Modalities and algorithms for generalized motor seizure detection and prediction: a scoping review

INTRODUCTION: Generalized tonic - clonic seizures (GTCS) is a major cause of sudden unexpected death in epilepsy (SUDEP); thus, continuous monitoring is essential. Electroencephalography (EEG) is the diagnostic gold standard; however, non-EEG wearables have emerged as promising, user-friendly alternatives enhancing comfort, mobility, and social acceptance. AREAS COVERED: This scoping review compared sensing modalities and computational methods used for seizure detection and prediction, identified effective sensor combinations, and highlighted current research gaps. Following PRISMA-ScR guidelines, Scopus, IEEE Xplore, and PubMed databases were searched up to 22 April 2025. Twenty-nine studies met inclusion criteria. For seizure detection, combining electrodermal activity (EDA) with motion sensors - accelerometers (ACC) and gyroscopes (GYR) - and surface electromyography (sEMG) achieved high reliability, 98.6% precision, while using ACC and EDA alone yielded superior sensitivities up to 97.2% and a lower false alarm rate (FAR) of 0.53/24 h. Regarding seizure prediction, combining EDA, blood volume pulse (BVP), ACC, and temperature showed the highest sensitivity of 75.6%. EXPERT OPINION: Wearable multimodal non-EEG seizure detection and prediction systems offer personalized care but face validation, hardware, and privacy hurdles. Future success depends on efficient AI, IoT integration, patient-centric design, and clear regulations ensuring accessible and trustworthy clinical tools.