The U.S. Food and Drug Administration has approved two innovative technologies that promise to transform epilepsy monitoring and management: Empatica's Embrace smartwatch and Epiminder's Minder implantable continuous electroencephalogram monitoring system (iCEM).
Cambridge, Massachusetts-based Empatica has developed the Embrace smartwatch, which utilizes machine learning to detect the most dangerous types of epileptic seizures. The device is the first smartwatch approved for use in neurology and represents a significant advancement in wearable medical technology for seizure detection.
In a rigorous multi-site clinical study, 135 epilepsy patients were monitored simultaneously with video-EEG and the Embrace device, generating 6,530 hours of data over 272 days. The results were remarkable: Embrace's algorithm detected 100% of the 40 generalized tonic-clonic seizures (also known as "grand mal" seizures) that occurred during the trial period.
"The FDA approval of the Embrace device to detect major convulsive seizures represents a major milestone in the care of epilepsy patients," said Orrin Devinsky, director of the Comprehensive Epilepsy Center at NYU.
Revolutionary Monitoring Technology
What sets Embrace apart from other seizure detection systems is its measurement of multiple seizure indicators, particularly Electrodermal Activity (EDA). This signal, commonly used in stress research, quantifies physiological changes related to sympathetic nervous system activity—the "fight or flight" response.
The smartwatch not only detects seizures but also immediately alerts caregivers, enabling rapid intervention. This feature is potentially life-saving, as more than 3,000 Americans die annually from Sudden Unexpected Death in Epilepsy (SUDEP).
"It's been quite the journey," said Rosalind Picard, Director of the Affective Computing Group at MIT Media Lab and Chief Scientist at Empatica. "We have worked for years building wearable stress and emotion sensors, and then accidentally discovered we could pick up changes in the skin elicited by brain activity related to the most dangerous kinds of seizures."
The technology, which received European approval as a medical device for seizure monitoring in April 2017, addresses a significant challenge in epilepsy management: accurate seizure reporting. Studies show that over 40% of dangerous generalized tonic-clonic seizures go unreported in traditional patient diaries.
Breakthrough in Long-Term EEG Monitoring
In another significant development, the FDA has granted De Novo classification and Breakthrough Device designation to Minder, an implantable continuous EEG monitoring system developed by Australian medical device company Epiminder. This marks the first authorization of an implantable, long-term EEG monitoring device in the United States.
Unlike current EEG technologies that typically record only a few days of data, Minder is designed to continuously monitor brain activity in epilepsy patients for months or even years. This extended monitoring capability has profound implications for the approximately 3.4 million Americans and 52 million people worldwide living with epilepsy.
"By extending the monitoring window of an EEG from days using current technologies to months or even years with Minder, we can deliver unprecedented access to a high-fidelity stream of continuous EEG data to health care professionals and their patients," explained Rohan Hoare, PhD, CEO of Epiminder.
Clinical Validation and Future Implementation
Epiminder's FDA application was supported by data from the UMPIRE clinical trial, conducted in leading Australian hospitals between 2019 and 2023. The trial demonstrated Minder's ability to continuously record high-quality EEG data, with one patient's device recording continuously for five years. Nearly 90% of participants received actionable clinical insights from the device.
Robert Fisher, MD, PhD, Director of the Stanford Epilepsy Center and chair of the UMPIRE trial's Data Safety Monitoring Board, highlighted the technology's potential impact: "One of the greatest difficulties in caring for people with epilepsy is the lack of accurate information about a patient's seizures. Seizure diaries are of limited effectiveness. Minder can greatly improve seizure tracking and therefore seizure management."
The continuous and accurate data from Minder will allow clinicians to make more precise diagnoses, adjust treatments more effectively, and better identify candidates for surgical interventions—potentially reducing the burden of drug-resistant epilepsy, which affects approximately one-third of epilepsy patients.
Market Availability and Future Developments
With FDA approval secured, Epiminder plans to launch Minder in the U.S. in the second half of 2025, beginning with a phased rollout at leading epilepsy centers. The company also aims to develop a suite of software tools, including AI-powered forecasting to help predict seizures before they occur.
Meanwhile, Empatica's Embrace smartwatch, which was launched through a crowdfunding campaign in 2015 as a spin-off from the MIT Media Lab, is already available in Europe and now in the United States.
These technological advancements represent significant progress in epilepsy care, offering new hope for more accurate monitoring, improved treatment outcomes, and potentially life-saving interventions for millions of people living with epilepsy worldwide.
