Wearable Artificial Intelligence for Epilepsy: Scoping Review

Background: Epilepsy affects approximately 50 million people globally and imposes a substantial clinical and societal burden, requiring continuous and personalized monitoring for effective management. Wearable artificial intelligence (AI) technologies offer a promising solution by leveraging physiological signals and machine learning for seizure detection and prediction. While various approaches have been proposed, a comprehensive overview summarizing these advances and challenges is still needed. Objective: This review aims to comprehensively explore and map the existing literature on AI-driven wearable technologies for epilepsy, identifying device characteristics, AI methodologies, biosignal measurements, validation approaches, and research gaps. Methods: A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search was performed across six electronic databases (Scopus, MEDLINE, Embase, ACM Digital Library, IEEE Xplore, and Google Scholar) to identify relevant studies published up to December 2023. We included studies that developed AI algorithms for epilepsy using noninvasive wearable devices (eg, smartwatches, smart clothing) and excluded those using nonwearables or in-body devices. Eligible publication types included journal articles, conference papers, and dissertations. Study selection and data extraction were performed independently by six reviewers. The extracted data were synthesized narratively. Results: A total of 67 studies met the inclusion criteria. Research in this domain has increased significantly since 2021, with India, the United States, and China leading contributions. The studies examined both commercial (n=31, 46.3%) and noncommercial (n=31, 46.3%) wearable devices, with Empatica smart bands being the most frequently used. The primary biosignals monitored included activity measures (n=36, 53.7%), cardiovascular metrics (n=33, 49.3%), brain activity (n=24, 35.8%), and skin conductance (n=23, 34.3%). The most common AI models were support vector machines (n=28, 41.8%), random forests (n=14, 20.9%), and convolutional neural networks (n=10, 14.9%). Most models focused on seizure detection (n=54, 80.6%) compared to seizure prediction (n=14, 20.9%), reflecting a research imbalance that suggests the need for further development in predictive analytics. Sensitivity (n=54, 80.6%) was the most frequently reported performance metric, indicating a focus on identifying seizures; however, comprehensive clinical validation remains limited. Closed-source data predominated (n=44, 65.7%), limiting the generalizability of findings. The most used validation methods were leave-one-out cross-validation (n=21, 31.3%) and k-fold cross-validation (n=20, 29.9%), while video electroencephalography served as the primary reference standard (n=35, 52.2%). Conclusions: Wearable AI technologies show significant promise in epilepsy management, offering real-time, continuous monitoring and early seizure detection. To realize clinical impact, future research should prioritize the standardization of validation methods, promote open data exchange for reproducibility, and develop energy-efficient algorithms that support real-world deployment in wearable devices.