At-home video monitoring for epilepsy
Topic Status Complete
At-home video monitoring for the diagnosis and management of epilepsy
Outcome of the appraisal
At-home video monitoring for the diagnosis and management of epilepsy, including systems utilising artificial intelligence, shows promise but the clinical and economic evidence is insufficient to support routine adoption.
There was limited clinical effectiveness evidence identified. In one study, the Nelli-hybrid system demonstrated good diagnostic sensitivity in identifying major motor seizures, but this was conducted in a hospital setting rather than at home. Opportunistic video recording of seizures at home is acknowledged as a useful source of supplementary information for clinicians.
Whilst the economic impact comparing the Nelli-hybrid system to video electroencephalogram was explored, the full economic impact could not be assessed due to limitations in the clinical effectiveness evidence.
Further high quality prospective comparative evidence reporting full diagnostic accuracy, quality of life and acceptability across different patient groups in the home setting is recommended.
Why was this topic appraised?
Epilepsy causes recurrent seizures due to abnormal brain activity, with symptoms like jerking movements and unusual sensations, which are often underreported by patients and carers. Video electroencephalogram (vEEG) and ambulatory electroencephalogram (aEEG) help diagnose and monitor seizures but can be resource intensive. Remote video recording at home may be an alternative to vEEGs and aEEGs in diagnosing or monitoring the condition, which may overcome barriers to access and be more tolerable for patients.
This topic was suggested to HTW by Neuro Event Labs (Tampere, Finland), the manufacturers of the at-home video monitoring system Nelli.
Plain language summary
Epilepsy is a condition where sudden, uncontrolled bursts of electrical activity in the brain stops normal brain activity. These bursts are known as ‘episodes’. They typically result in seizures. Not all seizures are the result of epilepsy. Epileptic seizures can include such things as:
- uncontrollable jerking and shaking, called a “fit”
- losing awareness and staring blankly into space
- becoming stiff
- strange sensations, such as a “rising” feeling in the tummy, unusual smells or tastes, and a tingling feeling in arms or legs
- collapsing, losing consciousness and memory loss
Epilepsy usually requires 1 or more episodes of a seizure to be diagnosed. Patients are asked to keep track of their seizures at home, including the length and frequency of episodes. This can be difficult as seizures can occur at any time of the day or night and patients may need help recognising or recording a seizure. Diagnosis is complicated as there may be other reasons why someone is experiencing seizures. The brain can be monitored for unusual activity by using an electroencephalogram (EEG) and brain scans. However, this relies on a seizure taking place at the same time as the EEG. Patients may need to stay in hospital for several days to achieve this.
At-home video monitoring includes setting up a camera at home to capture seizures on video as they happen. The device(s) conducts a report of brain activity that can be used for diagnosis and ongoing treatment of epilepsy. This eliminates the need to go into hospital for monitoring and reliance on patients and family for accurate record keeping.
Health Technology Wales looked for evidence on the use of at-home video monitoring for diagnosis and treatment of epilepsy. At-home video monitoring for the diagnosis and management of epilepsy, including systems utilising artificial intelligence, shows promise but the clinical and economic evidence is insufficient to support routine adoption.
Guidance
GUI064 08.2025
Evidence Appraisal Report
EAR064 08.2025
Topic Exploration Report
TER526 05.2024 (superseded by EAR064 08.2025)
Health Technology Wales Partners
