Research Strategy 1. Executive Summary of Predicate SBIR Phase I Grant and Team The overall goal of our predicate SBIR Phase I grant is to validate the Eysz mobile health (mHealth) application and develop algorithms to diagnose and monitor childhood absence epilepsy (CAE) in the clinical setting. Eysz, Inc. is developing a mobile health (mHealth) application and algorithms to remotely diagnose and monitor CAE to improve outcomes. Currently, absence seizures are challenging to identify,leading to diagnostic delays and difficulty measuring treatment efficacy. Untreated seizures place children at risk for accidental injury and learning loss. The gold standard for seizure detection is video EEG (VEEG), but it is expensive, limited to clinical settings, and hard to access. As a result, clinicians rely on self-reports, despite studies showing patients report only 6% of all absence seizures, and caregivers report only 14%. Even primary care providers have difficulty identifying absence seizures and rely on VEEG, referring 5 patients for every 1 diagnosed. Once diagnosed with CAE, children are started on anti-seizure medications (ASM), which result in seizure freedom in less than 60% of children. However, no new treatments have been approved since the 1990s, partially due to difficulty measuring seizures.4 Other strategies to monitor seizures, such as ambulatory EEG, lack the sensitivity and specificity of VEEG, and can add to the stigma of people with epilepsy. Thus, there is a critical need for a remote diagnostic/monitoring tool for absence seizures. The aim of the SBIR proposal is to test and further develop an mHealth app that uses (1) supervised guided hyperventilation (HV), with (2) eye movement and facial biometric data to monitor seizure susceptibility and treatment responses in CAE. Achieving these goals will decrease costs of care, morbidity, and mortality and improve quality of life for those with childhood absence epilepsy. CAE is the most common pediatric epilepsy syndrome, affecting 10–17% of all children with epilepsy. Seizures occur many times daily and consist of brief losses of consciousness (LOC), with immediate return to baseline awareness and activity. Seizures typically manifest as staring spells, sometimes with rhythmic eye blinking or motor automatisms. As LOC may occur at any time without warning, absence seizures have a significant impact on quality of life (QOL), and accidental injury is common, with 20% of young adults—3% per year—suffering an injury during a seizure. The clinical course of CAE is variable, and remission rates are far lower than in other idiopathic epilepsies. In five prospective cohort studies, only 57–74% achieved seizure freedom. Thus, there is a critical need for new therapeutics for absence epilepsy and better tools for monitoring therapeutic responses. The current standard of care for measuring treatment outcomes is self-reported data. Large-scale clinical trials, including those testing new antiseizure...