Patients increasingly use wearable devices to monitor health data, though the role of consumer wearables in clinical care remains uncertain, according to an American Academy of Neurology “Emerging Issues in Neurology” article published in Neurology.
Neurologists commonly encounter patient-generated health data from wearable devices in clinical settings. Nonetheless, many consumer devices lack United States Food and Drug Administration (FDA) clearance, and questions remain about their accuracy and clinical applicability.
To better clarify the current evidence and limitations of these technologies, researchers reviewed case examples of wearable devices in neurology.
As these technologies continue to proliferate, neurologists will need to become familiar with their capabilities and limitations.
Cardiovascular Monitoring and Stroke Risk
Many smartwatches estimate heart rate using photoplethysmography and may alert users to irregular rhythms suggestive of atrial fibrillation (AFib), a major risk factor for ischemic stroke.
Among 419,297 participants in the Apple Heart Study, 0.52% received irregular pulse notifications, and AFib was confirmed in 34% of those who underwent follow-up. The researchers noted, however, that the relatively young and healthy study population may limit the generalizability of these findings and raise concerns about false-positive alerts in broader use.
Epilepsy Monitoring
Devices that monitor movement, heart rate, and autonomic changes may help detect tonic-clonic seizures. Some consumer devices and smartwatch applications have demonstrated performance comparable with specialized seizure-detection wearables when validated against video-electroencephalography monitoring. Despite these results, relatively few algorithms have undergone rigorous validation.
In addition, physiologic changes recorded by wearables — such as increases in heart rate or alterations in sleep and activity patterns — may help identify unrecognized seizures or support efforts to forecast seizure risk. These applications remain under development.
Headache and Migraine Management
Biofeedback systems delivered through wearable sensors, which measure physiologic signals such as heart rate variability, muscle tension, or finger temperature, have shown promise for migraine management.
However, many of these devices rely on proprietary algorithms and have not been fully validated among patients with neurologic disorders. Long-term adherence also remains a challenge.
Sleep Monitoring
Consumer wearables that track movement and physiologic signals such as pulse rate variability have demonstrated reasonable agreement with gold-standard laboratory polysomnography for estimating total sleep time and sleep efficiency among healthy adults.
Conversely, many devices underestimate wake time after sleep onset and have not been adequately validated among individuals with neurologic disorders or sleep conditions. Additionally, proprietary algorithms often limit clinicians’ ability to independently verify raw data or evaluate device accuracy.
Future Directions
Wearable technologies may expand access to longitudinal physiologic monitoring and provide clinicians with additional insight into patients’ daily functioning. Ultimately, further validation and careful clinical interpretation will be necessary before these devices can be widely incorporated into neurologic practice.
“As these technologies continue to proliferate, neurologists will need to become familiar with their capabilities and limitations. Medical professionals will be looked to by their patients to know when it will be worth spending money, to assess value, and risk,” the researchers concluded.
