Automated seizure detection using wearable devices (ILAE and IFCN)

This clinical practice guideline (CPG) aims to offer healthcare professionals advice on using wearable devices for automated seizure detection in epilepsy patients in outpatient settings. Developed by the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology, the CPG was crafted using the ILAE Epilepsy Guidelines Working Group's methodology. We conducted a systematic review following the PRISMA guidelines and evaluated the evidence using the GRADE system to formulate our recommendations.

Our findings reveal strong evidence supporting the accuracy of automated seizure detection for generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS). We therefore recommend the use of wearable automated seizure detection devices for these patients, particularly when precise detection is clinically beneficial.

However, evidence for other seizure types is less robust. While alarms generated by these devices may not always lead to significant clinical outcomes, we advise using clinically validated devices, especially for unsupervised patients where rapid intervention is crucial. This is a weak recommendation based on current data.

Given the limitations, we do not endorse the widespread clinical use of current devices for other seizure types. Further research is essential to enhance the performance of automated seizure detection systems and to establish their accuracy and clinical utility.