The objective of this clinical practice guideline (CPG) is to provide recommendations for healthcare personnel working with patients with epilepsy on the use of wearable devices for automated seizure detection in patients with epilepsy, in outpatient, ambulatory settings. The Working Group of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) developed the CPG according to the methodology proposed by the ILAE Epilepsy Guidelines Working Group. We reviewed the published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and evaluated the evidence and formulated the recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We found high level of evidence for the accuracy of automated detection of generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS) and recommend the use of wearable automated seizure detection devices for selected patients when accurate detection of GTCS and FBTCS is recommended as a clinical adjunct. We also found a moderate level of evidence for seizure types without GTCS or FBTCS. However, it was uncertain whether the detected alarms resulted in meaningful clinical outcomes for the patients. We recommend using clinically validated devices for automated detection of GTCS and FBTCS, especially in unsupervised patients, where alarms can result in rapid intervention (weak/conditional recommendation). At present, we do not recommend clinical use of the currently available devices for other seizure types (weak/conditional recommendation). Further research and development are needed to improve the performance of automated seizure detection and to document their accuracy and clinical utility.

Behavioral and Social Neuroscience Research Group Central European Institute of Technology Masaryk University Brno Czech Republic

Brno Epilepsy Center Department of Neurology St Anne's University Hospital and Medical Faculty of Masaryk University Brno Czech Republic

Department of Clinical Medicine Aarhus University Aarhus C Denmark

Department of Clinical Neurophysiology Aarhus University Hospital Aarhus C Denmark

Department of Clinical Neurophysiology Danish Epilepsy Centre and Aarhus University Hospital Dianalund Denmark

Department of Clinical Neurosciences and Clinical Research Unit Cumming School of Medicine University of Calgary Calgary Canada

Department of Clinical Neurosciences Centre Hospitalier Universitaire Vaudois Université de Lausanne Lausanne Switzerland

Department of Neurology Barrow Neurological Institute Phoenix AZ USA

Department of Neurology Mayo Clinic Jacksonville Florida USA

Department of Neurology Xuanwu Hospital Capital Medical University Beijing China

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