Automated seizure detection with noninvasive wearable devices: A systematic review and meta‐analysis

OBJECTIVE: This study was undertaken to review the reported performance of noninvasive wearable devices in detecting epileptic seizures and psychogenic nonepileptic seizures (PNES). METHODS: We conducted a systematic review and meta‐analysis of studies reported up to November 15, 2021. We included studies that used video‐electroencephalographic (EEG) monitoring as the gold standard to determine the sensitivity and false alarm rate (FAR) of noninvasive wearables for automated seizure detection. RESULTS: Twenty‐eight studies met the criteria for the systematic review, of which 23 were eligible for meta‐analysis. These studies (1269 patients in total, median recording time = 52.9 h per patient) investigated devices for tonic–clonic seizures using wrist‐worn and/or ankle‐worn devices to measure three‐dimensional accelerometry (15 studies), and/or wearable surface devices to measure electromyography (eight studies). The mean sensitivity for detecting tonic–clonic seizures was .91 (95% confidence interval [CI] = .85–.96, I (2) = 83.8%); sensitivity was similar between the wrist‐worn (.93) and surface devices (.90). The overall FAR was 2.1/24 h (95% CI = 1.7–2.6, I (2) = 99.7%); FAR was higher in wrist‐worn (2.5/24 h) than in wearable surface devices (.96/24 h). Three of the 23 studies also detected PNES; the mean sensitivity and FAR from these studies were 62.9% and .79/24 h, respectively. Four studies detected both focal and tonic–clonic seizures, and one study detected focal seizures only; the sensitivities ranged from 31.1% to 93.1% in these studies. SIGNIFICANCE: Reported noninvasive wearable devices had high sensitivity but relatively high FARs in detecting tonic–clonic seizures during limited recording time in a video‐EEG setting. Future studies should focus on reducing FAR, detection of other seizure types and PNES, and longer recording in the community.