic seizures was found. Nelli-registration aided in confirming the therapeutic efficacy of modifications of antiseizure medications (ASMs) or neuromodulation therapies in 13 (12.5%) patients. Nelli-registration enabled to determine the change in seizure classification and facili-tated to reach clear diagnostic conclusions in 11 (10.6%) patients. In 14 (13.5%) patients, there was no change in clinical outcome, as Nelli-registration was unable to infer any clinical decision either due to inconclusive results or lack of typical events. Seizures detected during Nelli-registration aided in decision-making for therapeutic interventions in 71 (68%) patients. Altogether, 44 (42%) patients had adjustment of ASMs, and in 9 (9%) patients, Nelli-registrations led to the change in the settings of vagus nerve stimulation (VNS) or deep brain stimulation (DBS) treatment. Additionally, 18 (17%) patients were referred to presurgical evaluation or established a baseline seizure frequency before surgical implantation for neuromodulation treatment with VNS or DBS, while 33 (32%) patients had no change in therapy. Nine patients (8.7%) were referred to video-EEG mon-itoring (VEM), as Nelli-recorded events highlighted the need for presurgical evaluation in 6 patients or further diagnostic evaluation in 3 patients. Conclusion: This study confirms the clinical utility of the video/audio monitoring system Nelli (R) in home settings. Home monitoring with Nelli (R) hybrid system provides a new alternative for the assessment of frequency and type of epileptic seizures as well as for a recognition of nonepileptic events. Thus, Nelli-registration can facilitate the optimization of seizure monitoring and management in clinical practice, complementing existing methods such as VEM and ambulatory EEG recordings.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study evaluated the clinical utility of a semi-automated hybrid video/audio-based epilepsy monitoring system, Nelli(R), in a home setting. The results showed that the Nelli(R) hybrid system was able to recognize clinically relevant events and aid in clinical decision-making for new therapeutic interventions. Nelli(R) registration can optimize the monitoring and management of epileptic seizures.