Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related death in people living with epilepsy (PWE), with an incidence of 1.2 per 1000 patient years. ^{Reference Whitney, Keller and Li1–Reference Keller, Whitney and Li2} The strongest risk factor for SUDEP is the presence/frequency of bilateral tonic-clonic seizures, while other risk factors include nocturnal seizures, living alone and noncompliance with anti-seizure medications. ^{Reference Whitney, Keller and Li1} PWE and their caregivers want to be informed about epilepsy and should be counseled on SUDEP incidence, risk factors and SUDEP prevention. ^{Reference Whitney, Jones and Sharma3} Seizure monitoring devices may provide the opportunity for early medical intervention both during and after a seizure and could have the potential to mitigate seizure-related injuries and/or death. ^{Reference Donner, Devinsky and Friedman4} However, no device has been proven to prevent the occurrence of SUDEP. ^{Reference Whitney, Jones and Sharma3}

Maltseva et al. explore the experience of seizure monitoring devices in a cohort of caregivers of children with epilepsy from Alberta. ^{Reference Maltseva, Winterburn and Wasserman5} More than one-third of caregivers had experience with seizure monitoring devices, although most were medically unapproved, such as camera devices and vital sign monitors. ^{Reference Maltseva, Winterburn and Wasserman5} Caregivers with SUDEP knowledge were more likely to use seizure monitoring devices. ^{Reference Maltseva, Winterburn and Wasserman5} However, only 11% of caregivers had been recommended to use a device by their treating physician. ^{Reference Maltseva, Winterburn and Wasserman5} The main barriers to device use among caregivers were a lack of knowledge and seizure-type applicability. ^{Reference Maltseva, Winterburn and Wasserman5} These findings highlight the need for informed decision-making when discussing seizure monitoring devices with PWE.

Interestingly, the authors did not find a difference in device monitoring between PWE who had seizures with motor symptoms or without. ^{Reference Maltseva, Winterburn and Wasserman5} However, seizure monitoring devices are generally indicated/recommended for those with bilateral-tonic seizures. ^{Reference Beniczky, Wiebe and Jeppesen6} Both the International League Against Epilepsy and the International Federation of Clinical Neurophysiology recommend using validated devices for the detection of generalized tonic-clonic seizures and focal to bilateral tonic-clonic seizures, but not other seizure types (weak/conditional recommendation). ^{Reference Beniczky, Wiebe and Jeppesen6} In addition, more than half of caregivers in the cohort discontinued devices over time due to a number of factors such as poor seizure detection, high false alarms, disruptive sleep, etc. ^{Reference Maltseva, Winterburn and Wasserman5} Thus, this further emphasizes limitations with current seizure monitoring devices and the need for tailored physician guidance/education when counseling around device use in PWE.

Overall, Maltseva et al. provide important insights into the current landscape of seizure monitoring devices; however, there is a pressing need for increased awareness, advocacy/funding and medically approved device access nationally for PWE and their caregivers. ^{Reference Maltseva, Winterburn and Wasserman5}