This study aims to assess responsiveness during seizures through a “responsometer” app on a wristwatch and standardize ictal cognitive testing in the epilepsy monitoring unit (EMU).

Ictal cognition can be impaired during seizures and currently there is no international consensus for peri-ictal cognitive testing of patients in the EMU. The SmartWatch responsometer app (developed by SmartMonitor) uses sensory, language, and visual stimuli to measure ictal cognition, responsiveness, and recall. Furthermore, by training staff members to activate the watch during a seizure, we hope to reduce the time from seizure detection (push button or EEG change) to medical personnel coming into the room.

This ongoing, prospective study is recruiting about 50 adults aged 18 and older with epilepsy or epilepsy imitators admitted to the Stanford EMU. Patients undergoing Phase II monitoring, with significant intellectual impairment, or are unable to operate the watch are excluded from the study. During a seizure, subjects are tested with the app or the validated responsiveness in epilepsy scale (RES). The primary outcome is ictal cognitive testing using the watch vs. RES.

Based on limited data thus far (5 seizures collected from 3 patients), the SmartWatch is able to assess cognitive function during a seizure with most patients having a decline in cognitive function during seizures (about a 34% decrease from baseline score). Subgroup analysis comparing level of responsiveness in different seizure types will be done once enough data is compiled.

Testing responsiveness during seizures via the responsometer app on a wristwatch is feasible. The study is ongoing and data will be collected and analyzed to see if the app is more efficient than the RES. Furthermore, by implementing this study, we have been able to reduce the time from seizure detection to medical personnel entering the room, thus improving patient safety and bedside assessment.