ECG-Based Detection of Epileptic Seizures in Real-World Wearable Settings: Insights from the SeizeIT2 Dataset

Epilepsy is a prevalent neurological disorder where reliable seizure tracking is essential for patient care. Existing documentation often relies on self-reports, which are unreliable, creating a need for objective, wearable-based solutions. Prior work has shown that Electrocardiography (ECG)-based seizure detection is feasible but limited by small datasets. This study addresses this issue by evaluating Matrix Profile, MADRID, and TimeVQVAE-AD on SeizeIT2, the largest open wearable-ECG dataset with 11,640 recording hours and 886 annotated seizures. Using standardized preprocessing and clinically motivated windows, we benchmarked sensitivity, false-alarm rate (FAR), and a Harmonic Mean Score integrating both metrics. Across methods, TimeVQVAE-AD achieved the highest sensitivity, while MADRID produced the lowest FAR, illustrating the trade-off between detecting seizures and minimizing spurious alerts. Our findings show ECG anomaly detection on SeizeIT2 can reach clinically meaningful sensitivity while highlighting the sensitivity-false alarm trade-off. By releasing reproducible benchmarks and code, this work establishes the first open baseline and enables future research on personalization and clinical applicability.