Systematic Review Examines Cardiovascular Biomarkers for Pediatric Epilepsy Seizure Anticipation
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Key Takeaway
Recognize that no devices predict seizures despite observed biomarker changes in pediatric epilepsy patients.
This systematic review synthesizes evidence regarding non-invasive physiologic and environmental biomarkers for pediatric epilepsy patients. The authors specifically examined cardiovascular biomarkers using electrocardiogram (ECG) measurement to assess seizure anticipation capabilities. Eleven observational cohort studies were included in the analysis, though the total patient sample size was not reported.
Regarding performance metrics, pre-ictal anticipation algorithm times ranged from 21.8 s to 32 min across the reviewed literature. Correlational studies observed cardiovascular biomarker changes 3.59 s to 40 min before seizures. Cardiovascular biomarkers using electrocardiogram (ECG) measurement were most commonly used within these studies.
The authors note significant limitations affecting clinical translation. Evidence in 9/11 of reviewed studies were rated as either low or very low certainty using the GRADE tool. Limitations include methodological flaws, risk of bias, inconsistent results, and indirect or sparse evidence. The review explicitly states there are no devices or systems on the market that predict seizures.
Practice relevance involves ongoing opportunities to build on findings. Further testing of cardiovascular biomarkers with other physiologic and environmental factors is needed. Larger sample size studies and a precision medicine approach to tailoring algorithms and biomarker measurements to individual patients are recommended. Clinicians should interpret these findings cautiously given the observational nature of the data.
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View Original Abstract ↓
IntroductionEpilepsy is one of the most common neurological disorders globally. While medications, surgical interventions, and dietary changes can be successful in controlling seizures, a subset of individuals experience refractory epilepsy and are at increased risk for sudden unexpected death in epilepsy (SUDEP). Efforts to provide a detection system using devices have been successful at identifying seizures once they start, but there are no devices or systems on the market that predict seizures. The purpose of this systematic review (PROSPERO ID: CRD42024444250) is to determine non-invasive physiologic and environmental biomarkers that can be used to forecast seizures in pediatric epilepsy patients.MethodsA systematic search of relevant literature was conducted in PubMed, Web of Science, CINAHL Ultimate, and EMBASE in August 2023. Articles were reviewed by two investigators in a two-step process. Data extraction occurred using two independent extractors to identify study characteristics, patient characteristics, and forecasting results. Evidence quality was evaluated by two investigators using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.ResultsEleven observational cohort studies were included and cardiovascular biomarkers using electrocardiogram (ECG) measurement were most commonly used. Pre-ictal anticipation algorithm times ranged from 21.8 s to 32 min, while correlational studies observed cardiovascular biomarker changes 3.59 s to 40 min before seizures. This systematic review provides a comprehensive overview of the current evidence for seizure forecasting. However, the evidence in 9/11 of reviewed studies were rated as either low or very low certainty using the GRADE tool due to methodological flaws, risk of bias, inconsistent results, and indirect or sparse evidence.DiscussionThere are ongoing opportunities to build on our findings, including further testing of cardiovascular biomarkers with other physiologic and environmental factors, larger sample size studies, and a precision medicine approach to tailoring algorithms and biomarker measurements to individual patients.Systematic review registrationPROSPERO (ID: CRD42024444250).
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