A Neurosymbolic Framework for Interpretable Skeleton-Based Seizure Detection via Concept-Driven Logical Reasoning

Video-based seizure detection is essential for the management of epilepsy patients, offering a non-invasive complement to electroencephalography. While several deep learning approaches have been developed for video-based seizure detection, none are inherently interpretable, limiting their adoption and translation into clinical practice. We present, to our knowledge, the first exploration of a neurosymbolic framework for video-based seizure detection that directly addresses this gap. Our approach (1) extracts patient-centric skeleton sequences from epilepsy monitoring units via a prompt-guided foundation model, (2) predicts binary spatio-temporal concept activations grounded in clinical motor semiology guidelines, and (3) composes them via differentiable logic into interpretable Boolean rules with auditable contributions. Furthermore, to mitigate false positives arising from the traditional binary formulation (seizure vs. non-seizure), we sub-classify non-seizure segments into clinically relevant normal activities, providing the model with fine-grained discriminative supervision. Evaluated on two public seizure video benchmarks, our framework achieves 89.78% sensitivity with 0.06 false detections per hour on SAHZU and 85.27%,0.09 on IEEE, while producing complete three-level interpretability: every prediction decomposes into which motor primitives were detected, how they were logically composed, and how much each rule contributed to the clinical decision. We publicly release all annotations, extracted pose sequences, our data pipeline and code, https://github.com/Mr-TalhaIlyas/CDSD/.