{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:17:46Z","timestamp":1788848266234,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Wearable photoplethysmography (PPG) is increasingly used for seizure detection due to its ability to unobtrusively estimate heart rate (HR). However, the vulnerability of PPG to body movements often leads to unreliable HR estimates, compromising accurate seizure detection. Although this limitation is well recognized, methods for rejecting artifactual HR measures\u2014and their impact on seizure detection performance\u2014have not yet been studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We sourced data from the PROMISE trial, a home\u2010based study in children with refractory epilepsy that evaluated the performance of the NightWatch (NW) in detecting nocturnal motor seizures. We applied a novel pulse\u2010based quality assessment (PQA) method that evaluates the quality of each individual PPG pulse and excludes compromised ones prior to HR estimation. We compared the performance of PQA with two alternatives: HR\u2010based quality assessment (HRQA), rejecting extreme outliers in consecutive inter\u2010beat intervals, and no quality assessment (noQA). We assessed the impact of PQA, HRQA, and noQA on seizure detection performance by applying HR increase thresholds from 30% to 80% relative to the baseline. A permutation test with bootstrapping was applied for all statistical comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We analyzed 741 NW alarms, comprising 135 true seizures and 606 non\u2010seizure events in 28 children (46% female; age: 9.1\u2009\u00b1\u20093.3\u2009years). Averaged across all evaluated detection thresholds, both PQA and HRQA significantly improved seizure detection performance compared to noQA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.005). PQA led to mean increases of 0.248 in sensitivity, 0.025 in positive predictive value (PPV), and 0.082 in F1\u2010score. HRQA showed mean increases of 0.081 in sensitivity, 0.040 in PPV, and 0.056 in F1\u2010score. At clinically relevant sensitivity levels (0.8, 0.85, and 0.9), PQA showed a relative improvement over HRQA, with F1\u2010scores increasing by 4%\u201315% and PPV by 5%\u201319%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Implementing PPG quality assessment\u2014particularly pulse\u2010based\u2014improves the performance of wearable HR\u2010based seizure detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>This study aimed to improve seizure detection in wearable devices by introducing a new method for assessing the quality of the heart rate (HR) data derived from a light sensor called photoplethysmography (PPG). By applying our method to data from children with epilepsy, we showed that discarding low\u2010quality PPG data before HR estimation leads to better seizure detection, allowing more seizures to be correctly identified. This improvement is important because it enhances seizure detection performance through a software\u2010only upgrade.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi4.70242","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T08:56:48Z","timestamp":1781686608000},"page":"1149-1158","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pulse\u2010based photoplethysmography quality assessment improves wearable seizure detection performance"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6625-7923","authenticated-orcid":false,"given":"Mohammad","family":"Shahbakhti","sequence":"first","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5384-9975","authenticated-orcid":false,"given":"Anemoon T.","family":"Bosch","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede The Netherlands"},{"name":"Department of Neurology Leiden University Medical Centre (LUMC)  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9505-1270","authenticated-orcid":false,"given":"Xi","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering Eindhoven University of Technology  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6188-2973","authenticated-orcid":false,"given":"Johannes P.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering Eindhoven University of Technology  Eindhoven The Netherlands"},{"name":"Academic Center of Epileptology Kempenhaeghe  Heeze The Netherlands"},{"name":"Department of Orthodontics Ulm University  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1435-8970","authenticated-orcid":false,"given":"Roland D.","family":"Thijs","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede The Netherlands"},{"name":"Department of Neurology Leiden University Medical Centre (LUMC)  Leiden The Netherlands"},{"name":"UCL Queen Square Institute of Neurology  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14030863"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16818"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/acead2"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18280"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-024-02387-3"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18138"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/ada9c1"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-014-1080-y"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16590"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-25949-x"},{"issue":"1","key":"e_1_2_14_12_1","first-page":"S25","article-title":"Signal quality and patient experience with wearable devices for epilepsy management","volume":"61","author":"Nasseri M","year":"2020","journal-title":"Epilepsia"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12854"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17654"},{"issue":"6","key":"e_1_2_14_15_1","first-page":"701","article-title":"The periodic moving average filter for removing motion artifacts from PPG signals","volume":"5","author":"Lee HW","year":"2007","journal-title":"Int J Control Autom Syst"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.920946"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/33\/9\/1491"},{"issue":"3","key":"e_1_2_14_18_1","first-page":"832","article-title":"Signal\u2010quality indices for the electrocardiogram and photoplethysmogram: derivation and applications to wireless monitoring","volume":"19","author":"Orphanidou C","year":"2015","journal-title":"IEEE J Biomed Health Inform"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-018-0235-z"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2018.01.003"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16343"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2021.108321"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-018-0568-1"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/ad4e94"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-02127-3"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2025.12.001"}],"container-title":["Epilepsia Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi4.70242","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epi4.70242","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi4.70242","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:16:23Z","timestamp":1785773783000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi4.70242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/epi4.70242"],"URL":"https:\/\/doi.org\/10.1002\/epi4.70242","archive":["Portico"],"relation":{},"ISSN":["2470-9239","2470-9239"],"issn-type":[{"value":"2470-9239","type":"print"},{"value":"2470-9239","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"assertion":[{"value":"2025-09-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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