Patient-centered design criteria for wearable seizure detection devices.

INTRODUCTION: Epilepsy is a common neurological condition. Seizure diary reports and patient- or caregiver-reported seizure counts are often inaccurate and underestimated. Many caregivers express stress and anxiety about the patient with epilepsy having seizures when they are not present. Therefore, a need exists for the ability to recognize and/or detect a seizure in the home setting. However, few studies have inquired on detection device features that are important to patients and their caregivers. METHODS: A survey instrument utilizing a population of patients and caregivers was created to obtain information on the design criteria most desired for patients with epilepsy in regard to wearable devices. RESULTS: One thousand one hundred sixty-eight responses were collected. Respondents thought that sensors for muscle signal (61.4%) and heart rate (58.0%) would be most helpful followed by the O2 sensor (41.4%). There was more interest in these three sensor types than for an accelerometer (25.5%). There was very little interest in a microphone (8.9%), galvanic skin response sensor (8.0%), or a barometer (4.9%). Based on a rating scale of 1-5 with 5 being the most important, respondents felt that "detecting all seizures" (4.73) is the most important device feature followed by "text/email alerts" (4.53), "comfort" (4.46), and "battery life" (4.43) as an equally important group of features. Respondents felt that "not knowing device is for seizures" (2.60) and "multiple uses" (2.57) were equally the least important device features. Average ratings differed significantly across age groups for the following features: button, multiuse, not knowing device is for seizures, alarm, style, and text ability. The p-values were all<0.002. Eighty-two point five percent of respondents [95% confidence interval: 80.0%, 84.7%] were willing to pay more than $100 for a wearable seizure detection device, and 42.8% of respondents [95% confidence interval: 39.8%, 45.9%] were willing to pay more than $200. CONCLUSIONS: Our survey results demonstrated that patients and caregivers have design features that are important to them in regard to a wearable seizure detection device. Overall, the ability to detect all seizures rated highest among respondents which continues to be an unmet need in the community with epilepsy in regard to seizure detection. Additional uses for a wearable were not as important. Based on our results, it is important that an alert (via test and/or email) for events be a portion of the system. A reasonable price point appears to be around $200 to $300. An accelerometer was less important to those surveyed when compared with the use of heart rate, oxygen saturation, or muscle twitches/signals. As further products become developed for use in other health arenas, it will be important to consider patient and caregiver desires in order to meet the need and address the gap in devices that currently exist.

Patients exposed to diagnostic head and neck radiation for the management of shunted hydrocephalus have a significant risk of developing thyroid nodules.

PURPOSE: External radiation to the head and neck can lead to an increased incidence of thyroid nodules. We investigated whether patients requiring repeated head and neck imaging for the management of shunted hydrocephalus had a higher incidence of ultrasound-detected thyroid nodules compared to reports of comparable age. METHODS: Patients treated at our institution for shunted hydrocephalus from 1990 to 2003 were contacted. Enroled patients underwent a thyroid ultrasound. Demographic data and radiation exposure history were obtained retrospectively. RESULTS: Thyroid nodules were identified sonographically in 15/112 patients (13.6 %). Patients with thyroid nodules were older (mean 24.3 ± 7.6 years) than those without (mean 18.4 ± 8.0 years) (p = 0.005). Those with a detectable thyroid nodule had a longer follow up time compared to those who did not (mean 21.9 ± 5.5 vs. 15.1 ± 7 years, respectively) (p = 0.018). CONCLUSION: Patients with shunted hydrocephalus are exposed to substantial head and neck radiation from diagnostic imaging and have a higher incidence of thyroid nodules detected by ultrasonography. These patients should be provided ongoing surveillance for detection of thyroid nodules and the possibility of malignancy.