What absolute fucking laziness! Guidance; NOT PROTOCOLS!
AAN Issues Guidance on Consumer Wearable Devices in Neurologic Care
A new guidance from the American Academy of Neurology (AAN) advised clinicians on how to approach the growing use of consumer wearable devices in neurologic care, with respect to their potential application in epilepsy, headache, sleep disorders, and stroke risk detection.
The document focuses on devices such as smartwatches, fitness trackers, and digital health apps that have not received FDA clearance. While these tools may provide additional patient-generated data, questions remain about their accuracy, reliability, and role in clinical care.
Wearable devices are best viewed as an adjunct to traditional care rather than a replacement for clinical evaluation, guideline author Sarah M. Benish, MD, associate professor and General Neurology Division Director at the University of Minnesota, Minneapolis, explained to Medscape Medical News.
“The clinical situations where wearable data will be helpful are expected to be highly variable both with clinical diagnosis but also due to each individual patient. I don’t see wearables replacing clinical visits. I see them as an add-on to bring more data for even better decision-making,” Benish said.
The guidance was published online on March 11 in Neurology.
Defined by the authors as “electronics worn to monitor activities and vital signs,” wearables have become increasingly common. Individuals use them to track health data such as heart rate, sleep, and daily activity, and many are now sharing these data with their clinicians.
This new guidance is part of the Emerging Issues in Neurology series which offers timely expert commentary on evolving technologies rather than formal clinical recommendations.
The document highlights examples of how wearable devices are being used or evaluated in areas such as cardiac monitoring, epilepsy management, headache disorders, and sleep assessment.
To develop the report, the authors drew on published research and illustrative case examples describing the use of consumer wearable devices in neurologic care. Part of the AAN’s Emerging Issues in Neurology series, the document, reflects expert consensus rather than a systematic review.
It also highlights common limitations of consumer wearables, including inconsistent patient adherence, incomplete data capture, and concerns about the accuracy and interpretation of device-generated data.
For cardiac monitoring, the guidance notes that consumer wearables may help flag possible arrhythmias such as atrial fibrillation (AFib), a major risk factor for stroke, but the authors note that abnormal readings should be confirmed with medical-grade testing.
Results of the 2019 Apple Heart Study, which was published in The New England Journal of Medicine, showed 0.52% of the study’s 419,297 participants received irregular pulse notifications from a smartwatch algorithm.
Among those who underwent follow-up ECG patch testing, AFib was detected in 153 participants, and 44% of those who received alerts later reported a new AFib diagnosis, compared with 1.0% of participants who received no alerts.
Tracking Seizures, Identifying Triggers
Beyond cardiac monitoring, wearable technologies are also being explored in other areas of neurologic care, including epilepsy management. However, the authors caution that many consumer devices and algorithms remain insufficiently validated and should not replace clinical evaluation.
Consumer wearable devices and associated digital applications may assist with epilepsy management in several ways, including seizure detection, trigger identification, seizure-risk forecasting, symptom logging, and management of comorbidities.
Seizure detection is the most widely studied application. Wrist- or arm-worn devices use sensors such as accelerometry, photoplethysmography, and electrodermal activity to detect physiologic changes associated with convulsive seizures. Some of these systems have been validated against video-electroencephalography monitoring, the clinical reference standard, although most consumer devices have not undergone extensive validation.
“The most studied application is detecting convulsive seizures to alert caregivers, reducing morbidity and mortality,” the guidance notes.
Wearable devices may also help identify seizure triggers. In a 2022 study published in Epilepsy & Behavior, 234 patients with epilepsy who used a smartwatch diary to self-report seizures identified stress and poor sleep as common triggers. Preliminary studies integrating electronic seizure diaries with fitness trackers have also shown potential to improve the accuracy of seizure forecasting.
Headache Management, Biofeedback
Wearable technologies are also being explored in the management of headache disorders.
The report highlights emerging uses of wearable technologies in the management of headache disorders, particularly for delivering biofeedback therapy and monitoring activity patterns.
Biofeedback is an evidence-based treatment for migraine and can be delivered through wearable sensors that measure heart rate variability, skin temperature, and muscle activity to help patients regulate stress responses.
Actigraphy data from wearable devices have also been used to assess patterns associated with headache episodes. In a 2022 study published in Pain and Therapy, 509 participants who used Fitbit devices along with daily headache diaries tended to sleep more, engage in less physical activity, and have lower maximum heart rates during headache episodes.
However, the study also highlighted challenges with data completion and sustained device use.
Sleep Monitoring
Wearable technologies are also increasingly being used to monitor sleep.
The AAN guidance notes that consumer wearable devices may help monitor sleep patterns but should be interpreted cautiously in clinical practice.
Devices such as wristbands, rings, and headbands estimate sleep duration and sleep stages using accelerometry and pulse rate variability.
“Most consumer sleep detection devices have been reasonably well-validated against the gold standard of laboratory polysomnography,” the authors noted.
However, many devices underestimate wake time after sleep onset and have not been fully validated in patients with neurologic disease or sleep disorders. Moreover, proprietary algorithms often prevent clinicians from gaining access to raw data for independent analysis, which can limit its clinical utility.
These proprietary algorithms may give “sleep clinicians and researchers pause toward adopting consumer technologies without ability to scrutinize validity of accurate sleep-wake state detection,” the authors noted.
Despite these limitations, the AAN guidance suggests wearable sleep monitors may become more useful because they allow extended home-monitoring over longer periods of time.
Real-World Uses, Practical Challenges
Wearable devices and smartphones are reshaping neurologic research and care by enabling real-time monitoring, event detection, and outcome tracking.
Guidance author Mia T. Minen, MD, MPH, director of Headache Services and associate professor in the Department of Neurology at NYU Langone Medical Center in New York City, said integrating wearable data into routine neurologic care will require changes to current reimbursement and workflow models.
“As a headache specialist, despite so many patients preferring or needing nonpharmacologic treatment options, it’s nearly impossible to get commercial insurances to pay for these safe management options,” she told Medscape Medical News.
“We also need to figure out effective reimbursable workflow solutions for reviewing and then acting upon the digital data,” she added.
The guidance also cautions clinicians to consider the psychological effects wearable devices may have on some patients. Benish said clinicians should discuss both the potential benefits and drawbacks of device use.
“As a neurologist works with a patient, it is their role to outline the risks and benefits of using such devices,” she said. “Important steps during a patient visit include discussing how the person feels when they get alerts, asking how often they check the device or app for information, and inquiring about the psychological impact.”
A ‘Transformative Effect’
Outside expert Richard Lipton, MD, professor of neurology at Albert Einstein College of Medicine in New York City, who was not involved in developing the AAN guidance, said he uses wearable devices and smartphones in research on cognitive aging, dementia, and migraine.
Lipton said these tools may be particularly valuable for neurologic conditions characterized by episodic or fluctuating events, including seizures, migraine attacks, and cardiac arrhythmias.
“Devices can provide an objective record of events otherwise identified by self-report, and frequently under-ascertained,” he told Medscape Medical News.
He noted that almost 1 in 3 Americans use a wearable device such as a smartwatch or band to track health and fitness.
Wearables may also help capture real-world consequences of neurologic conditions. For example, step counts often drop during migraine attacks, providing an objective measure of activity impairment, Lipton said.
Environmental data collected by wearable devices, such as air pollution exposure, may also offer insights into potential triggers affecting cognitive status, seizure risk, or headaches.
Lipton said he remains optimistic about the broader potential of wearable technologies in clinical care.
“I believe wearables will have a transformative effect on neurologic practice, promoting healthy behaviors, detecting events and diseases, characterizing risk factors, and supporting education and intervention,” he said.
The guidance was supported by the AAN. Benish and Lipton reported no relevant financial disclosures. Minen reported receiving research support from National Institutes of Health and personal compensation for serving on the American Headache Society first contact-primary care advisory board and as a consultant for a PCORI grant on migraine evidence-based map for stakeholders with ECRI.
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