Elizabeth Donner, Orrin Devinsky, and Daniel Friedman; guest editors Stephen H. Friend, Geoffrey S. Ginsburg, Rosalind W. Picard, Jeffrey M. Drazen. "Wearable Digital Health Technology for Epilepsy." New England Journal of Medicine 2024; 390:736-745. DOI: 10.1056/NEJMra2301913

Abstract

For people living with epilepsy, as well as their families and caregivers, epilepsy is an unpredictable, challenging, and often frightening disorder, especially for the one third of people with epilepsy who have ongoing seizures despite medical treatment. The paroxysmal nature of Sam’s seizures makes it difficult for his parents to allow him the usual independence of a teenager. They fear he will have a seizure when no one is around to keep him safe. These fears are valid. Seizure-related injuries and accidents are most often associated with generalized tonic–clonic seizures, and up to 25% of people with such seizures have had at least one severe injury in their lifetime. Furthermore, generalized tonic–clonic seizures are the strongest risk factor for sudden unexpected death in epilepsy, the leading cause of epilepsy-related death. The average risk of sudden, unexpected death for a person living with epilepsy is 1% per decade. Thus, each year, sudden, unexpected death claims 1 in 1000 lives among people with epilepsy; the risk is 1 in 250 for those with severe forms of epilepsy. The risk of death increases with the frequency of generalized tonic–clonic seizures but is modified by living conditions. Living alone or sharing a household but not a bedroom is associated with an increased risk of sudden death; a person who sleeps alone and has frequent tonic–clonic seizures has the highest risk.