SynthesisFrontiers in bioengineering and biotechnology2026
Automated seizure detection using wearable devices: updated systematic review and meta-analysis of tonic-clonic and focal seizure detection.
Synthesis in Frontiers in bioengineering and biotechnology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Wearable devices have emerged as promising tools for continuous seizure monitoring in patients with epilepsy. This study aimed to update the evidence on the diagnostic performance of non-invasive wearable sensors for seizure detection, extending the previous systematic review by Naganur et al., which included studies published up to November 10, 2021. Methods: A systematic review and meta-analysis were conducted using studies published up to July 15, 2025. Eligible studies used video-electroencephalographic (video-EEG) monitoring as the reference standard and reported sensitivity and false alarm rate (FAR) for wearable seizure detection devices. Included devices comprised wrist-worn and surface-worn sensors measuring parameters such as accelerometry, heart rate, and electrodermal activity. Results: Thirty-one studies evaluating tonic-clonic seizures (TCS) were included, comprising 2,128 patients and 112,542 h of video-EEG monitoring. The pooled sensitivity for TCS detection was 89.9% (95% CI: 85.0-93.9%), with a FAR of 1.43 per 24 h (95% CI: 1.22-1.64). Wrist-worn devices demonstrated slightly higher sensitivity (90.3%) but higher FAR (1.7/24 h) than surface devices (88.1% sensitivity; 0.8/24 h FAR). For focal seizures, nine studies involving 660 patients and 15,056 monitoring hours were included. The pooled sensitivity was 73.5% (95% CI: 57.4-87.0%) and the FAR was 2.85 per 24 h (95% CI: 1.40-5.81). Excluding one study that reported only overall sensitivity increased focal seizure sensitivity to 78.4%. Discussion: Wearable devices demonstrate high sensitivity for detecting tonic-clonic seizures, although false alarms remain a challenge. Detection performance for focal seizures is substantially lower, highlighting the need for improved algorithms and multimodal sensing approaches. These findings support the continued development of wearable technologies for real-world epilepsy monitoring and management.
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