Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the clinical and cost effectiveness of wearable or bed-based technologies for the detection of tonic-clonic seizures in people with epilepsy?

Authors' results and conclusions: Evidence was identified for eight UK‑approved seizure‑detection devices across 13 mainly single‑arm observational studies involving 830 adults and children with 3,275 tonic‑clonic seizures. The sensitivity of wearable devices (wristbands and armbands) and piezoelectric under-mattress devices ranged between 70% and 100%. There was more variation in the sensitivity of older pressure-based under-mattress devices, which reported sensitivities of between 11% and 63%. Although there was wide variation between the false-alarm rates of different devices, all studies except one assessing an older pressure-based under-mattress sensor, reported no more than one false alarm every 20 hours. For accelerometry-based wearable devices and piezoelectric under-mattress sensors, approximately half of the alarms corresponded to true seizures. Most evidence focused on technical performance, with limited data on patient outcomes. There is little evidence on long‑term effectiveness, and no evidence was found for the impact on mortality. Limited evidence was identified for seizure-related injuries and quality of life. Usability was generally acceptable, but false alarms and practical issues led to some discontinuation. Limited evidence suggests improved seizure logging for some users. One economic study suggested that a multimodal armband may be cost effective, but overall, there is insufficient evidence to develop an economic model to evaluate the cost effectiveness of epilepsy alarms from a Welsh perspective. HTW collaborated with Epilepsy Action to collect evidence on the experiences and opinions of eight people with epilepsy. Patients valued epilepsy alarms due to the increased sense of security for those living alone with epilepsy, the potential for a reduction in seizure-related injuries, and the potential for a reduction in caregiver stress.

Authors' recommendations: More evidence is needed on wearable and bed-based technologies for detecting clonic-tonic seizures in people with epilepsy

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: Target populations and subgroups most likely to benefit; The most effective device features for detecting seizures; The comparative effectiveness of different device types (for example, under-mattress versus wearable alarms).

Project Status: Completed

Year Published: 2026

URL for published report: https://www.healthtechnology.wales/reports-guidance/epileptic-seizure-alarms/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk