Performance, impact and experiences of using wearable devices for seizure detection in community-based settings: a mixed methods systematic review

Background: There is growing scientific evidence that wearable devices for seizure detection (WDD) perform well in controlled environments. However, their impact on the health and experience of patients with epilepsy (PWE) in community-based settings is less documented. We aimed to synthesize the scientific evidence about the performance of wearable devices used by PWE in community-based settings, and their impact on health outcomes and patient experience. Methods: We performed a mixed methods systematic review. We performed searches in PubMed, Google Scholar, Web of Science and Embase from inception until December 2022. Independent reviewers checked studies published in English for eligibility based on predefined inclusion and exclusion criteria. We collected information about studies, wearable devices, their performance, and their impact on health outcomes and patient experience. We used a narrative method to synthetize separately data for each question. We assessed the quality of included studies with the QUADAS-C and MMAT tools. Results: On a total of 9,595 publications, 10 studies met our eligibility criteria. Study populations included mostly PWE who were young (<= 18 years) and/or their caregivers. Participants were living at home in most studies. Accelerometer was the wearable device mostly used for seizure detection. Wearable device performance was high (sensitivity >= 80% and false alarm rate <= 1/day), but some concerns remained due to false alarms according to qualitative studies. There was no significant effect of wearable device on quality of life (QoL) measures and no study reported quantitatively other health outcomes. Qualitative studies reported positive effect of wearable devices on QoL, seizure management and seizure-related injuries. Overall, patients reported that the device, especially the accelerometer, was suitable, but when the device was too visible, they found it uncomfortable. Study quality was low to medium. Conclusions: There is low quality scientific evidence supporting the performance of WDD in a home environment. Although qualitative findings support the positive impacts of wearable devices for patients and caregivers, more quantitative studies are needed to assess their impact on health outcomes such as QoL and seizure-related injuries.