Reproducible Synthetic Clinical Letters for Seizure Frequency Information Extraction

Seizure-frequency information is important for epilepsy research and clinical care, but it is usually recorded in variable free-text clinic letters that are hard to annotate and share. We developed a reproducible, privacy-preserving framework for extracting seizure frequency using fully synthetic yet task-faithful epilepsy letters. We defined a structured label scheme covering common descriptions of seizure burden, including explicit rates, ranges, clusters, seizure-free intervals, unknown frequency, and explicit no-seizure statements. A teacher language model generated NHS-style synthetic letters paired with normalized labels, rationales, and evidence spans. We fine-tuned several open-weight language models (4B-14B parameters) on these synthetic letters to extract seizure frequency from full documents, comparing direct numeric prediction with structured label prediction and testing evidence-grounded outputs. On a clinician-checked held-out set of real clinic letters, models trained only on synthetic data generalized well, and structured labels consistently outperformed direct numeric regression. With 15,000 synthetic training letters, models achieved micro-F1 scores up to 0.788 for fine-grained categories and 0.847 for pragmatic categories; a medically oriented 4B model achieved 0.787 and 0.858, respectively. Evidence-grounded outputs also supported rapid clinical verification and error analysis. These results show that synthetic, structured, evidence-grounded supervision can enable robust seizure-frequency extraction without sharing sensitive patient text and may generalize to other temporally complex clinical information extraction tasks.

Multimodal wearable EEG, EMG and accelerometry measurements improve the accuracy of tonic-clonic seizure detection in-hospital

Objective: Most current wearable tonic-clonic seizure (TCS) detection systems are based on extra-cerebral signals, such as electromyography (EMG) or accelerometry (ACC). Although many of these devices show good sensitivity in seizure detection, their false positive rates (FPR) are still relatively high. Wearable EEG may improve performance; however, studies investigating this remain scarce. This paper aims 1) to investigate the possibility of detecting TCSs with a behind-the-ear, two-channel wearable EEG, and 2) to evaluate the added value of wearable EEG to other non-EEG modalities in multimodal TCS detection. Method: We included 27 participants with a total of 44 TCSs from the European multicenter study SeizeIT2. The multimodal wearable detection system Sensor Dot (Byteflies) was used to measure two-channel, behind-the-ear EEG, EMG, electrocardiography (ECG), ACC and gyroscope (GYR). First, we evaluated automatic unimodal detection of TCSs, using performance metrics such as sensitivity, precision, FPR and F1-score. Secondly, we fused the different modalities and again assessed performance. Algorithm-labeled segments were then provided to a neurologist and a wearable data expert, who reviewed and annotated the true positive TCSs, and discarded false positives (FPs). Results: Wearable EEG outperformed the other modalities in unimodal TCS detection by achieving a sensitivity of 100.0% and a FPR of 10.3/24h (compared to 97.7% sensitivity and 30.9/24h FPR for EMG; 95.5% sensitivity and 13.9 FPR for ACC). The combination of wearable EEG and EMG achieved overall the most clinically useful performance in offline TCS detection with a sensitivity of 97.7%, a FPR of 0.4/24 h, a precision of 43.0%, and a F1-score of 59.7%. Subsequent visual review of the automated detections resulted in maximal sensitivity and zero FPs.