Extracerebral detection of seizures: a new era in epileptology?

The medical and psycho-socio-economic burden imposed on patients, caregivers, and health systems by pharmacoresistant epilepsies is enormous. Intracranial devices for automated detection, warning, and delivery of therapy, the presently preferred "line of attack" for an abundance of weighty reasons, would be insufficient to adequately address said burden on a global scale. Reliance on signals that, although extracerebral, are under cortical modulation or control and are altered by seizures, such as cardiac or motor signals, emerges as a viable research direction with potentially fruitful clinical applications. The greater ease of implementation and lower cost of automated real-time detection, warning, and therapy systems based on extracerebral signals, compared with those requiring intracranial placement, make them worthy of investigation. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.