Ictal time-irreversible intracranial EEG signals as markers of the epileptogenic zone

Visibility graph analysis for brain: scoping review

In the past two decades, network-based analysis has garnered considerable attention for analyzing time series data across various fields. Time series data can be transformed into graphs or networks using different methods, with the visibility graph (VG) being a widely utilized approach. The VG holds extensive applications in comprehending, identifying, and predicting specific characteristics of time series data. Its practicality extends to domains such as medicine, economics, meteorology, tourism, and others. This research presents a scoping review of scholarly articles published in reputable English-language journals and conferences, focusing on VG-based analysis methods related to brain disorders. The aim is to provide a foundation for further and future research endeavors, beginning with an introduction to the VG and its various types. To achieve this, a systematic search and refinement of relevant articles were conducted in two prominent scientific databases: Google Scholar and Scopus. A total of 51 eligible articles were selected for a comprehensive analysis of the topic. These articles categorized based on publication year, type of VG used, rationale for utilization, machine learning algorithms employed, frequently occurring keywords, top authors and universities, evaluation metrics, applied network properties, and brain disorders examined, such as Epilepsy, Alzheimer's disease, Autism, Alcoholism, Sleep disorders, Fatigue, Depression, and other related conditions. Moreover, there are recommendations for future advancements in research, which involve utilizing cutting-edge techniques like graph machine learning and deep learning. Additionally, the exploration of understudied medical conditions such as attention deficit hyperactivity disorder and Parkinson's disease is also suggested.

The time scales of irreversibility in spontaneous brain activity are altered in obsessive compulsive disorder

We study how obsessive-compulsive disorder (OCD) affects the complexity and time-reversal symmetry-breaking (irreversibility) of the brain resting-state activity as measured by magnetoencephalography (MEG). Comparing MEG recordings from OCD patients and age/sex matched control subjects, we find that irreversibility is more concentrated at faster time scales and more uniformly distributed across different channels of the same hemisphere in OCD patients than in control subjects. Furthermore, the interhemispheric asymmetry between homologous areas of OCD patients and controls is also markedly different. Some of these differences were reduced by 1-year of Kundalini Yoga meditation treatment. Taken together, these results suggest that OCD alters the dynamic attractor of the brain's resting state and hint at a possible novel neurophysiological characterization of this psychiatric disorder and how this therapy can possibly modulate brain function.

Source-sink connectivity: a novel interictal EEG marker for seizure localization

Over 15 million epilepsy patients worldwide have drug-resistant epilepsy. Successful surgery is a standard of care treatment but can only be achieved through complete resection or disconnection of the epileptogenic zone, the brain region(s) where seizures originate. Surgical success rates vary between 20% and 80%, because no clinically validated biological markers of the epileptogenic zone exist. Localizing the epileptogenic zone is a costly and time-consuming process, which often requires days to weeks of intracranial EEG (iEEG) monitoring. Clinicians visually inspect iEEG data to identify abnormal activity on individual channels occurring immediately before seizures or spikes that occur interictally (i.e. between seizures). In the end, the clinical standard mainly relies on a small proportion of the iEEG data captured to assist in epileptogenic zone localization (minutes of seizure data versus days of recordings), missing opportunities to leverage these largely ignored interictal data to better diagnose and treat patients. IEEG offers a unique opportunity to observe epileptic cortical network dynamics but waiting for seizures increases patient risks associated with invasive monitoring. In this study, we aimed to leverage interictal iEEG data by developing a new network-based interictal iEEG marker of the epileptogenic zone. We hypothesized that when a patient is not clinically seizing, it is because the epileptogenic zone is inhibited by other regions. We developed an algorithm that identifies two groups of nodes from the interictal iEEG network: those that are continuously inhibiting a set of neighbouring nodes ('sources') and the inhibited nodes themselves ('sinks'). Specifically, patient-specific dynamical network models were estimated from minutes of iEEG and their connectivity properties revealed top sources and sinks in the network, with each node being quantified by source-sink metrics. We validated the algorithm in a retrospective analysis of 65 patients. The source-sink metrics identified epileptogenic regions with 73% accuracy and clinicians agreed with the algorithm in 93% of seizure-free patients. The algorithm was further validated by using the metrics of the annotated epileptogenic zone to predict surgical outcomes. The source-sink metrics predicted outcomes with an accuracy of 79% compared to an accuracy of 43% for clinicians' predictions (surgical success rate of this dataset). In failed outcomes, we identified brain regions with high metrics that were untreated. When compared with high frequency oscillations, the most commonly proposed interictal iEEG feature for epileptogenic zone localization, source-sink metrics outperformed in predictive power (by a factor of 1.2), suggesting they may be an interictal iEEG fingerprint of the epileptogenic zone.

Permutation Jensen-Shannon distance: A versatile and fast symbolic tool for complex time-series analysis

The main motivation of this paper is to introduce the permutation Jensen-Shannon distance, a symbolic tool able to quantify the degree of similarity between two arbitrary time series. This quantifier results from the fusion of two concepts, the Jensen-Shannon divergence and the encoding scheme based on the sequential ordering of the elements in the data series. The versatility and robustness of this ordinal symbolic distance for characterizing and discriminating different dynamics are illustrated through several numerical and experimental applications. Results obtained allow us to be optimistic about its usefulness in the field of complex time-series analysis. Moreover, thanks to its simplicity, low computational cost, wide applicability, and less susceptibility to outliers and artifacts, this ordinal measure can efficiently handle large amounts of data and help to tackle the current big data challenges.

Phase irregularity: A conceptually simple and efficient approach to characterize electroencephalographic recordings from epilepsy patients

The severe neurological disorder epilepsy affects almost 1% of the world population. For patients who suffer from pharmacoresistant focal-onset epilepsy, electroencephalographic (EEG) recordings are essential for the localization of the brain area where seizures start. Apart from the visual inspection of the recordings, quantitative EEG signal analysis techniques proved to be useful for this purpose. Among other features, regularity versus irregularity and phase coherence versus phase independence allowed characterizing brain dynamics from the measured EEG signals. Can phase irregularities also characterize brain dynamics? To address this question, we use the univariate coefficient of phase velocity variation, defined as the ratio of phase velocity standard deviation and the mean phase velocity. Beyond that, as a bivariate measure we use the classical mean phase coherence to quantify the degree of phase locking. All phase-based measures are combined with surrogates to test null hypotheses about the dynamics underlying the signals. In the first part of our analysis, we use the Rössler model system to study our approach under controlled conditions. In the second part, we use the Bern-Barcelona EEG database which consists of focal and nonfocal signals extracted from seizure-free recordings. Focal signals are recorded from brain areas where the first seizure EEG signal changes can be detected, and nonfocal signals are recorded from areas that are not involved in the seizure at its onset. Our results show that focal signals have less phase variability and more phase coherence than nonfocal signals. Once combined with surrogates, the mean phase velocity proved to have the highest discriminative power between focal and nonfocal signals. In conclusion, conceptually simple and easy to compute phase-based measures can help to detect features induced by epilepsy from EEG signals. This holds not only for the classical mean phase coherence but even more so for univariate measures of phase irregularity.

Gait analysis under the lens of statistical physics

Human gait is a fundamental activity, essential for the survival of the individual, and an emergent property of the interactions between complex physical and cognitive processes. Gait is altered in many situations, due both to external constraints, as e.g. paced walk, and to physical and neurological pathologies. Its study is therefore important as a way of improving the quality of life of patients, but also as a door to understanding the inner working of the human nervous system. In this review we explore how four statistical physics concepts have been used to characterise normal and pathological gait: entropy, maximum Lyapunov exponent, multi-fractal analysis and irreversibility. Beyond some basic definitions, we present the main results that have been obtained in this field, as well as a discussion of the main limitations researchers have dealt and will have to deal with. We finally conclude with some biomedical considerations and avenues for further development.

Algorithmic Approaches for Assessing Irreversibility in Time Series: Review and Comparison

The assessment of time irreversibility, i.e., of the lack of invariance of the statistical properties of a system under the operation of time reversal, is a topic steadily gaining attention within the research community. Irreversible dynamics have been found in many real-world systems, with alterations being connected to, for instance, pathologies in the human brain, heart and gait, or to inefficiencies in financial markets. Assessing irreversibility in time series is not an easy task, due to its many aetiologies and to the different ways it manifests in data. It is thus not surprising that several numerical methods have been proposed in the last decades, based on different principles and with different applications in mind. In this contribution we review the most important algorithmic solutions that have been proposed to test the irreversibility of time series, their underlying hypotheses, computational and practical limitations, and their comparative performance. We further provide an open-source software library that includes all tests here considered. As a final point, we show that "one size does not fit all", as tests yield complementary, and sometimes conflicting views to the problem; and discuss some future research avenues.

Assessing time series irreversibility through micro-scale trends

Time irreversibility, defined as the lack of invariance of the statistical properties of a system or time series under the operation of time reversal, has received increasing attention during the last few decades, thanks to the information it provides about the mechanisms underlying the observed dynamics. Following the need of analyzing real-world time series, many irreversibility metrics and tests have been proposed, each one associated with different requirements in terms of, e.g., minimum time series length or computational cost. We here build upon previously proposed tests based on the concept of permutation patterns but deviating from them through the inclusion of information about the amplitude of the signal and how this evolves over time. We show, by means of synthetic time series, that the results yielded by this method are complementary to the ones obtained by using permutation patterns alone, thus suggesting that "one irreversibility metric does not fit all." We further apply the proposed metric to the analysis of two real-world data sets.

A Primer on Hyperdimensional Computing for iEEG Seizure Detection

A central challenge in today's care of epilepsy patients is that the disease dynamics are severely under-sampled in the currently typical setting with appointment-based clinical and electroencephalographic examinations. Implantable devices to monitor electrical brain signals and to detect epileptic seizures may significantly improve this situation and may inform personalized treatment on an unprecedented scale. These implantable devices should be optimized for energy efficiency and compact design. Energy efficiency will ease their maintenance by reducing the time of recharging, or by increasing the lifetime of their batteries. Biological nervous systems use an extremely small amount of energy for information processing. In recent years, a number of methods, often collectively referred to as brain-inspired computing, have also been developed to improve computation in non-biological hardware. Here, we give an overview of one of these methods, which has in particular been inspired by the very size of brains' circuits and termed hyperdimensional computing. Using a tutorial style, we set out to explain the key concepts of hyperdimensional computing including very high-dimensional binary vectors, the operations used to combine and manipulate these vectors, and the crucial characteristics of the mathematical space they inhabit. We then demonstrate step-by-step how hyperdimensional computing can be used to detect epileptic seizures from intracranial electroencephalogram (EEG) recordings with high energy efficiency, high specificity, and high sensitivity. We conclude by describing potential future clinical applications of hyperdimensional computing for the analysis of EEG and non-EEG digital biomarkers.

Imaging of focal seizures with Electrical Impedance Tomography and depth electrodes in real time

Intracranial EEG is the current gold standard technique for localizing seizures for surgery, but it can be insensitive to tangential dipole or distant sources. Electrical Impedance Tomography (EIT) offers a novel method to improve coverage and seizure onset localization. The feasibility of EIT has been previously assessed in a computer simulation, which revealed an improved accuracy of seizure detection with EIT compared to intracranial EEG. In this study, slow impedance changes, evoked by cell swelling occurring over seconds, were reconstructed in real time by frequency division multiplexing EIT using depth and subdural electrodes in a swine model of epilepsy. EIT allowed to generate repetitive images of ictal events at similar time course to fMRI but without its significant limitations. EIT was recorded with a system consisting of 32 parallel current sources and 64 voltage recorders. Seizures triggered with intracranial injection of benzylpenicillin (BPN) in five pigs caused a repetitive peak impedance increase of 3.4 ± 1.5 mV and 9.5 ± 3% (N =205 seizures); the impedance signal change was seen already after a single, first seizure. EIT enabled reconstruction of the seizure onset 9 ± 1.5 mm from the BPN cannula and 7.5 ± 1.1 mm from the closest SEEG contact (p<0.05, n =37 focal seizures in three pigs) and it could address problems with sampling error in intracranial EEG. The amplitude of the impedance change correlated with the spread of the seizure on the SEEG (p <<0.001, n =37). The results presented here suggest that combining a parallel EIT system with intracranial EEG monitoring has a potential to improve the diagnostic yield in epileptic patients and become a vital tool in improving our understanding of epilepsy.

An Ensemble of Hyperdimensional Classifiers: Hardware-Friendly Short-Latency Seizure Detection With Automatic iEEG Electrode Selection

We propose a new algorithm for detecting epileptic seizures. Our algorithm first extracts three features, namely mean amplitude, line length, and local binary patterns that are fed to an ensemble of classifiers using hyperdimensional (HD) computing. These features are embedded into prototype vectors representing ictal (during seizures) and interictal (between seizures) brain states are constructed. These vectors can be computed at different spatial scales ranging from a single electrode up to many electrodes. This flexibility allows our algorithm to identify the electrodes that discriminate best between ictal and interictal brain states. We assess our algorithm on the SWEC-ETHZ iEEG dataset that includes 99 short-time iEEG seizures recorded with 36 to 100 electrodes from 16 drug-resistant epilepsy patients. Using k-fold cross-validation and all electrodes, our algorithm surpasses state-of-the-art algorithms yielding significantly shorter latency (8.81 s vs. 11.57 s) in seizure onset detection, and higher specificity (97.31% vs. 94.84%) and accuracy (96.85% vs. 95.42%). We can further reduce the latency of our algorithm to 3.74 s by allowing a slightly higher percentage of false alarms (2% specificity loss). Using only the top 10% of the electrodes ranked by our algorithm, we still maintain superior latency, sensitivity, and specificity compared to the other algorithms with all the electrodes. We finally demonstrate the suitability of our algorithm to deployment on low-cost embedded hardware platforms, thanks to its robustness to noise/artifacts affecting the signal, its low computational complexity, and the small memory-footprint on a RISC-V microcontroller.

Time-Reversibility, Causality and Compression-Complexity

Detection of the temporal reversibility of a given process is an interesting time series analysis scheme that enables the useful characterisation of processes and offers an insight into the underlying processes generating the time series. Reversibility detection measures have been widely employed in the study of ecological, epidemiological and physiological time series. Further, the time reversal of given data provides a promising tool for analysis of causality measures as well as studying the causal properties of processes. In this work, the recently proposed Compression-Complexity Causality (CCC) measure (by the authors) is shown to be free of the assumption that the "cause precedes the effect", making it a promising tool for causal analysis of reversible processes. CCC is a data-driven interventional measure of causality (second rung on the Ladder of Causation) that is based on Effort-to-Compress (ETC), a well-established robust method to characterize the complexity of time series for analysis and classification. For the detection of the temporal reversibility of processes, we propose a novel measure called the Compressive Potential based Asymmetry Measure. This asymmetry measure compares the probability of the occurrence of patterns at different scales between the forward-time and time-reversed process using ETC. We test the performance of the measure on a number of simulated processes and demonstrate its effectiveness in determining the asymmetry of real-world time series of sunspot numbers, digits of the transcedental number π and heart interbeat interval variability.

Chance and risk in epilepsy

PURPOSE OF REVIEW

Epilepsy is a dynamical disorder of the brain characterized by sudden, seemingly unpredictable transitions to the ictal state. When and how these transitions occur remain unresolved questions in neurology.

RECENT FINDINGS

Modelling work based on dynamical systems theory proposed that a slow control parameter is necessary to explain the transition between interictal and ictal states. Recently, converging evidence from chronic EEG datasets unravelled the existence of cycles of epileptic brain activity at multiple timescales - circadian, multidien (over multiple days) and circannual - which could reflect cyclical changes in a slow control parameter. This temporal structure of epilepsy has theoretical implications and argues against the conception of seizures as completely random events. The practical significance of cycles in epilepsy is highlighted by their predictive value in computational models for seizure forecasting.

SUMMARY

The canonical randomness of seizures is being reconsidered in light of cycles of brain activity discovered through chronic EEG. This paradigm shift motivates development of next-generation devices to track more closely fluctuations in epileptic brain activity that determine time-varying seizure risk.

Quantitative EEG biomarkers for epilepsy and their relation to chemical biomarkers

The electroencephalogram (EEG) is the most important method to diagnose epilepsy. In clinical settings, it is evaluated by experts who identify patterns visually. Quantitative EEG is the application of digital signal processing to clinical recordings in order to automatize diagnostic procedures, and to make patterns visible that are hidden to the human eye. The EEG is related to chemical biomarkers, as electrical activity is based on chemical signals. The most well-known chemical biomarkers are blood laboratory tests to identify seizures after they have happened. However, research on chemical biomarkers is much less extensive than research on quantitative EEG, and combined studies are rarely published, but highly warranted. Quantitative EEG is as old as the EEG itself, but still, the methods are not yet standard in clinical practice. The most evident application is an automation of manual work, but also a quantitative description and localization of interictal epileptiform events as well as seizures can reveal important hints for diagnosis and contribute to presurgical evaluation. In addition, the assessment of network characteristics and entropy measures were found to reveal important insights into epileptic brain activity. Application scenarios of quantitative EEG in epilepsy include seizure prediction, pharmaco-EEG, treatment monitoring, evaluation of cognition, and neurofeedback. The main challenges to quantitative EEG are poor reliability and poor generalizability of measures, as well as the need for individualization of procedures. A main hindrance for quantitative EEG to enter clinical routine is also that training is not yet part of standard curricula for clinical neurophysiologists.

Time Irreversibility of Resting-State Activity in the Healthy Brain and Pathology

Characterizing brain activity at rest is of paramount importance to our understanding both of general principles of brain functioning and of the way brain dynamics is affected in the presence of neurological or psychiatric pathologies. We measured the time-reversal symmetry of spontaneous electroencephalographic brain activity recorded from three groups of patients and their respective control group under two experimental conditions (eyes open and closed). We evaluated differences in time irreversibility in terms of possible underlying physical generating mechanisms. The results showed that resting brain activity is generically time-irreversible at sufficiently long time scales, and that brain pathology is generally associated with a reduction in time-asymmetry, albeit with pathology-specific patterns. The significance of these results and their possible dynamical etiology are discussed. Some implications of the differential modulation of time asymmetry by pathology and experimental condition are examined.

Assessing Epileptogenicity Using Phase-Locked High Frequency Oscillations: A Systematic Comparison of Methods

High frequency oscillations (HFOs) are traditional biomarkers to identify the epileptogenic tissue during presurgical evaluation in pharmacoresistant epileptic patients. Recently, the resection of brain tissue exhibiting coupling between the amplitude of HFOs and the phase of low frequencies demonstrated a more favorable surgical outcome. Here we compare the predictive value of ictal HFOs and four methods for quantifying the ictal phase-amplitude coupling, namely mean vector length, phase-locked high gamma, phase locking value, and modulation index (MI). We analyzed 32 seizures from 16 patients to identify the channels that exhibit HFOs and phase-locked HFOs during seizures. We compared the resection ratio, defined as the percentage of channels exhibiting coupling located in the resected tissue, with the postsurgical outcome. We found that the MI is the only method to show a significant difference between the resection ratios of patients with good and poor outcomes. We further show that the whole seizure, not only the onset, is critical to assess epileptogenicity using the phase-locked HFOs. We postulate that the superiority of MI stems from its capacity to assess coupling of discrete HFO events and its independence from the HFO power. These results confirm that quantitative analysis of HFOs can boost presurgical evaluation and indicate the paramount importance of algorithm selection for clinical applications.

Epileptic foci localization based on mapping the synchronization of dynamic brain network

BACKGROUND

Characterizing the synchronous changes of epileptic seizures in different stages between different regions is profound to understand the transmission pathways of epileptic brain network and epileptogenic foci. There is currently no adequate quantitative calculation method for describing the propagation pathways of electroencephalogram (EEG) signals in the brain network from the short and long term. The goal of this study is to explore the innovative method to locate epileptic foci, mapping synchronization in the brain networks based on EEG.

METHODS

Mutual information was used to analyze the short-term synchronization in the full electrodes; while nonlinear dynamics quantifies the statistical independencies in the long -term among all electrodes. Then graph theory based on the complex network was employed to construct a dynamic brain network for epilepsy patients when they were awake, asleep and in seizure, analyzing the changing topology indexes.

RESULTS

Epileptic network achieved a high degree of nonlinear synchronization compared to awake time. and the main path of epileptiform activity was revealed by searching core nodes. The core nodes of the brain network were in connection with the onset zone. Seizures always happened with a high degree of distribution.

CONCLUSIONS

This study indicated the path of EEG synchronous propagation in seizures, and core nodes could locate the epileptic foci accurately in some epileptic patients.

Detection of time reversibility in time series by ordinal patterns analysis

Time irreversibility is a common signature of nonlinear processes and a fundamental property of non-equilibrium systems driven by non-conservative forces. A time series is said to be reversible if its statistical properties are invariant regardless of the direction of time. Here, we propose the Time Reversibility from Ordinal Patterns method (TiROP) to assess time-reversibility from an observed finite time series. TiROP captures the information of scalar observations in time forward as well as its time-reversed counterpart by means of ordinal patterns. The method compares both underlying information contents by quantifying its (dis)-similarity via the Jensen-Shannon divergence. The statistic is contrasted with a population of divergences coming from a set of surrogates to unveil the temporal nature and its involved time scales. We tested TiROP in different synthetic and real, linear, and non-linear time series, juxtaposed with results from the classical Ramsey's time reversibility test. Our results depict a novel, fast-computation, and fully data-driven methodology to assess time-reversibility with no further assumptions over data. This approach adds new insights into the current non-linear analysis techniques and also could shed light on determining new physiological biomarkers of high reliability and computational efficiency.

EEG synchronization measures are early outcome predictors in comatose patients after cardiac arrest

OBJECTIVE

Outcome prognostication in comatose patients after cardiac arrest (CA) remains a major challenge. Here we investigated the prognostic value of combinations of linear and non-linear bivariate EEG synchronization measures.

METHODS

94 comatose patients with EEG within 24h after CA were included. Clinical outcome was assessed at 3months using the Cerebral Performance Categories (CPC). EEG synchronization between the left and right parasagittal, and between the frontal and parietal brain regions was assessed with 4 different quantitative measures (delta power asymmetry, cross-correlation, mutual information, and transfer entropy). 2/3 of patients were used to assess the predictive power of all possible combinations of these eight features (4 measures×2 directions) using cross-validation. The predictive power of the best combination was tested on the remaining 1/3 of patients.

RESULTS

The best combination for prognostication consisted of 4 of the 8 features, and contained linear and non-linear measures. Predictive power for poor outcome (CPC 3-5), measured with the area under the ROC curve, was 0.84 during cross-validation, and 0.81 on the test set. At specificity of 1.0 the sensitivity was 0.54, and the accuracy 0.81.

CONCLUSION

Combinations of EEG synchronization measures can contribute to early prognostication after CA. In particular, combining linear and non-linear measures is important for good predictive power.

SIGNIFICANCE

Quantitative methods might increase the prognostic yield of currently used multi-modal approaches.