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Wrist sensor reveals sympathetic hyperactivity and hypoventilation before probable SUDEP

  1. Orrin Devinsky, MD
  1. From Massachusetts Institute of Technology (R.W.P.); Empatica, Inc. (R.W.P., M.M., C.C., F.O., G.R.), Cambridge, MA; and NYU Langone School of Medicine (D.F., O.D.), New York, NY.
  1. Correspondence to Dr. Picard: picard{at}media.mit.edu
Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for travel or speaker honoraria:

  1. Speaker travel expenses and/or honorarium from: ACM IUI, Seoul Digital Forum Korea, Trinity Institute, Society for Ambulatory Assessment, EmTech, CogSci, International Symposium on Pervasive Computing Paradigms for Mental Health, Scripps Mhealth, IEEE BCTM, Current Trends in Autism, University of PA, IEEE HCI, Veritas Forum (Georgia Tech, Harvard Medical School), Continuum, NIH, NIMH, Profectum, ETH Zurich, University of Bern, Florida International University, Lennox- Gastaut Society Foundation, XTech, NeuroTech, Body Sensor Networks, FDA OSEL, Santa Fe Institute, University of Florida, IEEE ISWC, ACM UBICOMP, Roanoke College, University of Notre Dame, Brown University, American Neuromodulation Society, USGov MITRE, ACM AAAI, Imperial College London, Deloitte, and Wharton/U Penn.

Editorial Boards:

  1. IEEE Journal Biomedical and Health Informatics, Guest Editor Special Issue, 2014-2015

Patents:

  1. (1) Patents related to the sensing of affective physiological data and to how autonomic data can characterize peri-ictal events

Publishing Royalties:

  1. (1) Affective Computing, MIT Press, 1997-present

Employment, Commercial Entity:

  1. (1) MIT Media Lab, Professor, since 1991 (2) Empatica, Chief Scientist and Chairman, since 2014

Consultancies:

  1. (1) Empatica (2) Consultant for Apple & Intel as expert witness (see list below)

Speakers' Bureaus:

  1. (1) SternStrategy

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. (1) Media Lab Member Consortium at MIT (2) MedImmune (3) Takeda/Millennium (4) Deloitte (5) Steelcase (6) NEC (7) Cisco (8) LKK (9) Bose

Research Support, Government Entities:

  1. (1) NIH (R01GM105018) PI on Subcontract, 2013-2018

Research Support, Academic Entities:

  1. (1) Mass General Hospital/MIT Challenge Award (2) University of Cambridge RG-70353 Marie Curie Award (3) University of Passau

Research Support, Foundations and Societies:

  1. (1) Simons Foundation Autism Research Initiative (2) Robert Wood Johnson Foundation

Stock/Stock Options/Board of Directors Compensation:

  1. Empatica Board of Directors, Travel expenses

License fee payments, Technology or Inventions:

  1. (1) Affective computing technology patents owned by MIT, payment of sublicense fees by Affectiva

Royalty Payments, Technology or Inventions:

  1. (1) MIT Case no 12957T entitled Wearable Physiological Sensing System with Wireless Communication, 2011- (2) MIT Case no 13335T entitled Apparatus for Real-time and Offline Measurement, Quantifying, Tagging, and Prediction of Person(s) Experiences, 2011- (3) MIT Case no 14177TK entitled An Automated Method for Simultaneous Measurement of Multi-User Physiological Parameters from Digital Color Video, 2011- (4) MIT Case no 13146T entitled A Multi-Modal Affective- Cognitive Technique for Product Evaluation with Computational Models for Predicting Customer Decision, 2011-

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. (1) Affectiva, 2009-present (2) Empatica, 2013-present

Legal Proceedings:

  1. Intel, consultant and expert witness Apple, consultant and expert witness

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. empatica inc, data scientist, 2

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. Empatica Inc

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. Empatica Inc., data scientist, 2

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. Empatica Inc., 1

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. (1) Empatica, Data Scientist, 2014-till now

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. (1) Empatica, 2015-till now

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. (1) Empatica Inc, data scientist, 2015-now

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. (1) Empatica Inc, 2015-till now

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

Scientific Advisory Boards:

  1. 1) Marmo Health, scientific advisory board 2) Supernus, advisory board

Gifts:

  1. NONE

Funding for travel or speaker honoraria:

  1. 1) Neuropace, speaker honorarium 2) Liva Nova, speaker honorarium

Editorial Boards:

  1. NONE

Patents:

  1. 1) Minimally invasive long term seizure monitor

Publishing Royalties:

  1. Dr. Friedman receives royalties from the sale of What Do I Do Now: Epilepsy (Oxford University Press, 2011)

Employment, Commercial Entity:

  1. Dr. Friedman receives salary support from The Epilepsy Study Consortium, a non-profit organization dedicated to improving the lives of epilepsy patients, and devotes 18% of his time to work done for the Consortium, supported by payments made by the Consortium to NYU. The Consortium receives payments from a large number of pharmaceutical companies for consulting activities. All payments are made to The Consortium and not to Dr. Friedman directly. Within the past year, the Epilepsy Study Consortium received payments from the companies listed below. All payments are reported annually and reviewed by NYU?s Conflict of Interest Committee. Accorda Pharmaceuticals, Alezxa Pharmaceuticals, GW Pharmaceuticals Eisai Medical Research, Pfizer, SK Life Science, Pfizer, Upsher Smith and Zynerba.

Consultancies:

  1. 1) Cyberonics 2) UCB, Inc 3) GW Pharmaceuticals

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. UCB Biosciences Inc

Research Support, Government Entities:

  1. 1) NINDS, Site-PI; R01 NS084142 2013-2018 2) NINDS, Site-PI; U01 NS090407 2014-2019 3) NINDS, Co-I; U01 NS090415 2014-2019 4) CDC, Co-I; SIP U48DP005008 2014-2019 5) NIMH, Co-I ; R01MH107396 2015-2020

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. Epilepsy Foundation, FACES (finding a cure for epilepsy and seizures).

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. Cognitive and Behavioral Neurology; Oxford University Press, 2002 Epilepsy: Patient and Family Guide, Demos Press, 2008 Alternative Therapies for Epilepsy, Demos Press, 2012 Epilepsy In Children, Demos Press, 2015

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other activities:

  1. Scientific Advisory Board for Pairnomix, Egg Rock, and Tilray. Principal Investigator, North American SUDEP Registry and Sudden Unexplained Childhood Death Registry and Research Collaborative

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. Ongoing Support NIH U01 NS090407 (PI: S. Lhatoo) 09/30/14 ? 7/31/2019 Center for SUDEP Research: Autonomic and Imaging Biomarkers of SUDEP The principal aim is to identify the central mechanisms and markers of autonomic and respiratory dysfunction that underlie the fatal scenario in SUDEP, and thus, provide insights into potential interventions. Role: Co-Investigator NIH U01 NS090415 (PIs: M. Thom, O. Devinsky) 9/30/14 ? 7/31/2019 Center for SUDEP Research: The Neuropathology of SUDEP: The central autonomic network, serotonin and adenosine The proposed studies will leverage the world?s largest collection of SUDEP brains to explore the role of specific histopathological and biomolecular abnormalities in the brain, focusing on critical brainstem regions and the neurotransmitters serotonin and adenosine. Role: PI National Center for Chronic Disease Prevention and Promotion U48 DP 005008-01S4 (PIs: T. Spruill, O. Devinsky) 9/1/2014 ? 8/31/2019 Managing Epilepsy Well: Adapting Project UPLIFT for Hispanic Adults with Epilepsy This project proposes to translate and culturally tailor Project UPLIFT for Hispanic patients, then test and disseminate the Spanish version. Project UPLIFT is an evidence-based intervention that incorporates cognitive behavioral and mindfulness techniques to reduce depression in adults with epilepsy. Role: Co-Investigator NIH R01 EB 018308 (PIs: K.T. Block, H. Chandarana) 9/1/2014 - 8/31/2019 Comprehensive Motion-Robust Pediatric MR Imaging Using Radial Acquisitions The proposed project aims to develop novel motion-robust magnetic resonance imaging techniques and evaluate them in clinical studies for imaging of pediatric patients with Tuberous Sclerosis. Role: Co-Investigator

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. Pairnomix - Stock Tilray - Stock Egg Rock - Stock

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

We report a probable sudden unexpected death in epilepsy (SUDEP) in a 20-year-old man wearing a smartwatch that recorded wrist motion via 3-axis accelerometer (ACC) and electrodermal activity (EDA). EDA reflects sympathetic activity without parasympathetic antagonism.1 The smartwatch (Empatica [Milan, Italy] Embrace, with CE Medical clearance from the European Union for seizure detection) issued an alert, received by the caregiver at 8:50 am, indicating a probable convulsive seizure. An adult trained in cardiopulmonary resuscitation (CPR) arrived at 9:05 am, found the patient pulseless, prone, face in pillow with mucus in his mouth, and commenced CPR for 15 minutes without recovery. The family declined autopsy.

  • Received December 11, 2016.
  • Accepted in final form May 1, 2017.
  1. Published online before print July 12, 2017, doi: 10.1212/WNL.0000000000004208 Neurology 10.1212/WNL.0000000000004208
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Print ISSN: 0028-3878
Online ISSN: 1526-632X
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