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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.
Footnotes
Author contributions: Rosalind Picard hypothesized the EDA finding and drafted the original manuscript. Matteo Migliorini conducted physiologic data analysis. Chiara Caborni conducted physiologic data analysis. Giulia Regalia conducted physiologic data analysis. Francesco Onorati verified the physiologic data analysis and wrote up these parts. Daniel Friedman helped interpret clinical data and revised the manuscript with clinical insights and guidance. Orrin Devinsky helped obtain and interpret clinical data and revised the manuscript with clinical insights and guidance.
Study funding: No targeted funding reported.
Disclosure: R. Picard is cofounder of Empatica and is a shareholder in Empatica. She serves as (unpaid, part-time) chief scientist and chairman of Empatica's board of directors. She is coinventor on an MIT-owned patent that relates to this work. M. Migliorini is an employee of Empatica and holds stock options in Empatica. C. Caborni is an employee of Empatica and holds stock options in Empatica. F. Onorati is an employee of Empatica and holds stock options in Empatica. G. Regalia is an employee of Empatica and holds stock options in Empatica. D. Friedman has disclosures not relevant to this manuscript. His NYU team has received a grant through the Epilepsy Foundation that involved research with Empatica devices. O. Devinsky has disclosures not relevant to this manuscript. His NYU team has received a grant through the Epilepsy Foundation that involved research with Empatica devices. Go to Neurology.org for full disclosures.
- Received December 11, 2016.
- Accepted in final form May 1, 2017.
- © 2017 American Academy of Neurology
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