Digital biomarkers and ambulatory seizure detection in epilepsy clinical trials

There is growing demand for reliable, real-time seizure detection technologies to improve epilepsy management and enhance data collection in clinical trials. This review examines various ambulatory seizure detection modalities, including electroencephalography (EEG), surface electromyography (sEMG), accelerometry, electrocardiography (ECG), and photoplethysmography (PPG), with a focus on their clinical utility, performance, and implementation challenges. While these technologies show significant promise, achieving consistent and accurate detection remains a major hurdle. Key barriers include device usability, limited seizure-type coverage, and the need for rigorous validation. A multi-stakeholder approach, involving researchers, clinicians, and patients, will be essential for designing tools that are fit for purpose and realizing their full potential in both epilepsy care and clinical research.