Towards generalizable seizure monitoring: EpiVLM for cross-environment detection and classification

Abstract

The translation of automated seizure detection from controlled clinical units to real-world settings is hindered by heterogeneous recording conditions and limited expert monitoring. We introduce EpiVLM, a multimodal vision–language system that combines clinically structured prompts with video reasoning for cross-environment seizure monitoring. Evaluated on a robust and diverse dataset of 232 video recordings from 127 patients, totaling 11,666 expert-annotated segments from two tertiary centers, unconstrained home recordings, and an independent public dataset, EpiVLM recognized five major semiologies with accuracy 0.795–0.947 and sensitivity 0.842–0.957. With prompts and decision thresholds fixed a priori, performance remained consistent across diverse real-world acquisition conditions without site-specific recalibration. In external validation sets, EpiVLM sustained strong recognition while maintaining low video-level false detections (0.47–2.45%) and timely detection (mean onset-to-detection delay <6 s). Compared with standard video deep-learning baselines, EpiVLM achieved superior overall performance. These results support scalable seizure recognition from routine video and motivate prospective evaluation for remote outcome monitoring.