A multistage knowledge-based system for EEG seizure detection in newborn infants

A Comparison of Automatically Extracted Quantitative EEG Features for Seizure Risk Stratification in Neonatal Encephalopathy

PURPOSE

Seizures occur in up to 40% of neonates with neonatal encephalopathy. Earlier identification of seizures leads to more successful seizure treatment, but is often delayed because of limited availability of continuous EEG monitoring. Clinical variables poorly stratify seizure risk, and EEG use to stratify seizure risk has previously been limited by need for manual review and artifact exclusion. The goal of this study is to compare the utility of automatically extracted quantitative EEG (qEEG) features for seizure risk stratification.

METHODS

We conducted a retrospective analysis of neonates with moderate-to-severe neonatal encephalopathy who underwent therapeutic hypothermia at a single center. The first 24 hours of EEG underwent automated artifact removal and qEEG analysis, comparing qEEG features for seizure risk stratification.

RESULTS

The study included 150 neonates and compared the 36 (23%) with seizures with those without. Absolute spectral power best stratified seizure risk with area under the curve ranging from 63% to 71%, followed by range EEG lower and upper margin, median and SD of the range EEG lower margin. No features were significantly more predictive in the hour before seizure onset. Clinical examination was not associated with seizure risk.

CONCLUSIONS

Automatically extracted qEEG features were more predictive than clinical examination in stratifying neonatal seizure risk during therapeutic hypothermia. qEEG represents a potential practical bedside tool to individualize intensity and duration of EEG monitoring and decrease time to seizure recognition. Future work is needed to refine and combine qEEG features to improve risk stratification.

Knowledge mapping of neonatal electroencephalogram: A bibliometric analysis (2004-2022)

BACKGROUND

Electroencephalography (EEG), a widely used noninvasive neurophysiological diagnostic tool, has experienced substantial advancements from 2004 to 2022, particularly in neonatal applications. Utilizing a bibliometric methodology, this study delineates the knowledge structure and identifies emergent trends within neonatal EEG research.

METHODS

An exhaustive literature search was conducted on the Web of Science Core Collection (WoSCC) database to identify publications related to neonatal EEG from 2004 to 2022. Analytical tools such as VOSviewer, CiteSpace, and the R package "bibliometrix" were employed to facilitate this investigation.

RESULTS

The search yielded 2501 articles originating from 79 countries, with the United States and England being the predominant contributors. A yearly upward trend in publications concerning neonatal EEG was observed. Notable research institutions leading this field include the University of Helsinki, University College London, and University College Cork. Clinical Neurophysiology is identified as the foremost journal in this realm, with Pediatrics as the most frequently co-cited journal. The collective body of work from 9977 authors highlights Sampsa Vanhatalo as the most prolific contributor, while Mark Steven Scher is recognized as the most frequently co-cited author. Key terms such as "seizures," "epilepsy," "hypoxic-ischemic encephalopathy," "amplitude-integrated EEG," and "brain injury" represent the focal research themes.

CONCLUSION

This bibliometric analysis offers the first comprehensive review, encapsulating research trends and progress in neonatal EEG. It reveals current research frontiers and crucial directions, providing an essential resource for researchers engaged in neonatal neuroscience.

Design of a Multi-Feature Classification Scheme for Infant Epileptic Seizures

Neonatal epileptic seizures take place in the early childhood years, accounting for a severe condition with several deaths and neurological problems in newborn neonates. Despite the early advancements on the diagnosis and/or treatment of this condition, as a major difficulty accounts the inability of the physicians to identify and characterize a seizure, as one a small percentage gets detected in neonatal intensive care units (NICU). An important step towards any kind of seizure classification is the detection and reduction of non-cerebral activity. Towards this direction, our multi-feature approach contains spectral and statistical characteristics of EEG signals of 79 infants with suspicion of seizure and assesses the performance of two classification algorithms iteratively. The trained models (Support Vector Machine (SVM) and Random Forest classifiers) yielded high classification performance (>80% and >85% respectively). A robust neonatal seizure classification scheme is thus proposed, along with nine high scoring spectrum and statistical features. The importance of embedding an artefact reduction approach is also discussed, since the complex artifacts spread throughout the signals have great impact on the accuracy of the algorithms. The nine extracted high scoring spectral and statistical features might be used as potential biomarkers for neonatal seizure prediction in a clinical setting.

Deep-EEG: An Optimized and Robust Framework and Method for EEG-Based Diagnosis of Epileptic Seizure

Detecting brain disorders using deep learning methods has received much hype during the last few years. Increased depth leads to more computational efficiency, accuracy, and optimization and less loss. Epilepsy is one of the most common chronic neurological disorders characterized by repeated seizures. We have developed a deep learning model using Deep convolutional Autoencoder-Bidirectional Long Short Memory for Epileptic Seizure Detection (DCAE-ESD-Bi-LSTM) for automatic detection of seizures using EEG data. The significant feature of our model is that it has contributed to the accurate and optimized diagnosis of epilepsy in ideal and real-life situations. The results on the benchmark (CHB-MIT) dataset and the dataset collected by the authors show the relevance of the proposed approach over the baseline deep learning techniques by achieving an accuracy of 99.8%, classification accuracy of 99.7%, sensitivity of 99.8%, specificity and precision of 99.9% and F1 score of 99.6%. Our approach can contribute to the accurate and optimized detection of seizures while scaling the design rules and increasing performance without changing the network's depth.

Optical Flow Estimation Improves Automated Seizure Detection in Neonatal EEG

PURPOSE

Existing automated seizure detection algorithms report sensitivities between 43% and 77% and specificities between 56% and 90%. The algorithms suffer from false alarms when applied to neonatal EEG because of the high degree of nurse handling and rhythmic patting used to soothe neonates. Computer vision technology that quantifies movement in real time could distinguish artifactual motion and improve automated neonatal seizure detection algorithms.

METHODS

The authors used video EEG recordings from 43 neonates undergoing monitoring for seizures as part of the NEOLEV2 clinical trial. The Persyst neonatal automated seizure detection algorithm ran in real time during study EEG acquisitions. Computer vision algorithms were applied to extract detailed accounts of artifactual movement of the neonate or people near the neonate though dense optical flow estimation.

RESULTS

Using the methods mentioned above, 197 periods of patting activity were identified and quantified, of which 45 generated false-positive automated seizure detection events. A binary patting detection algorithm was trained with a subset of 470 event videos. This supervised detection algorithm was applied to a testing subset of 187 event videos with 8 false-positive events, which resulted in a 24% reduction in false-positive automated seizure detections and a 50% reduction in false-positive events caused by neonatal care patting, while maintaining 11 of 12 true-positive seizure detection events.

CONCLUSIONS

This work presents a novel approach to improving automated seizure detection algorithms used during neonatal video EEG monitoring. This artifact detection mechanism can improve the ability of a seizure detector algorithm to distinguish between artifact and true seizure activity.

Hybrid classification model for eye state detection using electroencephalogram signals

The electroencephalography (EEG) signal is an essential source of Brain-Computer Interface (BCI) technology implementation. The BCI is nothing but a non-muscle communication medium among the external devices and the brain. The basic concept of BCI is to enable the interaction among the neurological ill patients to others with the help of brain signals. EEG signal classification is an essential requirement for various applications such as motor imagery classification, drug effects diagnosis, emotion classification, seizure prediction/detection, eye state prediction/detection, and so on. Thus, there is a need for an efficient classification model that can deal with the EEG datasets more adequately with better classification accuracy, which will further help in developing the automatic solution for the medical domain. In this paper, we have introduced a hybrid classification model for eye state detection using electroencephalogram (EEG) signals. This hybrid classification model has been evaluated with the other traditional machine learning models, eight classification models (Prepossessed + Hypertuned) and six state-of-the-art methods to assess its appropriateness and correctness. This proposed classification model establishes a machine learning-based hybrid model for the classification of eye state using EEG signals with greater exactness. It is also capable of solving the issue of outlier detection and removal to address the class imbalance problem, which will offer the solution toward building the robotic or smart machine-based solution for social well-being.

A Smart Integrated Brain-Computer Interaction for Epileptic Seizure Detection

Epilepsy is brain resulted activities which are affected by suddenly seizures which have unpredictable changes affects brain electrical functionalities. Epilepsy has a significant impact on society on the healthcare treatment, cost, responds, and patients behavior. The study has main objectives to propose accurate integrated framework for epileptic seizure detection from the pre-ictal phase of the EEG signal. Locate the connected channel lobe in region where epileptic is expected to occur. Provide automated and real-time monitoring and send warning messages to patient and epileptologist to take accurate actions before ictal occur. Enable future contribution for different Seizure features and impact. Also reduce cost, time and effort. Based on the hypothesis of entropy of EEG signals during seizure has low value if (n) of channels are detected to have seizure, then they are considered as connected neighbors in brain domain mapping, which is clear alert that patient will have a seizure ictal. This end to end framework has modules of data acquisition, pre-processing, feature extraction, pattern-matching, supports vector machines (SVM) classifier for extracted feature, in addition to monitoring and notification. The extracted features includes lower threshold, homogeneity, weighted permutation entropy, power and energy. Also identify the physiological field located inside the brain which the seizure will expected to occur. The final output results have 92% for True positive rate in addition to 95% of F1 and 98.9% of accuracy. This system has proved consistency during all its phases of seizure detection with valuable and effective support to the society.

Technical recommendations and interpretation guidelines for electroencephalography for premature and full-term newborns

Electroencephalography (EEG) of neonatal patients is amongst the most valuable diagnostic and prognostic tool. EEG recordings, acquired at the bedside of infants, evaluate brain function and the maturation of premature and extremely premature infants. Strict conditions of acquisition and interpretation must be respected to guarantee the quality of the EEG and ensure its safety for fragile children. This article provides guidance for EEG acquisition including: (1) the required equipment and devices, (2) the modalities of installation and asepsis precautions, and (3) the digital signal acquisition parameters to use during the recording. The fundamental role of a well-trained technician in supervising the EEG recording is emphasized. In parallel to the acquisition recommendations, we present a guideline for EEG interpretation and reporting. The successive steps of EEG interpretation, from reading the EEG to writing the report, are described. The complexity of the EEG signal in neonates makes artefact detection difficult. Thus, we provide an overview of certain characteristic artefacts and detail the methods for eliminating them.

Applications of advanced signal processing and machine learning in the neonatal hypoxic-ischemic electroencephalogram

Perinatal hypoxic-ischemic-encephalopathy significantly contributes to neonatal death and life-long disability such as cerebral palsy. Advances in signal processing and machine learning have provided the research community with an opportunity to develop automated real-time identification techniques to detect the signs of hypoxic-ischemic-encephalopathy in larger electroencephalography/amplitude-integrated electroencephalography data sets more easily. This review details the recent achievements, performed by a number of prominent research groups across the world, in the automatic identification and classification of hypoxic-ischemic epileptiform neonatal seizures using advanced signal processing and machine learning techniques. This review also addresses the clinical challenges that current automated techniques face in order to be fully utilized by clinicians, and highlights the importance of upgrading the current clinical bedside sampling frequencies to higher sampling rates in order to provide better hypoxic-ischemic biomarker detection frameworks. Additionally, the article highlights that current clinical automated epileptiform detection strategies for human neonates have been only concerned with seizure detection after the therapeutic latent phase of injury. Whereas recent animal studies have demonstrated that the latent phase of opportunity is critically important for early diagnosis of hypoxic-ischemic-encephalopathy electroencephalography biomarkers and although difficult, detection strategies could utilize biomarkers in the latent phase to also predict the onset of future seizures.

Real-Time Localization of Epileptogenic Foci EEG Signals: An FPGA-Based Implementation

The epileptogenic focus is a brain area that may be surgically removed to control of epileptic seizures. Locating it is an essential and crucial step prior to the surgical treatment. However, given the difficulty of determining the localization of this brain region responsible of the initial seizure discharge, many works have proposed machine learning methods for the automatic classification of focal and non-focal electroencephalographic (EEG) signals. These works use automatic classification as an analysis tool for helping neurosurgeons to identify focal areas off-line, out of surgery, during the processing of the huge amount of information collected during several days of patient monitoring. In turn, this paper proposes an automatic classification procedure capable of assisting neurosurgeons online, during the resective epilepsy surgery, to refine the localization of the epileptogenic area to be resected, if they have doubts. This goal requires a real-time implementation with as low a computational cost as possible. For that reason, this work proposes both a feature set and a classifier model that minimizes the computational load while preserving the classification accuracy at 95.5%, a level similar to previous works. In addition, the classification procedure has been implemented on a FPGA device to determine its resource needs and throughput. Thus, it can be concluded that such a device can embed the whole classification process, from accepting raw signals to the delivery of the classification results in a cost-effective Xilinx Spartan-6 FPGA device. This real-time implementation begins providing results after a 5 s latency, and later, can deliver floating-point classification results at 3.5 Hz rate, using overlapped time-windows.

An automatic single-channel EEG-based sleep stage scoring method based on hidden Markov Model

OBJECTIVE

Sleep stage scoring is essential for diagnosing sleep disorders. Visual scoring of sleep stages is very time-consuming and prone to human errors. In this work, we introduce an efficient approach to improve the accuracy of sleep stage scoring and classification for sleep analysis.

METHOD

In this approach, a set of optimal features was first selected from a pool of features extracted from sleep EEG epochs by using a feature selection method based on the relevance and redundancy analysis. EEG segments were then classified using a random forest classifier. Finally, a Hidden Markov Model (HMM) was used to reduce false positives by incorporating knowledge of the temporal structure of transitions between sleep stages. We evaluated the proposed method using single-channel EEG signals from four public sleep EEG datasets scored according to R&K and AASM guidelines. We compared the performance of our method with existing methods using different cross validation strategies.

RESULTS

Using a leave-one-out validation strategy, our method achieved overall accuracies in the range of (79.4-87.4%) and (77.6-80.4%) with Kappa values in the range of 0.7-0.85 for six-stage (R&K) and five-stage (AASM) classification, respectively. Our method showed a reduction in overall accuracy up to 8% using the cross-dataset validation strategy in comparison with the subject cross-validation method.

COMPARISON WITH EXISTING METHOD(S)

Our method outperformed the existing methods for all multi-stage classification.

CONCLUSIONS

The proposed single-channel method can be used for robust and reliable sleep stage scoring with high accuracy and relatively low complexity required for real time applications.

Diagnosis of seizures and encephalopathy using conventional EEG and amplitude integrated EEG

Seizures are more common in the neonatal period than at any other time of life, partly due to the relative hyperexcitability of the neonatal brain. Brain monitoring of sick neonates in the NICU using either conventional electroencephalography or amplitude integrated EEG is essential to accurately detect seizures. Treatment of seizures is important, as evidence increasingly indicates that seizures damage the brain in addition to that caused by the underlying etiology. Prompt treatment has been shown to reduce seizure burden with the potential to ameliorate seizure-mediated damage. Neonatal encephalopathy most commonly caused by a hypoxia-ischemia results in an alteration of mental status and problems such as seizures, hypotonia, apnea, and feeding difficulties. Confirmation of encephalopathy with EEG monitoring can act as an important adjunct to other investigations and the clinical examination, particularly when considering treatment strategies such as therapeutic hypothermia. Brain monitoring also provides useful early prognostic indicators to clinicians. Recent use of machine learning in algorithms to continuously monitor the neonatal EEG, detect seizures, and grade encephalopathy offers the exciting prospect of real-time decision support in the NICU in the very near future.

Epileptic Seizure Detection in Long-Term EEG Recordings by Using Wavelet-Based Directed Transfer Function

GOAL

The accurate automatic detection of epileptic seizures is very important in long-term electroencephalogram (EEG) recordings. In this study, the wavelet decomposition and the directed transfer function (DTF) algorithm were combined to present a novel wavelet-based directed transfer function (WDTF) method for the patient-specific seizure detection.

METHODS

First, five subbands were extracted from 19-channel EEG signals by using wavelet decomposition in a sliding window. Second, the information flow characteristics of five subbands and full frequency band of EEG signals were calculated by the DTF method. The intensity of the outflow information was then used to reduce the feature dimensionality. Finally, all features were combined to identify interictal and ictal EEG segments by the support vector machine classifier.

RESULTS

By using fivefold cross validation, the proposed method had achieved excellent performance with the average accuracy of 99.4%, the average selectivity of 91.1%, the average sensitivity of 92.1%, the average specificity of 99.5%, and the average detection rate of 95.8%.

CONCLUSION

The WDTF method is able to enhance seizure detection results in long-term EEG recordings of focal epilepsy patients.

SIGNIFICANCE

This study may lead to the development of seizure detection system with high performance, thus reducing the workload of epileptologists and facilitating to take corresponding steps promptly after the seizure onset. The high-frequency activity in the epilepsy brain may be of great importance for investigating the pathological mechanism and treatment of seizure.

Toward a Personalized Real-Time Diagnosis in Neonatal Seizure Detection

The problem of creating a personalized seizure detection algorithm for newborns is tackled in this paper. A probabilistic framework for semi-supervised adaptation of a generic patient-independent neonatal seizure detector is proposed. A system that is based on a combination of patient-adaptive (generative) and patient-independent (discriminative) classifiers is designed and evaluated on a large database of unedited continuous multichannel neonatal EEG recordings of over 800 h in duration. It is shown that an improvement in the detection of neonatal seizures over the course of long EEG recordings is achievable with on-the-fly incorporation of patient-specific EEG characteristics. In the clinical setting, the employment of the developed system will maintain a seizure detection rate at 70% while halving the number of false detections per hour, from 0.4 to 0.2 FD/h. This is the first study to propose the use of online adaptation without clinical labels, to build a personalized diagnostic system for the detection of neonatal seizures.

Improved neonatal seizure detection using adaptive learning

In neonatal intensive care units performing continuous EEG monitoring, there is an unmet need for around-the-clock interpretation of EEG, especially for recognizing seizures. In recent years, a few automated seizure detection algorithms have been proposed. However, these are suboptimal in detecting brief-duration seizures (<; 30s), which frequently occur in neonates with severe neurological problems. Recently, a multi-stage neonatal seizure detector, composed of a heuristic and a data-driven classifier was proposed by our group and showed improved detection of brief seizures. In the present work, we propose to add a third stage to the detector in order to use feedback of the Clinical Neurophysiologist and adaptively retune a threshold of the second stage to improve the performance of detection of brief seizures. As a result, the false alarm rate (FAR) of the brief seizure detections decreased by 50% and the positive predictive value (PPV) increased by 18%. At the same time, for all detections, the FAR decreased by 35% and PPV increased by 5% while the good detection rate remained unchanged.

Improved epileptic seizure detection combining dynamic feature normalization with EEG novelty detection

Continuous electroencephalographic monitoring of critically ill patients is an established procedure in intensive care units. Seizure detection algorithms, such as support vector machines (SVM), play a prominent role in this procedure. To correct for inter-human differences in EEG characteristics, as well as for intra-human EEG variability over time, dynamic EEG feature normalization is essential. Recently, the median decaying memory (MDM) approach was determined to be the best method of normalization. MDM uses a sliding baseline buffer of EEG epochs to calculate feature normalization constants. However, while this method does include non-seizure EEG epochs, it also includes EEG activity that can have a detrimental effect on the normalization and subsequent seizure detection performance. In this study, EEG data that is to be incorporated into the baseline buffer are automatically selected based on a novelty detection algorithm (Novelty-MDM). Performance of an SVM-based seizure detection framework is evaluated in 17 long-term ICU registrations using the area under the sensitivity-specificity ROC curve. This evaluation compares three different EEG normalization methods, namely a fixed baseline buffer (FB), the median decaying memory (MDM) approach, and our novelty median decaying memory (Novelty-MDM) method. It is demonstrated that MDM did not improve overall performance compared to FB (p < 0.27), partly because seizure like episodes were included in the baseline. More importantly, Novelty-MDM significantly outperforms both FB (p = 0.015) and MDM (p = 0.0065).

An Automatic Prediction of Epileptic Seizures Using Cloud Computing and Wireless Sensor Networks

Epilepsy is one of the most common neurological disorders which is characterized by the spontaneous and unforeseeable occurrence of seizures. An automatic prediction of seizure can protect the patients from accidents and save their life. In this article, we proposed a mobile-based framework that automatically predict seizures using the information contained in electroencephalography (EEG) signals. The wireless sensor technology is used to capture the EEG signals of patients. The cloud-based services are used to collect and analyze the EEG data from the patient's mobile phone. The features from the EEG signal are extracted using the fast Walsh-Hadamard transform (FWHT). The Higher Order Spectral Analysis (HOSA) is applied to FWHT coefficients in order to select the features set relevant to normal, preictal and ictal states of seizure. We subsequently exploit the selected features as input to a k-means classifier to detect epileptic seizure states in a reasonable time. The performance of the proposed model is tested on Amazon EC2 cloud and compared in terms of execution time and accuracy. The findings show that with selected HOS based features, we were able to achieve a classification accuracy of 94.6 %.

Optimal training dataset composition for SVM-based, age-independent, automated epileptic seizure detection

Automated seizure detection is a valuable asset to health professionals, which makes adequate treatment possible in order to minimize brain damage. Most research focuses on two separate aspects of automated seizure detection: EEG feature computation and classification methods. Little research has been published regarding optimal training dataset composition for patient-independent seizure detection. This paper evaluates the performance of classifiers trained on different datasets in order to determine the optimal dataset for use in classifier training for automated, age-independent, seizure detection. Three datasets are used to train a support vector machine (SVM) classifier: (1) EEG from neonatal patients, (2) EEG from adult patients and (3) EEG from both neonates and adults. To correct for baseline EEG feature differences among patients feature, normalization is essential. Usually dedicated detection systems are developed for either neonatal or adult patients. Normalization might allow for the development of a single seizure detection system for patients irrespective of their age. Two classifier versions are trained on all three datasets: one with feature normalization and one without. This gives us six different classifiers to evaluate using both the neonatal and adults test sets. As a performance measure, the area under the receiver operating characteristics curve (AUC) is used. With application of FBC, it resulted in performance values of 0.90 and 0.93 for neonatal and adult seizure detection, respectively. For neonatal seizure detection, the classifier trained on EEG from adult patients performed significantly worse compared to both the classifier trained on EEG data from neonatal patients and the classier trained on both neonatal and adult EEG data. For adult seizure detection, optimal performance was achieved by either the classifier trained on adult EEG data or the classifier trained on both neonatal and adult EEG data. Our results show that age-independent seizure detection is possible by training one classifier on EEG data from both neonatal and adult patients. Furthermore, our results indicate that for accurate age-independent seizure detection, it is important that EEG data from each age category are used for classifier training. This is particularly important for neonatal seizure detection. Our results underline the under-appreciated importance of training dataset composition with respect to accurate age-independent seizure detection.

Improvement of an automated neonatal seizure detector using a post-processing technique

Visual recognition of neonatal seizures during continuous EEG monitoring in neonatal intensive care units (NICUs) is labor-intensive, has low inter-rater agreement and requires special expertise that is not available around the clock. Development of an accurate automated seizure detection system with a low false alarm rate will support clinical decision making and alleviate significantly the workload. However, this is an ongoing difficult challenge for engineers as the neonatal EEG signal is non-stationary and often includes complex patterns of seizures and artifacts. In this study, we show an improvement of our previously developed neonatal seizure detector (developed using heuristic if-then rules). In order to improve the detection accuracy, mean phase coherence as a new feature is used to characterize artifacts and also support vector machine is applied to perform the post-processing step to remove false detections. As a result, the false alarm rate drops 42% (from 2.6 h(-1) to 1.5 h(-1)), whereas the good detection rate reduces only by 4%.

Early Seizure Detection Using Neuronal Potential Similarity: A Generalized Low-Complexity and Robust Measure

A novel approach using neuronal potential similarity (NPS) of two intracranial electroencephalogram (iEEG) electrodes placed over the foci is proposed for automated early seizure detection in patients with refractory partial epilepsy. The NPS measure is obtained from the spectral analysis of space-differential iEEG signals. Ratio between the NPS values obtained from two specific frequency bands is then investigated as a robust generalized measure, and reveals invaluable information about seizure initiation trends. A threshold-based classifier is subsequently applied on the proposed measure to generate alarms. The performance of the method was evaluated using cross-validation on a large clinical dataset, involving 183 seizure onsets in 1785 h of long-term continuous iEEG recordings of 11 patients. On average, the results show a high sensitivity of 86.9% (159 out of 183), a very low false detection rate of 1.4 per day, and a mean detection latency of 13.1 s from electrographic seizure onsets, while in average preceding clinical onsets by 6.3 s. These high performance results, specifically the short detection latency, coupled with the very low computational cost of the proposed method make it adequate for using in implantable closed-loop seizure suppression systems.

Epileptic Seizure Detection Based on Partial Directed Coherence Analysis

Long-term video EEG epilepsy monitoring can help doctors diagnose and cure epilepsy. The workload of doctors to read the EEG signals of epilepsy patients can be effectively reduced by automatic seizure detection. The application of partial directed coherence (PDC) analysis as mechanism for feature extraction in the scalp EEG recordings for seizure detection could reflect the physiological changes of brain activity before and after seizure onsets. In this study, a new approach on the basis of PDC was proposed to detect the seizure intervals of epilepsy patients. First of all, the multivariate autoregressive model was established for a moving window and the direction and intensity of information flow based on PDC analysis was calculated. Then, the outflow information related to certain EEG channel could be obtained by summing up the intensity of information flow propagated to other EEG channels in order to reduce the feature dimensionality. At last, according to the pathological features of epileptic seizures, the outflow information was regarded as the input vectors to a support vector machine classifier for discriminating interictal periods and ictal periods of EEG signals. The proposed method had achieved a good performance with the correct rate of 98.3%, the selectivity rate of 67.88%, the sensitivity rate of 91.44%, the specificity rate of 99.34%, and the average detection rate of 95.39%, which demonstrated that this method was suitable for detecting the seizure intervals of epilepsy patients. By comparing with other existing techniques, the proposed method based on PDC analysis achieved significant improvement in terms of seizure detection.

Neonatal seizure detection using atomic decomposition with a novel dictionary

Atomic decomposition (AD) can be used to efficiently decompose an arbitrary signal. In this paper, we present a method to detect neonatal electroencephalogram (EEG) seizure based on AD via orthogonal matching pursuit using a novel, application-specific, dictionary. The dictionary consists of pseudoperiodic Duffing oscillator atoms which are designed to be coherent with the seizure epochs. The relative structural complexity (a measure of the rate of convergence of AD) is used as the sole feature for seizure detection. The proposed feature was tested on a large clinical dataset of 826 h of EEG data from 18 full-term newborns with 1389 seizures. The seizure detection system using the proposed dictionary was able to achieve a median receiver operator characteristic area of 0.91 (IQR 0.87-0.95) across 18 neonates.

Clinical implementation of a neonatal seizure detection algorithm

Technologies for automated detection of neonatal seizures are gradually moving towards cot-side implementation. The aim of this paper is to present different ways to visualize the output of a neonatal seizure detection system and analyse their influence on performance in a clinical environment. Three different ways to visualize the detector output are considered: a binary output, a probabilistic trace, and a spatio-temporal colormap of seizure observability. As an alternative to visual aids, audified neonatal EEG is also considered. Additionally, a survey on the usefulness and accuracy of the presented methods has been performed among clinical personnel. The main advantages and disadvantages of the presented methods are discussed. The connection between information visualization and different methods to compute conventional metrics is established. The results of the visualization methods along with the system validation results indicate that the developed neonatal seizure detector with its current level of performance would unambiguously be of benefit to clinicians as a decision support system. The results of the survey suggest that a suitable way to visualize the output of neonatal seizure detection systems in a clinical environment is a combination of a binary output and a probabilistic trace. The main healthcare benefits of the tool are outlined. The decision support system with the chosen visualization interface is currently undergoing pre-market European multi-centre clinical investigation to support its regulatory approval and clinical adoption.

Robust and low complexity algorithms for seizure detection

This paper presents two low complexity and yet robust methods for automated seizure detection using a set of 2 intracranial Electroencephalogram (iEEG) recordings. Most current seizure detection methods suffer from high number of false alarms, even when designed to be subject-specific. In this study, the ratios of power between pairs of frequency bands are used as features to detect epileptic seizures. For comparison, these features are calculated from monopolar and bipolar iEEG recordings. Optimal thresholds are individually determined and used for each feature. Alarms are generated when the measure passes the threshold. The detector was applied to long-term continuous invasive recordings from 5 patients with refractory partial epilepsy, containing 54 seizures in 780 hours. On average, the results revealed 88.9% sensitivity, a very low false detection rate of 0.041 per hour (h(-1)) and detection latency of 9.4 seconds.

EEG feature pre-processing for neonatal epileptic seizure detection

Aim of our project is to further optimize neonatal seizure detection using support vector machine (SVM). First, a Kalman filter (KF) was used to filter both feature and classifier output time series in order to increase temporal precision. Second, EEG baseline feature correction (FBC) was introduced to reduce inter patient variability in feature distributions. The performance of the detection methods is evaluated on 54 multi channel routine EEG recordings from 39 both term and pre-term newborns. The area under the receiver operating characteristics curve (AUC) as well as sensitivity and specificity are used to evaluate the performance of the classification method. SVM without KF and FBC achieves an AUC of 0.767 (sensitivity 0.679, specificity 0.707). The highest AUC of 0.902 (sensitivity 0.801, specificity 0.831) is achieved on baseline corrected features with a Kalman smoother used for training data pre-processing and a KF used to filter the classifier output. Both FBC and KF significantly improve neonatal epileptic seizure detection. This paper introduces significant improvements for the state of the art SVM based neonatal epileptic seizure detection.

Teager Energy Based Filter-Bank Cepstra in EEG Classification for Seizure Detection Using Radial Basis Function Neural Network

About 1–3% of the world population suffers from epilepsy. Epileptic seizures are abnormal sudden discharges in the brain with signatures manifesting in the electroencephalograph (EEG) recordings by frequency changes and increased amplitudes. These changes, in this work, are captured through static and dynamic features derived from three Teager energy based filter-bank cepstra (TE-FB-CEPs). We compared the performance of linear, logarithmic, and Mel frequency scale TE-FB-CEPs using radial basis function neural network in general epileptic seizure detection. The comparison is tried on eight different classification problems which encompass all the possible discriminations in the medical field related to epilepsy. In a previous study, using traditional cepstrum on the same database, we had found that the composite vectors showed a degraded performance in seizure detection. In this study, however, irrespective of frequency scaling used, it is found that the composite vectors of TE-FB-CEPs maintain excellent overall accuracy in all the eight classification problems.

Monitoring neonatal seizures

Neonatal seizures are a neurological emergency and prompt treatment is required. Seizure burden in neonates can be very high, status epilepticus a frequent occurrence, and the majority of seizures do not have any clinical correlate. Detection of neonatal seizures is only possible with continuous electroencephalogram (EEG) monitoring. EEG interpretation requires special expertise that is not available in most neonatal intensive care units (NICUs). As a result, a simplified method of EEG recording incorporating an easy-to-interpret compressed trend of the EEG output (amplitude integrated EEG) from one of the EEG output from one or two channels has emerged as a popular way to monitor neurological function in the NICU. This is not without limitations; short duration and low amplitude seizures can be missed, artefacts are problematic and may mimic seizure-like activity and only a restricted area of the brain is monitored. Continuous multichannel EEG is the gold standard for detecting seizures and monitoring response to therapy but expert interpretation of the EEG output is generally not available. Some centres have set up remote access for neurophysiologists to the cot-side EEG, but reliable interpretation is wholly dependent on the 24 h availability of experts, an expensive solution. A more practical solution for the NICU without such expertise is an automated seizure detection system. This review outlines the current state of the art regarding cot-side monitoring of neonatal seizures in the NICU.

Robust neonatal EEG seizure detection through adaptive background modeling

Adaptive probabilistic modeling of the EEG background is proposed for seizure detection in neonates with hypoxic ischemic encephalopathy. The decision is made based on the temporal derivative of the seizure probability with respect to the adaptively modeled level of background activity. The robustness of the system to long duration "seizure-like" artifacts, in particular those due to respiration, is improved. The system was developed using statistical leave-one-patient-out performance assessment, on a large clinical dataset, comprising 38 patients of 1479 h total duration. The developed technique was then validated by a single test on a separate totally unseen randomized prospective dataset of 51 neonates totaling 2540 h of duration. By exploiting the proposed adaptation, the ROC area is increased from 93.4% to 96.1% (41% relative improvement). The number of false detections per hour is decreased from 0.42 to 0.24, while maintaining the correct detection of seizure burden at 70%. These results on the unseen data were predicted from the rigorous leave-one-patient-out validation and confirm the validity of our algorithm development process.

Inclusion of temporal priors for automated neonatal EEG classification

The aim of this paper is to use recent advances in the clinical understanding of the temporal evolution of seizure burden in neonates with hypoxic ischemic encephalopathy to improve the performance of automated detection algorithms. Probabilistic weights are designed from temporal locations of neonatal seizure events relative to time of birth. These weights are obtained by fitting a skew-normal distribution to the temporal seizure density and introduced into the probabilistic framework of the previously developed neonatal seizure detector. The results are validated on the largest available clinical dataset, comprising 816.7 h. By exploiting these priors, the receiver operating characteristic area is increased by 23% (relative) reaching 96.74%. The number of false detections per hour is decreased from 0.45 to 0.25, while maintaining the correct detection of seizure burden at 70%.

Automatic detection and analysis of the EEG sharp wave-slow wave patterns evoked by fluorinated inhalation anesthetics

OBJECTIVE

The aim of this study was to develop a method for the automatic detection of sharp wave-slow wave (SWSW) patterns evoked in EEG by volatile anesthetics and to identify the patterns' characteristics.

METHODS

The proposed method consisted in the k-NN classification with a reference set obtained using expert knowledge, the morphology of the EEG patterns and the condition for their synchronization. The decision rules were constructed and evaluated using 24h EEG records in ten patients.

RESULTS

The sensitivity, specificity and selectivity of the method were 0.88 ± 0.10, 0.81 ± 0.13 and 0.42 ± 0.16, respectively. SWSW patterns' recruitment was strictly dependent on anesthetic concentration. SWSW patterns evoked by different types of anesthetics expressed different characteristics.

CONCLUSIONS

Synchronization criterion and adequately selected morphological features of "slow wave" were sufficient to achieve the high sensitivity and specificity of the method.

SIGNIFICANCE

The monitoring of SWSW patterns is important in view of possible side effects of volatile anesthetics. The analysis of SWSW patterns' recruitment and morphology could be helpful in the diagnosis of the anesthesia effects on the CNS.

Temporal evolution of seizure burden for automated neonatal EEG classification

The aim of this paper is to use recent advances in the clinical understanding of the temporal evolution of seizure burden in neonates with hypoxic ischemic encephalopathy to improve the performance of automated detection algorithms. Probabilistic weights are designed from temporal locations of neonatal seizure events relative to time of birth. These weights are obtained by fitting a skew-normal distribution to the temporal seizure density and introduced into the probabilistic framework of the previously developed neonatal seizure detector. The results are validated on the largest available clinical dataset, comprising 816.7 hours. By exploiting these priors, the ROC area is increased by 23% (relative) reaching 96.75%. The number of false detections per hour is decreased from 0.72 to 0.36, while maintaining the correct detection of seizure burden at 75%.

Instantaneous measure of EEG channel importance for improved patient-adaptive neonatal seizure detection

A measure of bipolar channel importance is proposed for EEG-based detection of neonatal seizures. The channel weights are computed based on the integrated synchrony of classifier probabilistic outputs for the channels which share a common electrode. These estimated time-varying weights are introduced within a Bayesian probabilistic framework to provide a channel specific and, thus, adaptive seizure classification scheme. Validation results on a clinical dataset of neonatal seizures confirm the utility of the proposed channel weighting for the two patient-independent seizure detectors recently developed by this research group: one based on support vector machines (SVMs) and the other on Gaussian mixture models (GMMs). By exploiting the channel weighting, the receiver operating characteristic (ROC) area can be significantly increased for the most difficult patients, with the average ROC area across 17 patients increased by 22% (relative) for the SVM and by 15% (relative) for the GMM-based detector, respectively. It is shown that the system developed here outperforms the recent published studies in this area.

Improving early seizure detection

Over the last decade, the search for a method able to reliably predict seizures hours in advance has been largely replaced by the more realistic goal of very early detection of seizure onset, which would allow therapeutic or warning devices to be triggered prior to the onset of disabling clinical symptoms. We explore in this article the steps along the pathway from data acquisition to closed-loop applications that can and should be considered to design the most efficient early seizure detection. Microelectrodes, high-frequency oscillations, high sampling rate, high-density arrays, and modern analysis techniques are all elements of the recording and detection process that in combination with modeling studies can provide new insights into the dynamics of seizure onsets. Each of these steps needs to be considered if detection devices that will favorably impact the quality of life of patients are to be implemented. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.