Rationale: The epilepsies are a significant contributor to the global burden of neuropsychiatric disease. Disability in epilepsy is multifactorial, modulated by seizure frequency/recency, anticonvulsant side effects and the burden of comorbid psychiatric symptoms. In this study, we utilize wrist actigraphy to explore how objective, continuous and in situ assessments of rest and activity patterns correlate with epilepsy-specific variables and psychometric scales of emotional and cognitive well-being. Methods: This protocol was approved by the Baylor College of Medicine Institutional Review Board. Adults aged 18-64 with focal epilepsy (confirmed by an EMU evaluation) were enrolled during routine ambulatory clinic visits. Patients who were pregnant, with co-existing motor impairments (e.g., stroke-related hemiparesis) or with moderate-severe intellectual disability were excluded. Subjects were instructed to (i) wear an FDA-approved wrist-worn device (Actigraph 2) on their non-dominant wrist continuously for at least seven days, (ii) maintain a log of seizure events, and (iii) complete a series of standardized questionnaires, including the Adverse Event Profile (AEP), Quick Inventory of Depressive Symptomatology – Self Report (QIDS-SR), Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire for Somatic, Anxiety and Depressive Symptoms (PHQ-SADS). Cosinor analysis was applied to derive measures of circadian-ness (mesor, amplitude, acrophase). We also computed the morphology and frequency of active states, defined quantitatively as sustained/continuous epochs of activity (at least 10 units/min, lasting at least three contiguous minutes). Results: Eleven patients have been enrolled so far (54% male, 63% medically refractory), with a median of two daily anticonvulsants, and mean age of 35 (range: 21 to 63). Higher somatic symptom subscores of the PHQ-SADS positively correlated with circadian amplitude (r = +0.628, p< 0.05) and active state duration (r = +0.920, p< 0.0001). In contrast, higher anxiety symptom subscores of the PHQ-SADS were associated with a lower number of active states per day (r = -0.658, p< 0.05). Variations in seizure intractability, subjective sleepiness or depression symptoms were not correlated with the actigraphic parameters analyzed in this study. Conclusions: These early results suggest that objectively derived actigraphic parameters may correlate with somatic and anxiety-related symptoms in an ambulatory population of adult patients with focal epilepsy. As we gradually transition towards digital psychiatry and device-based remote patient surveillance, wrist actigraphy and other wearable technologies may provide an avenue to monitor both ictal and interictal contributions to disability in epilepsy. Funding: Please list any funding that was received in support of this abstract.: VK receives support from the NIH (1K08NS110924-01), an AES Junior Investigator Award (2020), SK Life Science, and seed funding from Baylor College of Medicine’s Office of Research.