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Accurate seizure forecasters could improve quality of life for those with epilepsy but must be practical for long\u2010term use. This study presents the first validation of a seizure\u2010forecasting system using ultra\u2010long\u2010term, non\u2010invasive wearable data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eleven participants with epilepsy were recruited for continuous monitoring, capturing heart rate and step count via wrist\u2010worn devices and seizures via electroencephalography (average recording duration of 337\u2009days). Two hybrid models\u2014combining machine learning and cycle\u2010based methods\u2014were proposed to forecast seizures at both short (minutes) and long (up to 44\u2009days) horizons.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The Seizure Warning System (SWS), designed for forecasting near\u2010term seizures, and the Seizure Risk System (SRS), designed for forecasting long\u2010term risk, both outperformed traditional models. In addition, the SRS reduced high\u2010risk time by 29% while increasing sensitivity by 11%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>These improvements mark a significant advancement in making seizure forecasting more practical and effective.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18466","type":"journal-article","created":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T11:49:17Z","timestamp":1748087357000},"page":"3293-3308","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Forecasting epileptic seizures with wearable devices: A hybrid short\u2010 and long\u2010horizon pseudo\u2010prospective approach"],"prefix":"10.1111","volume":"66","author":[{"given":"Mona","family":"Nasseri","sequence":"first","affiliation":[{"name":"Departments of Neurology and Physiology and Biomedical Engineering Mayo Foundation  Rochester Minnesota USA"},{"name":"School of Engineering University of North Florida  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E.","family":"Stirling","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Melbourne  Melbourne Victoria Australia"},{"name":"Graeme Clark Institute University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0861-8705","authenticated-orcid":false,"given":"Pedro F.","family":"Viana","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology &amp; Neuroscience King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Cui","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Physiology and Biomedical Engineering Mayo Foundation  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8981-0074","authenticated-orcid":false,"given":"Ewan","family":"Nurse","sequence":"additional","affiliation":[{"name":"Graeme Clark Institute University of Melbourne  Melbourne Victoria Australia"},{"name":"Seer Medical  Melbourne Victoria Australia"},{"name":"Department of Medicine St. Vincent's Hospital Melbourne, University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa J.","family":"Karoly","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Melbourne  Melbourne Victoria Australia"},{"name":"Graeme Clark Institute University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaclav","family":"Kremen","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Physiology and Biomedical Engineering Mayo Foundation  Rochester Minnesota USA"},{"name":"Czech Institute of Informatics, Robotics, and Cybernetics Czech Technical University in Prague  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1476-7777","authenticated-orcid":false,"given":"Matthias","family":"D\u00fcmpelmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Epilepsy Center, Medical Center, University of Freiburg  Freiburg Germany"},{"name":"Department of Microsystems Engineering (IMTEK) University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2916-0553","authenticated-orcid":false,"given":"Gregory A.","family":"Worrell","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Physiology and Biomedical Engineering Mayo Foundation  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean R.","family":"Freestone","sequence":"additional","affiliation":[{"name":"Graeme Clark Institute University of Melbourne  Melbourne Victoria Australia"},{"name":"S\u2010Labs AI Pty Ltd.  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