{"doi":"10.1002/epi.70083","title":"Deployable seizure forecasting requires clinically meaningful performance: Response to Stirling et al.","abstract":"To the Editors: In contrast with our recent study,1 Stirling et al. state that Cycle forecasts outperform the Napkin method in electroencephalographic (EEG) cohorts (n = 24; hourly area under the curve [AUC] ≈ .70 vs. .47, daily AUC ≈ .58 vs. .47) and in a diary cohort (n = 808; hourly AUC ≈ .66 vs. .50, daily AUC ≈ .58 vs. .50). We have several comments. First, we provide code from our analysis: https://github.com/GoldenholzLab/Deepman2.git. Second, the forecasting code we used in our study for computing Cycle was provided by the Stirling/Karoly labs; our lab generated these forecasts just as they do. Therefore, the main difference between their result and ours is likely the cohort of patients tested. Third, we recommend Stirling's group exclude the 101 diary patients (12.5%) and eight EEG patients (33.3%) with seizure frequency > .5/day, as such patients are inappropriate for daily forecasts. The magnitude of effect on discrimination is only marginally better for the Cycle than the Napkin method and is nearly indistinguishable on calibration. Cycle is likely clinically indistinguishable from Napkin, despite statistical significance. Some might misread “statistically significant” to indicate “accurate.” Studies from our lab3 and theirs4 suggest patients are eager to have forecasts, even inaccurate forecasts. Moreover, they report that patients desire forecasts for scheduling “travel activities.”4 Perhaps the common misunderstanding of statistics,5 coupled with low accuracy forecasting, could translate into increases in motor vehicle accidents and other injuries for people with epilepsy.6 We view the findings Stirling et al. present as not a refutation, but a validation of our main conclusion; the Cycle method in both our analysis and theirs does not demonstrate a clinically significant superiority to the Napkin method. We continue to hope for better models. None. D.M.G. and C.-Y.C. were supported by NINDS K23NS124656. M.B.W. was supported by grants from the NIH (RF1AG064312, RF1NS120947, R01AG073410, R01HL161253, R01NS126282, R01AG073598, R01NS131347, R01NS130119) and NSF (2014431). C-YC has no conflict of interest. R.M. is the cofounder and owner of Seizure Tracker and has received personal fees from Courtagen Life Sciences, Engage Therapeutics, Epitel, LivaNova, Marinus Pharmaceuticals, Neurelis, NeuroPace, and UCB and grants from the Tuberous Sclerosis Complex Alliance. Seizure Tracker was paid for the effort to participate in this project via NIH funding. D.M.G. is an unpaid advisor for Epilepsy AI and Eysz. He has been provided speaker fees by AAN, AES, ACNS, and NNS. He also previously has been a paid consultant for Neuro Event Labs, IDR, LivaNova. and Health Advances. M.B.W. is a cofounder, scientific advisor, and consultant to Beacon Biosignals and has a personal equity interest in the company. He also receives royalties for authoring Pocket Neurology from Wolters Kluwer and Atlas of Intensive Care Quantitative EEG from Demos Medical. No ethical approval was needed for the present commentary. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Data sharing is not applicable to this article, as no datasets were generated or analyzed during the current study.","journal":"Epilepsia","year":2025,"id":587575,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9591,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":477801,"name":"Robert Moss","orcid":"0000-0002-9407-5681","position":1,"is_corresponding":false},{"id":280809,"name":"M. Brandon Westover","orcid":"0000-0003-4803-312X","position":2,"is_corresponding":false},{"id":424528,"name":"Daniel M. Goldenholz","orcid":"0000-0002-8370-2758","position":3,"is_corresponding":false},{"id":1258242,"name":"Chi‐Yuan Chang","orcid":"0000-0002-2033-1857","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T02:59:39.958043Z","pmid":"41474369","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}