App Identifies Stress and Missed Sleep as Seizure Triggers

BOSTON—Research using an Apple Watch app to track seizures in people with epilepsy finds that common triggers include stress and missed sleep, according to a preliminary study presented at the 69th Annual Meeting of the American Academy of Neurology.

Gregory Krauss, MD

Gregory Krauss, MD, Professor of Neurology at Johns Hopkins University in Baltimore, and colleagues conducted the study to identify common seizure triggers and estimate their relative frequency in a US population of people with epilepsy. For the 10-month study, 598 people signed up to track their seizures with an app called EpiWatch that had been created using ResearchKit, a software framework designed by Apple to make it easy for researchers to gather data more frequently and more accurately from participants using an iPhone or Apple Watch.

When a participant felt a seizure aura starting, he or she opened the app. Using the Apple Watch's biosensors, EpiWatch recorded the participant's heart rate and movements for 10 minutes. The app asked him or her to perform tasks to test responsiveness. After the seizure ended, the participant was given a brief survey about seizure type, aura, loss of awareness, and possible seizure triggers.

"The data collected will help researchers better understand epilepsy, while helping people with epilepsy keep a more complete history of their seizures," said Dr. Krauss. "The app also provides helpful tracking of seizures, prescription medication use, and drug side effects--activities that are important in helping people manage their condition."

In all, 40% of the group tracked a total of 1,485 seizures, and 177 participants reported what triggered their seizures. Stress was the most common trigger and was linked to 37% of seizures. Participants also identified lack of sleep as a trigger for 18% of the seizures, menstruation for 12%, and overexertion for 11%. Other reported triggers included diet (9%), missed medications (7%), and fever or infection (6%). Demographics and seizure types were generally similar between participants who reported seizure triggers and those who did not. Seizure triggers did not vary by the type of seizure people had.

The investigators found that stress was more commonly reported as a trigger for participants who worked full-time (35%), compared with those who worked part-time (21%), were unemployed (27%), or were disabled (29%). Nonadherence to medication was reported slightly more frequently among younger participants (ie, ages 16 to 25), among whom 40% reported a missed medication as a trigger, compared with older participants (ie, ages 26 to 66), among whom 34% reported a missed medication.

"Seizures are very unpredictable," said Dr. Krauss. "Our eventual goal is to be able to use wearable technology to predict an oncoming seizure. This could potentially save lives, as well as give people with epilepsy more freedom. The data collected in this study help us take a step in that direction."