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Rogers CB, Meller S, Meyerhoff N, Volk HA. Comparative subcutaneous and submuscular implantation of an electroencephalography device for long term electroencephalographic monitoring in dogs. Front Vet Sci 2024; 11:1419792. [PMID: 39071780 PMCID: PMC11272624 DOI: 10.3389/fvets.2024.1419792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024] Open
Abstract
Background Implantable electroencephalography (EEG) recording devices have been used for ultra-long-term epilepsy monitoring both in clinical and home settings in people. Objective and accurate seizure detection and recording at home could be of great benefit in diagnosis, management and research in canine idiopathic epilepsy (IE). Continuous EEG monitoring would allow accurate detection of seizure patterns, seizure cycles, and seizure frequency. An EEG acquisition system usable in an "out of clinic" setting could improve owner and veterinary compliance for EEG diagnostics and seizure management. Objectives Whether a subcutaneous ultra-long term EEG monitoring device designed for humans could be implanted in dogs. Animals Cadaver study with 8 medium to large breed dogs. Methods Comparatively using a subcutaneous and submuscular approach to implant the UNEEG SubQ-Implant in each dog. Positioning was controlled via CT post implantation and cranial measurements were taken. Results In four of the eight dogs a submuscular implantation without any complications was possible. Complications were close contact to the optic nerve in the first approaches, before the implantation angle was changed and in the smallest dog contact of the implant with the orbital fat body. Cranial measurements of less than 95 mm length proved to be too small for reliable implantation via this approach. The subcutaneous approach showed severe limitations and the implant was prone to dislocation. Conclusion The UNEEQ SubQ-Implant can be implanted in dogs, via submuscular approach. CT imaging and cranial measurements should be taken prior to implantation.
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Affiliation(s)
- Casey B. Rogers
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Nina Meyerhoff
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Holger A. Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- Center for Systems Neuroscience Hannover, Hannover, Germany
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2
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Löscher W, Worrell GA. Novel subscalp and intracranial devices to wirelessly record and analyze continuous EEG in unsedated, behaving dogs in their natural environments: A new paradigm in canine epilepsy research. Front Vet Sci 2022; 9:1014269. [PMID: 36337210 PMCID: PMC9631025 DOI: 10.3389/fvets.2022.1014269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Epilepsy is characterized by unprovoked, recurrent seizures and is a common neurologic disorder in dogs and humans. Roughly 1/3 of canines and humans with epilepsy prove to be drug-resistant and continue to have sporadic seizures despite taking daily anti-seizure medications. The optimization of pharmacologic therapy is often limited by inaccurate seizure diaries and medication side effects. Electroencephalography (EEG) has long been a cornerstone of diagnosis and classification in human epilepsy, but because of several technical challenges has played a smaller clinical role in canine epilepsy. The interictal (between seizures) and ictal (seizure) EEG recorded from the epileptic mammalian brain shows characteristic electrophysiologic biomarkers that are very useful for clinical management. A fundamental engineering gap for both humans and canines with epilepsy has been the challenge of obtaining continuous long-term EEG in the patients' natural environment. We are now on the cusp of a revolution where continuous long-term EEG from behaving canines and humans will be available to guide clinicians in the diagnosis and optimal treatment of their patients. Here we review some of the devices that have recently emerged for obtaining long-term EEG in ambulatory subjects living in their natural environments.
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Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hanover, Germany
- Center for Systems Neuroscience, Hanover, Germany
- *Correspondence: Wolfgang Löscher
| | - Gregory A. Worrell
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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3
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Abstract
Epilepsy is a common neurological disease in both humans and domestic dogs, making dogs an ideal translational model of epilepsy. In both species, epilepsy is a complex brain disease characterized by an enduring predisposition to generate spontaneous recurrent epileptic seizures. Furthermore, as in humans, status epilepticus is one of the more common neurological emergencies in dogs with epilepsy. In both species, epilepsy is not a single disease but a group of disorders characterized by a broad array of clinical signs, age of onset, and underlying causes. Brain imaging suggests that the limbic system, including the hippocampus and cingulate gyrus, is often affected in canine epilepsy, which could explain the high incidence of comorbid behavioral problems such as anxiety and cognitive alterations. Resistance to antiseizure medications is a significant problem in both canine and human epilepsy, so dogs can be used to study mechanisms of drug resistance and develop novel therapeutic strategies to benefit both species. Importantly, dogs are large enough to accommodate intracranial EEG and responsive neurostimulation devices designed for humans. Studies in epileptic dogs with such devices have reported ictal and interictal events that are remarkably similar to those occurring in human epilepsy. Continuous (24/7) EEG recordings in a select group of epileptic dogs for >1 year have provided a rich dataset of unprecedented length for studying seizure periodicities and developing new methods for seizure forecasting. The data presented in this review substantiate that canine epilepsy is an excellent translational model for several facets of epilepsy research. Furthermore, several techniques of inducing seizures in laboratory dogs are discussed as related to therapeutic advances. Importantly, the development of vagus nerve stimulation as a novel therapy for drug-resistant epilepsy in people was based on a series of studies in dogs with induced seizures. Dogs with naturally occurring or induced seizures provide excellent large-animal models to bridge the translational gap between rodents and humans in the development of novel therapies. Furthermore, because the dog is not only a preclinical species for human medicine but also a potential patient and pet, research on this species serves both veterinary and human medicine.
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Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
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4
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Ong JS, Wong SN, Arulsamy A, Watterson JL, Shaikh MF. Medical Technology: A Systematic Review on Medical Devices Utilized for Epilepsy Prediction and Management. Curr Neuropharmacol 2022; 20:950-964. [PMID: 34749622 PMCID: PMC9881104 DOI: 10.2174/1570159x19666211108153001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epilepsy is a devastating neurological disorder that affects nearly 70 million people worldwide. Epilepsy causes uncontrollable, unprovoked and unpredictable seizures that reduce the quality of life of those afflicted, with 1-9 epileptic patient deaths per 1000 patients occurring annually due to sudden unexpected death in epilepsy (SUDEP). Predicting the onset of seizures and managing them may help patients from harming themselves and may improve their well-being. For a long time, electroencephalography (EEG) devices have been the mainstay for seizure detection and monitoring. This systematic review aimed to elucidate and critically evaluate the latest advancements in medical devices, besides EEG, that have been proposed for the management and prediction of epileptic seizures. A literature search was performed on three databases, PubMed, Scopus and EMBASE. METHODS Following title/abstract screening by two independent reviewers, 27 articles were selected for critical analysis in this review. RESULTS These articles revealed ambulatory, non-invasive and wearable medical devices, such as the in-ear EEG devices; the accelerometer-based devices and the subcutaneous implanted EEG devices might be more acceptable than traditional EEG systems. In addition, extracerebral signalbased devices may be more efficient than EEG-based systems, especially when combined with an intervention trigger. Although further studies may still be required to improve and validate these proposed systems before commercialization, these findings may give hope to epileptic patients, particularly those with refractory epilepsy, to predict and manage their seizures. CONCLUSION The use of medical devices for epilepsy may improve patients' independence and quality of life and possibly prevent sudden unexpected death in epilepsy (SUDEP).
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Affiliation(s)
- Jen Sze Ong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Shuet Nee Wong
- School of Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Jessica L. Watterson
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Mohd. Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia,Address correspondence to this author at the Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia; Tel/Fax: +60 3 5514 4483; E-mail:
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5
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Engineering nonlinear epileptic biomarkers using deep learning and Benford's law. Sci Rep 2022; 12:5397. [PMID: 35354911 PMCID: PMC8967852 DOI: 10.1038/s41598-022-09429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/22/2022] [Indexed: 12/15/2022] Open
Abstract
In this study, we designed two deep neural networks to encode 16 features for early seizure detection in intracranial EEG and compared them and their frequency responses to 16 widely used engineered metrics to interpret their properties: epileptogenicity index (EI), phase locked high gamma (PLHG), time and frequency domain Cho Gaines distance (TDCG, FDCG), relative band powers, and log absolute band powers (from alpha, beta, theta, delta, low gamma, and high gamma bands). The deep learning models were pretrained for seizure identification on the time and frequency domains of 1 s, single-channel clips of 127 seizures (from 25 different subjects) using "leave-one-out" (LOO) cross validation. Each neural network extracted unique feature spaces that were interpreted using spectral power modulations before being used to train a Random Forest Classifier (RFC) for seizure identification. The Gini Importance of each feature was calculated from the pretrained RFC, enabling the most significant features (MSFs) for each task to be identified. The MSFs were extracted to train another RFC for UPenn and Mayo Clinic's Seizure Detection Kaggle Challenge. They obtained an AUC score of 0.93, demonstrating a transferable method to identify and interpret biomarkers for seizure detection.
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Müller J, Yang H, Eberlein M, Leonhardt G, Uckermann O, Kuhlmann L, Tetzlaff R. Coherent false seizure prediction in epilepsy, coincidence or providence? Clin Neurophysiol 2021; 133:157-164. [PMID: 34844880 DOI: 10.1016/j.clinph.2021.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Seizure forecasting using machine learning is possible, but the performance is far from ideal, as indicated by many false predictions and low specificity. Here, we examine false and missing alarms of two algorithms on long-term datasets to show that the limitations are less related to classifiers or features, but rather to intrinsic changes in the data. METHODS We evaluated two algorithms on three datasets by computing the correlation of false predictions and estimating the information transfer between both classification methods. RESULTS For 9 out of 12 individuals both methods showed a performance better than chance. For all individuals we observed a positive correlation in predictions. For individuals with strong correlation in false predictions we were able to boost the performance of one method by excluding test samples based on the results of the second method. CONCLUSIONS Substantially different algorithms exhibit a highly consistent performance and a strong coherency in false and missing alarms. Hence, changing the underlying hypothesis of a preictal state of fixed time length prior to each seizure to a proictal state is more helpful than further optimizing classifiers. SIGNIFICANCE The outcome is significant for the evaluation of seizure prediction algorithms on continuous data.
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Affiliation(s)
- Jens Müller
- TU Dresden, Faculty of Electrical and Computer Engineering, Institute of Circuits and Systems, 01062 Dresden, Germany.
| | - Hongliu Yang
- TU Dresden, Faculty of Electrical and Computer Engineering, Institute of Circuits and Systems, 01062 Dresden, Germany
| | - Matthias Eberlein
- TU Dresden, Faculty of Electrical and Computer Engineering, Institute of Circuits and Systems, 01062 Dresden, Germany
| | - Georg Leonhardt
- TU Dresden, Neurosurgery of University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Ortrud Uckermann
- TU Dresden, Neurosurgery of University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Levin Kuhlmann
- Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Ronald Tetzlaff
- TU Dresden, Faculty of Electrical and Computer Engineering, Institute of Circuits and Systems, 01062 Dresden, Germany
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Abstract
SUMMARY Electrical brain stimulation is an established therapy for movement disorders, epilepsy, obsessive compulsive disorder, and a potential therapy for many other neurologic and psychiatric disorders. Despite significant progress and FDA approvals, there remain significant clinical gaps that can be addressed with next generation systems. Integrating wearable sensors and implantable brain devices with off-the-body computing resources (smart phones and cloud resources) opens a new vista for dense behavioral and physiological signal tracking coupled with adaptive stimulation therapy that should have applications for a range of brain and mind disorders. Here, we briefly review some history and current electrical brain stimulation applications for epilepsy, deep brain stimulation and responsive neurostimulation, and emerging applications for next generation devices and systems.
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Affiliation(s)
- Gregory A Worrell
- Department of Neurology, Mayo Bioelectronics and Neurophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
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8
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Fischer A. Idiopathic epilepsy in dogs: insights into factors that may predict upcoming seizure activity. Vet Rec 2020; 187:149-151. [PMID: 32826373 DOI: 10.1136/vr.m3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Toth E, Kumar S, Ganne C, Riley KO, Balasubramanian K, Pati S. Machine learning approach to detect focal-onset seizures in the human anterior nucleus of the thalamus. J Neural Eng 2020; 17. [PMID: 33059336 DOI: 10.1088/1741-2552/abc1b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE There is an unmet need to develop seizure detection algorithms from brain regions outside the epileptogenic cortex. The study aimed to demonstrate the feasibility of classifying seizures and interictal states from local field potentials (LFPs) recorded from the human thalamus- a subcortical region remote to the epileptogenic cortex. We tested the hypothesis that spectral and entropy-based features extracted from LFPs recorded from the anterior nucleus of the thalamus (ANT) can distinguish its state of ictal recruitment from other interictal states (including awake, sleep). APPROACH Two supervised machine learning tools (random forest and the random kitchen sink) were used to evaluate the performance of spectral (discrete wavelet transform-DWT), and time-domain (multiscale entropy-MSE) features in classifying seizures from interictal states in patients undergoing stereo EEG evaluation for epilepsy surgery. Under the supervision of IRB, field potentials were recorded from the ANT in consenting adults with drug-resistant temporal lobe epilepsy. Seizures were confirmed in the ANT using line-length and visual inspection. Wilcoxon rank-sum (WRS) method was used to test the differences in spectral patterns between seizure and interictal (awake and sleep) states. MAIN RESULTS 79 seizures (10 patients) and 158 segments (approx. 4 hours) of interictal stereo EEG data were analyzed. The mean seizure detection latencies with line length in the ANT varied between seizure types (range 5-34 seconds). However, the DWT and MSE in the ANT showed significant changes for all seizure types within the first 20 seconds after seizure onset. The random forest (accuracy 93.9 % and false-positive 4.6%) and the random kitchen sink (accuracy 97.3% and false-positive 1.8%) classified seizures and interictal states. SIGNIFICANCE These results suggest that features extracted from the thalamic LFPs can be trained to detect seizures that can be used for monitoring seizure counts and for closed-loop seizure abortive interventions.
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Affiliation(s)
- Emilia Toth
- University of Alabama School of Medicine, Birmingham, Alabama, UNITED STATES
| | - Sachin Kumar
- Centre for Computational Engineering and Networking , Amrita Vishwa Vidyapeetham Amrita School of Engineering, Coimbatore, Tamil Nadu, INDIA
| | - Chaitanya Ganne
- Neurology, University of Alabama at Birmingham, 1720 7th Ave S, Suite 405F, SPARKS building, Birmingham, UNITED STATES
| | - Kristen O Riley
- Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama, UNITED STATES
| | - Karthi Balasubramanian
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham Amrita School of Engineering, Coimbatore, Tamil Nadu, INDIA
| | - Sandipan Pati
- University of Alabama School of Medicine, Birmingham, Alabama, 35294-3412, UNITED STATES
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10
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Gregg NM, Nasseri M, Kremen V, Patterson EE, Sturges BK, Denison TJ, Brinkmann BH, Worrell GA. Circadian and multiday seizure periodicities, and seizure clusters in canine epilepsy. Brain Commun 2020; 2:fcaa008. [PMID: 32161910 PMCID: PMC7052793 DOI: 10.1093/braincomms/fcaa008] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 01/22/2023] Open
Abstract
Advances in ambulatory intracranial EEG devices have enabled objective analyses of circadian and multiday seizure periodicities, and seizure clusters in humans. This study characterizes circadian and multiday seizure periodicities, and seizure clusters in dogs with naturally occurring focal epilepsy, and considers the implications of an animal model for the study of seizure risk patterns, seizure forecasting and personalized treatment protocols. In this retrospective cohort study, 16 dogs were continuously monitored with ambulatory intracranial EEG devices designed for humans. Detailed medication records were kept for all dogs. Seizure periodicity was evaluated with circular statistics methods. Circular non-uniformity was assessed for circadian, 7-day and approximately monthly periods. The Rayleigh test was used to assess statistical significance, with correction for multiple comparisons. Seizure clusters were evaluated with Fano factor (index of dispersion) measurements, and compared to a Poisson distribution. Relationships between interseizure interval (ISI) and seizure duration were evaluated. Six dogs met the inclusion criteria of having at least 30 seizures and were monitored for an average of 65 weeks. Three dogs had seizures with circadian seizure periodicity, one dog had a 7-day periodicity, and two dogs had approximately monthly periodicity. Four dogs had seizure clusters and significantly elevated Fano factor values. There were subject-specific differences in the dynamics of ISI and seizure durations, both within and between lead and clustered seizure categories. Our findings show that seizure timing in dogs with naturally occurring epilepsy is not random, and that circadian and multiday seizure periodicities, and seizure clusters are common. Circadian, 7-day, and monthly seizure periodicities occur independent of antiseizure medication dosing, and these patterns likely reflect endogenous rhythms of seizure risk.
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Affiliation(s)
- Nicholas M Gregg
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mona Nasseri
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vaclav Kremen
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Edward E Patterson
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St Paul, MN 55108, USA
| | - Beverly K Sturges
- Department of Surgical and Radiological Sciences, University of California at Davis School of Veterinary Medicine, Davis, CA 95616, USA
| | - Timothy J Denison
- The Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Benjamin H Brinkmann
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory A Worrell
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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11
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Abstract
Automatic seizure detection is extremely important in the monitoring and diagnosis of epilepsy. The paper presents a novel method based on dictionary pair learning (DPL) for seizure detection in the long-term intracranial electroencephalogram (EEG) recordings. First, for the EEG data, wavelet filtering and differential filtering are applied, and the kernel function is performed to make the signal linearly separable. In DPL, the synthesis dictionary and analysis dictionary are learned jointly from original training samples with alternating minimization method, and sparse coefficients are obtained by using of linear projection instead of costly [Formula: see text]-norm or [Formula: see text]-norm optimization. At last, the reconstructed residuals associated with seizure and nonseizure sub-dictionary pairs are calculated as the decision values, and the postprocessing is performed for improving the recognition rate and reducing the false detection rate of the system. A total of 530[Formula: see text]h from 20 patients with 81 seizures were used to evaluate the system. Our proposed method has achieved an average segment-based sensitivity of 93.39%, specificity of 98.51%, and event-based sensitivity of 96.36% with false detection rate of 0.236/h.
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Affiliation(s)
- Xin Ma
- School of Information Science and Engineering, Shandong University, Jinan 250100, P. R. China
| | - Nana Yu
- School of Information Science and Engineering, Shandong University, Jinan 250100, P. R. China
| | - Weidong Zhou
- School of Microelectronics, Shandong University, Jinan 250100, P. R. China
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12
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Oppenheimer J, Leviton A, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler EW, Chan E, Loddenkemper T. Caring electronically for young outpatients who have epilepsy. Epilepsy Behav 2018; 87:226-232. [PMID: 30197227 DOI: 10.1016/j.yebeh.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability. METHOD We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems. CONCLUSIONS The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems. This system and variants have the potential to reduce seizure burden through improved management, keep children out of the emergency department and hospital, and even reduce the number of outpatient visits.
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Affiliation(s)
- Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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13
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Kremen V, Brinkmann BH, Kim I, Guragain H, Nasseri M, Magee AL, Pal Attia T, Nejedly P, Sladky V, Nelson N, Chang SY, Herron JA, Adamski T, Baldassano S, Cimbalnik J, Vasoli V, Fehrmann E, Chouinard T, Patterson EE, Litt B, Stead M, Van Gompel J, Sturges BK, Jo HJ, Crowe CM, Denison T, Worrell GA. Integrating Brain Implants With Local and Distributed Computing Devices: A Next Generation Epilepsy Management System. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:2500112. [PMID: 30310759 PMCID: PMC6170139 DOI: 10.1109/jtehm.2018.2869398] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/18/2018] [Accepted: 08/16/2018] [Indexed: 12/16/2022]
Abstract
Brain stimulation has emerged as an effective treatment for a wide range of neurological and psychiatric diseases. Parkinson’s disease, epilepsy, and essential tremor have FDA indications for electrical brain stimulation using intracranially implanted electrodes. Interfacing implantable brain devices with local and cloud computing resources have the potential to improve electrical stimulation efficacy, disease tracking, and management. Epilepsy, in particular, is a neurological disease that might benefit from the integration of brain implants with off-the-body computing for tracking disease and therapy. Recent clinical trials have demonstrated seizure forecasting, seizure detection, and therapeutic electrical stimulation in patients with drug-resistant focal epilepsy. In this paper, we describe a next-generation epilepsy management system that integrates local handheld and cloud-computing resources wirelessly coupled to an implanted device with embedded payloads (sensors, intracranial EEG telemetry, electrical stimulation, classifiers, and control policy implementation). The handheld device and cloud computing resources can provide a seamless interface between patients and physicians, and realtime intracranial EEG can be used to classify brain state (wake/sleep, preseizure, and seizure), implement control policies for electrical stimulation, and track patient health. This system creates a flexible platform in which low demand analytics requiring fast response times are embedded in the implanted device and more complex algorithms are implemented in offthebody local and distributed cloud computing environments. The system enables tracking and management of epileptic neural networks operating over time scales ranging from milliseconds to months.
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Affiliation(s)
- Vaclav Kremen
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague160 00PrahaCzech Republic.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | - Benjamin H Brinkmann
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | - Inyong Kim
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Hari Guragain
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Mona Nasseri
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Abigail L Magee
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Tal Pal Attia
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | - Petr Nejedly
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA.,International Clinical Research CenterSt. Anne's University Hospital656 91BrnoCzech Republic
| | - Vladimir Sladky
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA.,International Clinical Research CenterSt. Anne's University Hospital656 91BrnoCzech Republic
| | - Nathanial Nelson
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Su-Youne Chang
- Department of NeurosurgeryMayo ClinicRochesterMN55905USA
| | - Jeffrey A Herron
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Tom Adamski
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Steven Baldassano
- Center for Neuroengineering and TherapeuticsDepartment of BioengineeringUniversity of PennsylvaniaPhiladelphiaPA19104USA
| | - Jan Cimbalnik
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,International Clinical Research CenterSt. Anne's University Hospital656 91BrnoCzech Republic
| | - Vince Vasoli
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Elizabeth Fehrmann
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Tom Chouinard
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Edward E Patterson
- Department of Veterinary Clinical SciencesUniversity of Minnesota College of Veterinary MedicineSt. PaulMN55108USA
| | - Brian Litt
- Center for Neuroengineering and TherapeuticsDepartment of BioengineeringUniversity of PennsylvaniaPhiladelphiaPA19104USA
| | - Matt Stead
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | | | - Beverly K Sturges
- Department of Surgical and Radiological SciencesUniversity of California at DavisDavisCA95616USA
| | - Hang Joon Jo
- Department of NeurosurgeryMayo ClinicRochesterMN55905USA.,Department of NeurologyMayo ClinicRochesterMN55905USA
| | - Chelsea M Crowe
- Veterinary Medical Teaching HospitalUniversity of California at DavisDavisCA95616USA
| | - Timothy Denison
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Gregory A Worrell
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
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Bankstahl M, Bankstahl JP. Recent Advances in Radiotracer Imaging Hold Potential for Future Refined Evaluation of Epilepsy in Veterinary Neurology. Front Vet Sci 2017; 4:218. [PMID: 29326952 PMCID: PMC5733338 DOI: 10.3389/fvets.2017.00218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022] Open
Abstract
Non-invasive nuclear imaging by positron emission tomography and single photon emission computed tomography has significantly contributed to epileptic focus localization in human neurology for several decades now. Offering functional insight into brain alterations, it is also of particular relevance for epilepsy research. Access to these techniques for veterinary medicine is becoming more and more relevant and has already resulted in first studies in canine patients. In view of the substantial proportion of drug-refractory epileptic dogs and cats, image-guided epileptic focus localization will be a prerequisite for selection of patients for surgical focus resection. Moreover, radiotracer imaging holds potential for a better understanding of the pathophysiology of underlying epilepsy syndromes as well as to forecast disease risk after epileptogenic brain insults. Importantly, recent advances in epilepsy research demonstrate the suitability and value of several novel radiotracers for non-invasive assessment of neuroinflammation, blood–brain barrier alterations, and neurotransmitter systems. It is desirable that veterinary epilepsy patients will also benefit from these promising developments in the medium term. This paper reviews the current use of radiotracer imaging in the veterinary epilepsy patient and suggests possible future directions for the technique.
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Affiliation(s)
- Marion Bankstahl
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Center of Systems Neuroscience Hannover, Hannover, Germany
| | - Jens P Bankstahl
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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Vuu I, Coles LD, Maglalang P, Leppik IE, Worrell G, Crepeau D, Mishra U, Cloyd JC, Patterson EE. Intravenous Topiramate: Pharmacokinetics in Dogs with Naturally Occurring Epilepsy. Front Vet Sci 2016; 3:107. [PMID: 27995128 PMCID: PMC5136567 DOI: 10.3389/fvets.2016.00107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/15/2016] [Indexed: 11/13/2022] Open
Abstract
RATIONALE Barriers to developing treatments for human status epilepticus include the inadequacy of experimental animal models. In contrast, naturally occurring canine epilepsy is similar to the human condition and can serve as a platform to translate research from rodents to humans. The objectives of this study were to characterize the pharmacokinetics of an intravenous (IV) dose of topiramate (TPM) in dogs with epilepsy and evaluate its effect on intracranial electroencephalographic (iEEG) features. METHODS Five dogs with naturally occurring epilepsy were used for this study. Three were getting at least one antiseizure drug as maintenance therapy including phenobarbital (PB). Four (ID 1-4) were used for the 10 mg/kg IV TPM + PO TPM study, and three (ID 3-5) were used for the 20 mg/kg IV TPM study. IV TPM was infused over 5 min at both doses. The animals were observed for vomiting, diarrhea, ataxia, and lethargy. Blood samples were collected at scheduled pre- and post-dose times. Plasma concentrations were measured using a validated high-performance liquid chromatography-mass spectrometry method. Non-compartmental and population compartmental modeling were performed (Phoenix WinNonLin and NLME) using plasma concentrations from all dogs in the study. iEEG was acquired in one dog. The difference between averaged iEEG energy levels at 15 min pre- and post-dose was assessed using a Kruskal-Wallis test. RESULTS No adverse events were noted. TPM concentration-time profiles were best fit by a two compartment model. PB co-administration was associated with a 5.6-fold greater clearance and a ~4-fold shorter elimination half-life. iEEG data showed that TPM produced a significant energy increase at frequencies >4 Hz across all 16 electrodes within 15 min of dosing. Simulations suggested that dogs on an enzyme inducer would require 25 mg/kg, while dogs on non-inducing drugs would need 20 mg/kg to attain the target concentration (20-30 μg/mL) at 30 min post-dose. CONCLUSION This study shows that IV TPM has a relatively rapid onset of action, loading doses appear safe, and the presence of PB necessitates a higher dose to attain targeted concentrations. Consequently, it is a good candidate for further evaluation for treatment of seizure emergencies in dogs and people.
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Affiliation(s)
- Irene Vuu
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Lisa D Coles
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Maglalang
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; College of Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Ilo E Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; UMP MINCEP Epilepsy Care, Minneapolis, MN, USA
| | | | | | - Usha Mishra
- Center for Orphan Drug Research, University of Minnesota , Minneapolis, MN , USA
| | - James C Cloyd
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Edward E Patterson
- College of Veterinary Medicine, University of Minnesota , Saint Paul, MN , USA
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Uriarte A, Maestro Saiz I. Canine versus human epilepsy: are we up to date? J Small Anim Pract 2016; 57:115-21. [PMID: 26931499 DOI: 10.1111/jsap.12437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/21/2015] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
In this paper we analyse and compare features of canine and human epilepsy and we suggest new tools for better future understanding of canine epilepsy. The prevalence of epileptic seizures in dogs ranges between 0.5% and 5.7% and between 1% and 3% in the human population. Studies on human epilepsy provide a ready-made format for classification, diagnosis and treatment in veterinary epilepsy. Human studies highlight the value of a thorough seizure classification. Nevertheless, a matter of concern in canine epilepsy is the limited information regarding seizure description and classification because of the lack of EEG-video recording. Establishment of a consensus protocol for ambulatory home video-recording in dogs who suffer from epilepsy, mainly considering indications, duration of monitoring, the sufficient essential training for an optimal interpretation of ictal semiology and the methodology of recordings is needed. The ultimate goal is that the information gathered by these videos will be analysed to describe the epileptic seizures thoroughly, recognize patterns and move towards a better understanding and therefore classification of canine epileptic seizures.
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Affiliation(s)
- A Uriarte
- North Down Specialist Referrals, Surrey, RH1 4QP
| | - I Maestro Saiz
- Clinical Neurophysiology Department, Cruces University Hospital, Barakaldo, Biscay, 48903, Spain
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17
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Cho D, Min B, Kim J, Lee B. EEG-Based Prediction of Epileptic Seizures Using Phase Synchronization Elicited from Noise-Assisted Multivariate Empirical Mode Decomposition. IEEE Trans Neural Syst Rehabil Eng 2016; 25:1309-1318. [PMID: 27775526 DOI: 10.1109/tnsre.2016.2618937] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, we examined the phase locking value (PLV) for seizure prediction, particularly, in the gamma frequency band. We prepared simulation data and 65 clinical cases of seizure. In addition, various filtering algorithms including bandpass filtering, empirical mode decomposition, multivariate empirical mode decomposition and noise-assisted multivariate empirical mode decomposition (NA-MEMD) were used to decompose spectral components from the data. Moreover, in the case of clinical data, the PLVs were used to classify between interictal and preictal stages using a support vector machine. The highest PLV was achieved with NA-MEMD with 0-dB white noise algorithm (0.9988), which exhibited statistically significant differences compared to other filtering algorithms. Moreover, the classification rate was the highest for the NA-MEMD with 0-dB algorithm (83.17%). In terms of frequency components, examining the gamma band resulted in the highest classification rates for all algorithms, compared to other frequency bands such as theta, alpha, and beta bands. We found that PLVs calculated with the NA-MEMD algorithm could be used as a potential biological marker for seizure prediction. Moreover, the gamma frequency band was useful for discriminating between interictal and preictal stages.
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18
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Diagnostic techniques to detect the epileptogenic zone: Pathophysiological and presurgical analysis of epilepsy in dogs and cats. Vet J 2016; 215:64-75. [DOI: 10.1016/j.tvjl.2016.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/24/2016] [Accepted: 03/05/2016] [Indexed: 12/17/2022]
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Varatharajah Y, Iyer RK, Berry BM, Worrell GA, Brinkmann BH. Seizure Forecasting and the Preictal State in Canine Epilepsy. Int J Neural Syst 2016; 27:1650046. [PMID: 27464854 DOI: 10.1142/s0129065716500465] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The ability to predict seizures may enable patients with epilepsy to better manage their medications and activities, potentially reducing side effects and improving quality of life. Forecasting epileptic seizures remains a challenging problem, but machine learning methods using intracranial electroencephalographic (iEEG) measures have shown promise. A machine-learning-based pipeline was developed to process iEEG recordings and generate seizure warnings. Results support the ability to forecast seizures at rates greater than a Poisson random predictor for all feature sets and machine learning algorithms tested. In addition, subject-specific neurophysiological changes in multiple features are reported preceding lead seizures, providing evidence supporting the existence of a distinct and identifiable preictal state.
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Affiliation(s)
- Yogatheesan Varatharajah
- * Electrical and Computer Engineering, University of Illinois at Urbana-Champaign Urbana, IL 61801, USA
| | - Ravishankar K Iyer
- * Electrical and Computer Engineering, University of Illinois at Urbana-Champaign Urbana, IL 61801, USA
| | - Brent M Berry
- † Department of Neurology and Physiology & Biomedical Engineering, Mayo Clinic Rochester, MN 55905, USA
| | - Gregory A Worrell
- † Department of Neurology and Physiology & Biomedical Engineering, Mayo Clinic Rochester, MN 55905, USA
| | - Benjamin H Brinkmann
- † Department of Neurology and Physiology & Biomedical Engineering, Mayo Clinic Rochester, MN 55905, USA
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Brinkmann BH, Wagenaar J, Abbot D, Adkins P, Bosshard SC, Chen M, Tieng QM, He J, Muñoz-Almaraz FJ, Botella-Rocamora P, Pardo J, Zamora-Martinez F, Hills M, Wu W, Korshunova I, Cukierski W, Vite C, Patterson EE, Litt B, Worrell GA. Crowdsourcing reproducible seizure forecasting in human and canine epilepsy. Brain 2016; 139:1713-22. [PMID: 27034258 PMCID: PMC5022671 DOI: 10.1093/brain/aww045] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/28/2016] [Indexed: 11/13/2022] Open
Abstract
See Mormann and Andrzejak (doi:10.1093/brain/aww091) for a scientific commentary on this article. Seizures are thought to arise from an identifiable pre-ictal state. Brinkmann et al. report the results of an online, open-access seizure forecasting competition using intracranial EEG recordings from canines with naturally occurring epilepsy and human patients undergoing presurgical monitoring. The winning algorithms forecast seizures at rates significantly greater than chance. See Mormann and Andrzejak (doi:10.1093/brain/aww091) for a scientific commentary on this article. Accurate forecasting of epileptic seizures has the potential to transform clinical epilepsy care. However, progress toward reliable seizure forecasting has been hampered by lack of open access to long duration recordings with an adequate number of seizures for investigators to rigorously compare algorithms and results. A seizure forecasting competition was conducted on kaggle.com using open access chronic ambulatory intracranial electroencephalography from five canines with naturally occurring epilepsy and two humans undergoing prolonged wide bandwidth intracranial electroencephalographic monitoring. Data were provided to participants as 10-min interictal and preictal clips, with approximately half of the 60 GB data bundle labelled (interictal/preictal) for algorithm training and half unlabelled for evaluation. The contestants developed custom algorithms and uploaded their classifications (interictal/preictal) for the unknown testing data, and a randomly selected 40% of data segments were scored and results broadcasted on a public leader board. The contest ran from August to November 2014, and 654 participants submitted 17 856 classifications of the unlabelled test data. The top performing entry scored 0.84 area under the classification curve. Following the contest, additional held-out unlabelled data clips were provided to the top 10 participants and they submitted classifications for the new unseen data. The resulting area under the classification curves were well above chance forecasting, but did show a mean 6.54 ± 2.45% (min, max: 0.30, 20.2) decline in performance. The kaggle.com model using open access data and algorithms generated reproducible research that advanced seizure forecasting. The overall performance from multiple contestants on unseen data was better than a random predictor, and demonstrates the feasibility of seizure forecasting in canine and human epilepsy.
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Affiliation(s)
- Benjamin H Brinkmann
- Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Joost Wagenaar
- University of Pennsylvania, Penn Center for Neuroengineering and Therapeutics, Philadelphia, PA, USA
| | | | | | - Simone C Bosshard
- University of Queensland, Centre for Advanced Imaging, Queensland, Australia
| | - Min Chen
- University of Queensland, Centre for Advanced Imaging, Queensland, Australia
| | - Quang M Tieng
- University of Queensland, Centre for Advanced Imaging, Queensland, Australia
| | | | | | | | - Juan Pardo
- CEU Cardenal Herrera University, Valencia, Spain
| | | | | | | | | | | | - Charles Vite
- University of Pennsylvania, School of Veterinary Medicine Philadelphia, PA, USA
| | | | - Brian Litt
- University of Pennsylvania, Penn Center for Neuroengineering and Therapeutics, Philadelphia, PA, USA
| | - Gregory A Worrell
- Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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Packer RMA, Volk HA. Epilepsy beyond seizures: a review of the impact of epilepsy and its comorbidities on health-related quality of life in dogs. Vet Rec 2015; 177:306-15. [DOI: 10.1136/vr.103360] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rowena M. A. Packer
- Department of Clinical Science and Services; Royal Veterinary College, Hawkshead Lane Hatfield Hertfordshire AL9 7TA UK
| | - Holger A. Volk
- Department of Clinical Science and Services; Royal Veterinary College, Hawkshead Lane Hatfield Hertfordshire AL9 7TA UK
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Forecasting Seizures Using Intracranial EEG Measures and SVM in Naturally Occurring Canine Epilepsy. PLoS One 2015; 10:e0133900. [PMID: 26241907 PMCID: PMC4524640 DOI: 10.1371/journal.pone.0133900] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 07/02/2015] [Indexed: 12/02/2022] Open
Abstract
Management of drug resistant focal epilepsy would be greatly assisted by a reliable warning system capable of alerting patients prior to seizures to allow the patient to adjust activities or medication. Such a system requires successful identification of a preictal, or seizure-prone state. Identification of preictal states in continuous long- duration intracranial electroencephalographic (iEEG) recordings of dogs with naturally occurring epilepsy was investigated using a support vector machine (SVM) algorithm. The dogs studied were implanted with a 16-channel ambulatory iEEG recording device with average channel reference for a mean (st. dev.) of 380.4 (+87.5) days producing 220.2 (+104.1) days of intracranial EEG recorded at 400 Hz for analysis. The iEEG records had 51.6 (+52.8) seizures identified, of which 35.8 (+30.4) seizures were preceded by more than 4 hours of seizure-free data. Recorded iEEG data were stratified into 11 contiguous, non-overlapping frequency bands and binned into one-minute synchrony features for analysis. Performance of the SVM classifier was assessed using a 5-fold cross validation approach, where preictal training data were taken from 90 minute windows with a 5 minute pre-seizure offset. Analysis of the optimal preictal training time was performed by repeating the cross validation over a range of preictal windows and comparing results. We show that the optimization of feature selection varies for each subject, i.e. algorithms are subject specific, but achieve prediction performance significantly better than a time-matched Poisson random predictor (p<0.05) in 5/5 dogs analyzed.
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Patterson EE, Leppik IE, Coles LD, Podell M, Vite CH, Bush W, Cloyd JC. Canine status epilepticus treated with fosphenytoin: A proof of principle study. Epilepsia 2015; 56:882-7. [PMID: 25953073 DOI: 10.1111/epi.12994] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are a limited number of marketed intravenous antiepileptic drugs (AEDs) available to treat status epilepticus (SE). All were first developed for chronic therapy of epilepsy, not specifically for SE. Epilepsy and canine SE (CSE) occur naturally in dogs, with prevalence, presentation, and percentage of refractory cases similar to human epilepsy. The objective of this study was to determine if CSE treated with fosphenytoin (FOS) results in a similar responder rate as for people. METHODS A randomized clinical trial was performed for dogs with CSE. Dogs who presented during a seizure or who had additional seizures after enrolling received intravenous (i.v.) benzodiazepine (BZD) followed immediately by intravenous infusion of 15 mg/kg phenytoin equivalent (PE) of fosphenytoin (FOS) or saline placebo (PBO). If seizures continued, additional AEDs were administered per the standard of care for veterinary patients. Total and unbound plasma phenytoin (PHT) concentrations were measured. RESULTS Consent was obtained for 50 dogs with CSE. Thirty-one had additional motor seizures and were randomized to the study intervention (22 FOS and 9 PBO). There was a statistically significant difference in the 12 h responder rate, with 63% in the FOS group versus 22% in the placebo group (p = 0.043) having no further seizures. The unbound PHT concentrations at 30 and 60 min were within the therapeutic concentrations for people (1-2 μg/ml) with the exception of one dog. There was mild vomiting in 36% of the FOS group (7/22) within 20 min of FOS administration and none of the placebo group (0/9) (p = 0.064). SIGNIFICANCE This proof of concept study provides the first evidence that FOS is tolerated and effective in canine SE at PHT concentrations clinically relevant for human SE. Furthermore, naturally occurring CSE can be utilized as a translational platform for future studies of novel SE compounds.
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Affiliation(s)
- Edward E Patterson
- Veterinary Medical Center, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Ilo E Leppik
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, U.S.A.,UMP MINCEP Epilepsy Care, Minneapolis, Minnesota, U.S.A
| | - Lisa D Coles
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, Chicago, Illinois, U.S.A
| | - Charles H Vite
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - William Bush
- Bush Veterinary Neurology Service, Leesburg, Virginia, U.S.A
| | - James C Cloyd
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Temko A, Sarkar A, Lightbody G. Detection of seizures in intracranial EEG: UPenn and Mayo Clinic's Seizure Detection Challenge. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:6582-6585. [PMID: 26737801 DOI: 10.1109/embc.2015.7319901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A system for detection of seizures in intracranial EEG is presented that is based on a combination of generative, discriminative and hybrid approaches. We present a methodology to effectively benefit from the advantages each classifier offers. In particular, Gaussian mixture models, Support Vector Machines, hybrid likelihood ratio and Gaussian supervector approaches are developed and combined for the task. This system participated in the UPenn and Mayo Clinic's Seizure Detection Challenge, ranking in the top 5 of over 200 participants. The drawbacks of the proposed method with respect to the winning solutions are critically assessed.
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Zhang Z, Parhi KK. Seizure detection using regression tree based feature selection and polynomial SVM classification. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:6578-6581. [PMID: 26737800 DOI: 10.1109/embc.2015.7319900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper presents a novel patient-specific algorithm for detection of seizures in epileptic patients with low hardware complexity and low power consumption. In the proposed approach, we first compute the spectrogram of the input fragmented EEG signals from three or four electrodes. Each fragmented data clip is one second in duration. Spectral powers and spectral ratios are then extracted as features. The features are then subjected to feature selection using regression tree. The selected features are then subjected to a polynomial support vector machine (SVM) classifier with degree of 2. The algorithm is tested using the intra-cranial EEG (iEEG) from the UPenn and Mayo Clinic's Seizure Detection Challenge database. It is shown that the proposed algorithm can achieve a sensitivity of 100.0%, an average area under curve (AUC) of 0.9818, a mean detection horizon of 5.8 seconds, and a specificity of 99.9% on using half of the training data for classification. The proposed approach also achieved a mean AUC of seizure detection and early seizure detection of 0.9136 on the testing data.
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Howbert JJ, Patterson EE, Stead SM, Brinkmann B, Vasoli V, Crepeau D, Vite CH, Sturges B, Ruedebusch V, Mavoori J, Leyde K, Sheffield WD, Litt B, Worrell GA. Forecasting seizures in dogs with naturally occurring epilepsy. PLoS One 2014; 9:e81920. [PMID: 24416133 PMCID: PMC3885383 DOI: 10.1371/journal.pone.0081920] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
Abstract
Seizure forecasting has the potential to create new therapeutic strategies for epilepsy, such as providing patient warnings and delivering preemptive therapy. Progress on seizure forecasting, however, has been hindered by lack of sufficient data to rigorously evaluate the hypothesis that seizures are preceded by physiological changes, and are not simply random events. We investigated seizure forecasting in three dogs with naturally occurring focal epilepsy implanted with a device recording continuous intracranial EEG (iEEG). The iEEG spectral power in six frequency bands: delta (0.1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), low-gamma (30–70 Hz), and high-gamma (70–180 Hz), were used as features. Logistic regression classifiers were trained to discriminate labeled pre-ictal and inter-ictal data segments using combinations of the band spectral power features. Performance was assessed on separate test data sets via 10-fold cross-validation. A total of 125 spontaneous seizures were detected in continuous iEEG recordings spanning 6.5 to 15 months from 3 dogs. When considering all seizures, the seizure forecasting algorithm performed significantly better than a Poisson-model chance predictor constrained to have the same time in warning for all 3 dogs over a range of total warning times. Seizure clusters were observed in all 3 dogs, and when the effect of seizure clusters was decreased by considering the subset of seizures separated by at least 4 hours, the forecasting performance remained better than chance for a subset of algorithm parameters. These results demonstrate that seizures in canine epilepsy are not randomly occurring events, and highlight the feasibility of long-term seizure forecasting using iEEG monitoring.
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Affiliation(s)
| | - Edward E. Patterson
- Veterinary Medical Center, University of Minnesota, St. Paul, Minnesota, United States of America
| | - S. Matt Stead
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ben Brinkmann
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Vincent Vasoli
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Daniel Crepeau
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Charles H. Vite
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Beverly Sturges
- Veterinary School, University of California Davis, Davis, California, United States of America
| | | | - Jaideep Mavoori
- NeuroVista Corp., Seattle, Washington, United States of America
| | - Kent Leyde
- NeuroVista Corp., Seattle, Washington, United States of America
| | | | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gregory A. Worrell
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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