Optimizing Therapy in Epilepsy Using Seizure Forecasts Via EEG and Wearables

Trial statusRecruiting
Trial phaseEarly Phase 1
Trial typeInterventional
Biological sexAll
Age18-75
SponsorMayo Clinic

About this trial

Mayo Clinic is conducting a research study to test a new approach to managing seizures in people with epilepsy whose seizures have not been fully controlled with regular medications. The study uses a small sensor placed just under the skin (not inside the brain) that continuously records electrical brain activity. This information is used to train a personalized computer algorithm that learns your individual seizure patterns and forecasts when a seizure is more likely to occur. If you are eligible and choose to participate, you would receive advance warning of elevated seizure risk, allowing you to take a fast-acting medication before a seizure happens. This medication would be in addition to the regular medicines prescribed by your doctor. The goal of the study is to understand whether this kind of forecasting system is safe, comfortable to live with, and capable of helping people gain more control over their seizures with a minimum amount of additional medication.

Participation involves a minor surgical procedure to implant a small electrode under the skin above your ear that records your brain's electrical signals continuously over time. You would also wear a smart watch during the study. For the first six months, the system collects data to personalize your seizure forecast model and would not give you an alert. In the second six months, we would calculate your daily seizure risk and you would receive alerts on days when your risk is elevated. On these higher seizure risk days you would take a prescribed fast-acting nasal spray medication. The study is open to adults who continue to have 2 or more seizures per month in spite of having tried at least two antiseizure medications in the past, and whose seizures have shown involvement of the temporal lobe. All study-related procedures, devices, and study medication are provided at no cost to participants. Participants receive financial compensation for their time, and travel expenses to and from Mayo Clinic Rochester are reimbursed for anyone traveling more than 100 miles. If you are interested in learning more, please contact our research coordinator by email at [email protected].

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

disabling seizure (i.e. involving loss of awareness, motor control, speech, or other essential functions) counts at least 2 per month on average over the preceding 3 months, established by verbal history or caregiver report.

For 3 months prior to enrollment, subject's AED dosages have been stable (less than a 25% change in dosage) and subject has had at least two seizures per month, on average, with a seizure-free interval not to exceed 60 days. Seizures must be separated by a minimum of four hours not to be considered part of a cluster. A cluster, for the purpose of this criterion, shall be considered a single seizure.

With the exception of epilepsy, subject must be medically and neurologically stable.

Age 18 to 75.

Disqualifiers

For 3 months prior to enrollment, subject's AED dosages have not been stable (greater than 25% change in dosage), or subject has had more than 30 disabling seizures per month, on average, or more than 10 seizure days per month, on average.

Subject needs to have magnetic resonance imaging during the study period.

Subject has a substance abuse history (alcohol, prescription, or illicit medications) within the preceding two years.

Subject participated in another drug or device trial within the preceding 30 days.

Trial design

Design model

Single group

Treatments tested in this trial

  • UNEEG SubQ device, seizure forecasts, nasal diazepam

    Device

    Subjects will be implanted with the UNEEG SubQ device in the neurosurgical operating suite. Electrodes will be placed over the temporal lobe of the hemisphere established as the origin of seizures by previous EEG monitoring. Only one UNEEG device will be placed, and only the seizure onset hemisphere will be covered. Subjects will have individualized seizure forecast models created, and will take a supplemental antiseizure medicine during periods of elevated seizure risk.

  • Preventative Medication (PM)

    Drug

    Subjects will take nasal diazepam in response to pre-seizure alerts to evaluate the potential for this medication to prevent seizures.

Treatment groups

12 Participants
are divided into 1 treatment group
Group A: subscalp EEGExperimental treatment 2 interventions

Trial outcomes

Primary outcomes

1

Safety and Adverse Events

VALTOCO discontinuation rate due to TEAE below 10% of subjects

Time frame
12 months
2

Safety- cardiorespiratory events

no observed drug-related serious cardiorespiratory events

Time frame
12 months
3

Feasibility outcome

greater than 75% data collection adherence (18 hours/day) with the UNEEG and Apple Watch systems on average during the prospective forecasting portion of the study for over 90% of participants

Time frame
12 months
4

Preseizure alert feasibility

greater than 80% of pre-seizure alerts resulting in VALTOCO administration within 90 minutes in over 90% of participants

Time frame
12 months

Secondary outcomes

1

Reduction in seizure rates during the prospective phase of the trial compared to baseline

For each subject, we will compare detected seizure rates during the Training and Validation phases (baseline) to rates during the prospective forecast-triggered VALTOCO phase, and report the per-subject change.

Time frame
12 months
2

Quality of Life Inventory and seizure related impact scores

Change in quality of life in the prospective phase of the trial compared to baseline: Measures determined from the QUOLIE-31

Time frame
Baseline, 6 months, 12 months
3

Seizure related severity score

Change in seizure severity score in the prospective phase of the trial compared to baseline: Measures determined from the SERIAS (Foster, Conquest et al. 2025) neuropsychometric test

Time frame
Baseline, 6months, 12months

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Mayo Clinic

Lead sponsor

National Institute of Neurological Disorders and Stroke (NINDS)

Collaborator