SEIZURE DISORDERS: Edited by Christian E. ElgerAre the days of counting seizures numbered?Karoly, Philippaa,b,∗; Goldenholz, Daniel M.c,∗; Cook, MarkaAuthor Information aDepartment of Medicine, St Vincent's Hospital Melbourne bDepartment of Biomedical Engineering, The University of Melbourne, Victoria, Australia cDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA Correspondence to Mark Cook, MBBS, MD, Department of Medicine, St Vincent's Hospital Melbourne, 47 Victoria Parade, Fitzroy, 3065 VIC, Australia. E-mail: [email protected] Current Opinion in Neurology: April 2018 - Volume 31 - Issue 2 - p 162-168 doi: 10.1097/WCO.0000000000000533 Buy Metrics Abstract Purpose of review The estimation of seizure frequency is a cornerstone of clinical management of epilepsy and the evaluation of new therapies. Current estimation approaches are significantly limited by several factors. Comparing patient diaries and objective estimates (through both inpatient video-EEG monitoring of and long-term ambulatory EEG studies) reveal that patients document seizures inaccurately. So far, few practical alternative methods of estimation have been available. Recent findings We review the systems of counting currently utilized and their limitations, as well as the limitations imposed by problems defining clinical events. Alternative methodologies that permit the volatility of seizure rates to be accommodated, and possible alternative measures of brain excitability will be outlined. Recent developments in technologies around data capture, such as wearable and implantable devices, as well as significant advances in the ability to analyse the large data-sets supplied by these systems have provided a wealth of information. Summary There are now unprecedented opportunities to utilize and apply these insights in routine clinical management and assessment of therapies. The rapid adoption of long-term, wearable monitoring systems will permit major advances in our understanding of the natural history of epilepsy, and lead to more effective therapies and improved patient safety. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.