Seizure detection devices in outpatient epilepsy care: High demand, low use, and the need for specialized counseling

OBJECTIVE: To determine real-world uptake of seizure detection devices (SDDs), quantify patient demand, and identify factors associated with their adoption in routine outpatient epilepsy care. METHODS: A monocentric cross-sectional questionnaire-based study was performed in outpatients at a tertiary epilepsy center. Consecutive people with epilepsy (PwE) completed a 22-item paper-based questionnaire assessing sociodemographic and clinical variables, digital health use, counseling demand, willingness to pay, and perceived benefits and concerns regarding SDDs. A predefined subgroup with specific interest in SDDs was identified and characterized. Descriptive analyses and appropriate inferential tests were performed with false discovery rate correction. RESULTS: A total of 276 evaluable questionnaires were analyzed. Digital health technologies were used by 42.5% of PwE. While only 3.1% reported SDD use, 45% indicated their willingness to purchase and 58% expressed interest in specialized counseling on digital health tools. Importantly, the latter was independent of demographic and clinical characteristics, affinity for digital technologies, and current digital health technology use. Accuracy-related concerns were most frequently reported. The SDD-interested subgroup (21.4%) was more burdened, reported lower disease-related security, and demonstrated higher counseling demand and willingness to pay (all p < .002). SIGNIFICANCE: Our findings reveal a substantial gap between patient demand and real-world use of SDDs. Integrating structured counseling on digital seizure-detection tools into routine epilepsy care may represent a scalable strategy to facilitate adoption.