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Muralidharan P, Sankaran R, Bendapudi P, Kumar CS, Kumar AA. AI in ECG: Validating an ambulatory semiology labeller and predictor. Epilepsy Res 2024; 204:107403. [PMID: 38944916 DOI: 10.1016/j.eplepsyres.2024.107403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Early prediction of epileptic seizures can help reduce morbidity and mortality. In this work, we explore using electrocardiographic (ECG) signal as input to a seizure prediction system and note that the performance can be improved by using selected signal processing techniques. METHODS We used frequency domain analysis with a deep neural network backend for all our experiments in this work. We further analysed the effect of the proposed system for different seizure semiologies and prediction horizons. We explored refining the signal using signal processing to enhance the system's performance. RESULTS Our final system using the Temple University Hospital's Seizure (TUHSZ) corpus gave an overall prediction accuracy of 84.02 %, sensitivity of 87.59 %, specificity of 81.9 %, and an area under the receiver operating characteristic curve (AUROC) of 0.9112. Notably, these results surpassed the state-of-the-art outcomes reported using the TUHSZ database; all findings are statistically significant. We also validated our study using the Siena scalp EEG database. Using the frequency domain data, our baseline system gave a performance of 75.17 %, 79.17 %, 70.04 % and 0.82 for prediction accuracy, sensitivity, specificity and AUROC, respectively. After selecting the optimal frequency band of 0.8-15 Hz, we obtained a performance of 80.49 %, 89.51 %, 75.23 % and 0.89 for prediction accuracy, sensitivity, specificity and AUROC, respectively which is an improvement of 5.32 %, 10.34 %, 5.19 % and 0.08 for prediction accuracy, sensitivity, specificity and AUROC, respectively. CONCLUSIONS The seizure information in ECG is concentrated in a narrow frequency band. Identifying and selecting that band can help improve the performance of seizure detection and prediction. SIGNIFICANCE EEG is susceptible to artefacts and is not preferred in a low-cost ambulatory device. ECG can be used in wearable devices (like chest bands) and is feasible for developing a low-cost ambulatory device for seizure prediction. Early seizure prediction can provide patients and clinicians with the required alert to take necessary precautions and prevent a fatality, significantly improving the patient's quality of life.
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Affiliation(s)
- Pooja Muralidharan
- Machine Intelligence Research Laboratory, Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu 641112, India
| | - Ravi Sankaran
- Department of Physical Medicine and Rehabilitation, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala 682041, India
| | - Perraju Bendapudi
- Department of Neonatology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala 682041, India
| | - C Santhosh Kumar
- Machine Intelligence Research Laboratory, Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu 641112, India.
| | - A Anand Kumar
- Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala 682041, India
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Tulbah AS, Elkomy MH, Zaki RM, Eid HM, Eissa EM, Ali AA, Yassin HA, Aldosari BN, Naguib IA, Hassan AH. Novel nasal niosomes loaded with lacosamide and coated with chitosan: A possible pathway to target the brain to control partial-onset seizures. Int J Pharm X 2023; 6:100206. [PMID: 37637477 PMCID: PMC10458293 DOI: 10.1016/j.ijpx.2023.100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
This work aimed to develop and produce lacosamide-loaded niosomes coated with chitosan (LCA-CTS-NSM) using a thin-film hydration method and the Box-Behnken design. The effect of three independent factors (Span 60 amount, chitosan concentration, and cholesterol amount) on vesicle size, entrapment efficiency, zeta potential, and cumulative release (8 h) was studied. The optimal formulation of LCA-CTS-NSM was chosen from the design space and assessed for morphology, in vitro release, nasal diffusion, stability, tolerability, and in vivo biodistribution for brain targeting after intranasal delivery. The vesicle size, entrapment, surface charge, and in vitro release of the optimal formula were found to be 194.3 nm, 58.3%, +35.6 mV, and 81.3%, respectively. Besides, it exhibits sustained release behavior, enhanced nasal diffusion, and improved physical stability. Histopathological testing revealed no evidence of toxicity or structural damage to the nasal mucosa. It demonstrated significantly more brain distribution than the drug solution. Overall, the data is encouraging since it points to the potential for non-invasive intranasal administration of LCA as an alternative to oral or parenteral routes.
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Affiliation(s)
- Alaa S. Tulbah
- Department of Pharmaceutics, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Mohammed H. Elkomy
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia
| | - Randa Mohammed Zaki
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Hussein M. Eid
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Essam M. Eissa
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Adel A. Ali
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Heba A. Yassin
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Sinai University (Arish campus), Arish, Egypt
| | - Basmah Nasser Aldosari
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Ibrahim A. Naguib
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amira H. Hassan
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
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Zhang W, Guan X, Jiao S, Wang G, Wang X. Development and validation of an artificial intelligence prediction model and a survival risk stratification for lung metastasis in colorectal cancer from highly imbalanced data: A multicenter retrospective study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107107. [PMID: 37883884 DOI: 10.1016/j.ejso.2023.107107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND To assist clinicians with diagnosis and optimal treatment decision-making, we attempted to develop and validate an artificial intelligence prediction model for lung metastasis (LM) in colorectal cancer (CRC) patients. METHODS The clinicopathological characteristics of 46037 CRC patients from the Surveillance, Epidemiology, and End Results (SEER) database and 2779 CRC patients from a multi-center external validation set were collected retrospectively. After feature selection by univariate and multivariate analyses, six machine learning (ML) models, including logistic regression, K-nearest neighbor, support vector machine, decision tree, random forest, and balanced random forest (BRF), were developed and validated for the LM prediction. In addition, stratified LM patients by risk score were utilized for survival analysis. RESULTS Extremely low rates of LM with 2.59% and 4.50% were present in the development and validation set. As the imbalanced learning strategy, the BRF model with an Area under the receiver operating characteristic curve (AUC) of 0.874 and an average precision (AP) of 0.184 performed best compares with other models and clinical predictor. Patients with LM in the high-risk group had significantly poorer survival (P<0.001) and failed to benefit from resection (P = 0.125). CONCLUSIONS In summary, we have utilized the BRF algorithm to develop an effective, non-invasive, and practical model for predicting LM in CRC patients based on highly imbalanced datasets. In addition, we have implemented a novel approach to stratify the survival risk of CRC patients with LM based the output of the model.
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Affiliation(s)
- Weiyuan Zhang
- Department of Colorectal Cancer Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China; Department of Colorectal Surgery, Shanxi Province Cancer Hospital/Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, China.
| | - Shuai Jiao
- Department of Colorectal Surgery, Shanxi Province Cancer Hospital/Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, China
| | - Guiyu Wang
- Department of Colorectal Cancer Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China.
| | - Xishan Wang
- Department of Colorectal Cancer Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China; Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China; Department of Colorectal Surgery, Shanxi Province Cancer Hospital/Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, China.
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Loddenkemper T. Detect, predict, and prevent acute seizures and status epilepticus. Epilepsy Behav 2023; 141:109141. [PMID: 36871317 DOI: 10.1016/j.yebeh.2023.109141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
Status epilepticus is one of the most frequent pediatric neurological emergencies. While etiology is often influencing the outcome, more easily modifiable risk factors of outcome include detection of prolonged convulsive seizures and status epilepticus and appropriately dosed and timely applied medication treatment. Unpredictability and delayed or incomplete treatment may at times lead to longer seizures, thereby affecting outcomes. Barriers in the care of acute seizures and status epilepticus include the identification of patients at greatest risk of convulsive status epilepticus, potential stigma, distrust, and uncertainties in acute seizure care, including caregivers, physicians, and patients. Furthermore, unpredictability, detection capability, and identification of acute seizures and status epilepticus, limitations in access to obtaining and maintaining appropriate treatment, and rescue treatment options pose challenges. Additionally, timing and dosing of treatment and related acute management algorithms, potential variations in care due to healthcare and physician culture and preference, and factors related to access, equity, diversity, and inclusion of care. We outline strategies for the identification of patients at risk of acute seizures and status epilepticus, improved status epilepticus detection and prediction, and acute closed-loop treatment and status epilepticus prevention. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA.
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5
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Abstract
Artificial intelligence is already innovating in the provision of neurologic care. This review explores key artificial intelligence concepts; their application to neurologic diagnosis, prognosis, and treatment; and challenges that await their broader adoption. The development of new diagnostic biomarkers, individualization of prognostic information, and improved access to treatment are among the plethora of possibilities. These advances, however, reflect only the tip of the iceberg for the ways in which artificial intelligence may transform neurologic care in the future.
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Affiliation(s)
- James M Hillis
- Digital Clinical Research Organization, Data Science Office, Mass General Brigham, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bernardo C Bizzo
- Digital Clinical Research Organization, Data Science Office, Mass General Brigham, Boston, Massachusetts.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Tsai CM, Chang SF, Chang H. Transcranial photobiomodulation add-on therapy to valproic acid for pentylenetetrazole-induced seizures in peripubertal rats. BMC Complement Med Ther 2022; 22:81. [PMID: 35313886 PMCID: PMC8935768 DOI: 10.1186/s12906-022-03562-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background Convulsive status epilepticus (CSE) prevention is critical for pediatric patients with epilepsy. Immediate intervention before CSE reduce severity. Despite its wide usage as an anticonvulsant, valproic acid (VPA) results in harmful side effects such as dose-dependent hepatotoxicity. Hence, reducing VPA dosage to minimize side effects while maintaining its efficacy is necessary, and transcranial photobiomodulation (tPBM) add-on therapy could facilitate this. We recently demonstrated for the first time that tPBM at a wavelength of 808 nm attenuated CSE in peripubertal rats. However, the effects of VPA with the add-on therapy of tPBM prior to seizures have not yet been explored. This study investigated whether adding tPBM to VPA exerts synergistic effect for CSE prevention in peripubertal rats. Methods A gallium-aluminum-arsenide laser (wavelength of 808 nm with an exposure duration of 100 s and irradiance of 1.333 W/cm2 at the target) was applied transcranially 30 min after VPA injection in Sprague Dawley rats. All the rats received 90 mg/kg of pentylenetetrazole (PTZ). Except for the saline (n = 3), tPBM + saline (n = 3), and PTZ group (n = 6), all the rats received a PTZ injection 30 min after VPA injection. The rats received add-on tPBM with PTZ immediately after tPBM. In the VPA + PTZ group, the rats received low-dose (100 mg/kg, n = 6), medium-dose (200 mg/kg, n = 6), and high-dose (400 mg/kg, n = 7) VPA. In the VPA + tPBM + PTZ group, the rats received low (100 mg/kg, n = 5), medium (200 mg/kg, n = 6), and high (400 mg/kg, n = 3) doses of VPA. Seizures were evaluated according to the revised Racine’s scale in a non-blinded manner. Results Adding tPBM to low-dose VPA reduced the incidence of severe status epilepticus and significantly delayed the latency to stage 2 seizures. However, adding tPBM to high-dose VPA increased the maximum seizure stage, prolonged the duration of stage 4–7 seizures, and shortened the latency to stage 6 seizures. Conclusions Adding tPBM to low-dose VPA exerted a synergistic prevention effect on PTZ-induced seizures, whereas adding tPBM to high-dose VPA offset the attenuation effect.
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Affiliation(s)
- Chung-Min Tsai
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Shwu-Fen Chang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Pediatrics, Taipei Medical University Hospital, 250 Wuxing St., Taipei, 11031, Taiwan.
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Tsai CM, Chang SF, Li CC, Chang H. Transcranial photobiomodulation (808 nm) attenuates pentylenetetrazole-induced seizures by suppressing hippocampal neuroinflammation, astrogliosis, and microgliosis in peripubertal rats. NEUROPHOTONICS 2022; 9:015006. [PMID: 35345494 PMCID: PMC8955735 DOI: 10.1117/1.nph.9.1.015006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Significance: Transcranial photobiomodulation (tPBM) at 808 nm attenuates pentylenetetrazole (PTZ)-induced seizures and convulsive status epilepticus (CSE) in peripubertal rats by protecting neurons from injury and parvalbumin-positive interneurons from apoptosis, and preserving the integrity of perisomatic inhibitory networks. However, the effects of tPBM on neuroinflammation, astrogliosis, and microgliosis in epileptic rat brains are unknown. Thus, further study to unveil these aspects is needed for understanding the phenomena of tPBM on pediatric CSE prevention. Aim: To evaluate the effects of tPBM on neuroinflammation, astrogliosis, and microgliosis in peripubertal rat hippocampus with PTZ-induced seizures and SE. Approach: An 808-nm diode laser was applied transcranially to peripubertal rats prior to PTZ injection. Immunofluorescence staining of neuron-specific enolase (NSE) was used as a marker of neuroinflammation, glial fibrillary acid protein (GFAP) for astrogliosis, ionized calcium-binding adapter molecule 1 (Iba-1) for microgliosis, and mitochondrial cytochrome c oxidase subunit 1 (MT-CO1) for confirming the involvement of cytochrome c oxidase (CCO). Results: tPBM significantly reduced NSE immunoreactivity in CA3 in PTZ-treated rats, GFAP immunoreactivity in CA1, and Iba-1 immunoreactivity in CA3. Enhancement of hippocampal MT-CO1 reflected that tPBM acted in CCO-dependent manner. Conclusions: tPBM (808) attenuated PTZ-induced seizures and SE by suppressing neuroinflammation, astrogliosis, and microgliosis in peripubertal rats.
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Affiliation(s)
- Chung-Min Tsai
- Taipei Medical University, Graduate Institute of Medical Sciences, College of Medicine, Taipei, Taiwan
- MacKay Children’s Hospital, Department of Pediatrics, Taipei, Taiwan
| | - Shwu-Fen Chang
- Taipei Medical University, Graduate Institute of Medical Sciences, College of Medicine, Taipei, Taiwan
| | - Chih-Chuan Li
- Taipei Medical University Hospital, Department of Pediatrics, Taipei, Taiwan
| | - Hsi Chang
- Taipei Medical University Hospital, Department of Pediatrics, Taipei, Taiwan
- Taipei Medical University, College of Medicine, School of Medicine, Department of Pediatrics, Taipei, Taiwan
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El Atrache R, Tamilia E, Amengual-Gual M, Mohammadpour Touserkani F, Yang Y, Wang X, Ufongene C, Sheehan T, Cantley S, Jackson M, Zhang B, Papadelis C, Sarkis RA, Loddenkemper T. Association between semiologic, autonomic, and electrographic seizure characteristics in children with generalized tonic-clonic seizures. Epilepsy Behav 2021; 122:108228. [PMID: 34388667 DOI: 10.1016/j.yebeh.2021.108228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Generalized tonic-clonic seizures (GTCS) are associated with elevated electrodermal activity (EDA) and postictal generalized electroencephalographic suppression (PGES), markers that may indicate sudden unexpected death in epilepsy (SUDEP) risk. This study investigated the association of GTCS semiology, EDA, and PGES in children with epilepsy. METHODS Patients admitted to the Boston Children's Hospital long-term video-EEG monitoring unit wore a sensor that records EDA. We selected patients with at least one GTCS and reviewed video-EEGs for semiology, tonic and clonic phase duration, total clinical seizure duration, electrographic onset, offset, and PGES. We grouped patients into three semiology classes: GTCS 1: bilateral symmetric tonic arm extension, GTCS 2: no specific tonic arm extension or flexion, GTCS 3: unilateral or asymmetrical arm extension, tonic arm flexion or posturing that does not fit into GTCS 1 or 2. We analyzed the correlation between semiology, EDA, and PGES, and measured the area under the curve (AUC) of the ictal EDA (seizure onset to one hour after), subtracting baseline EDA (one-hour seizure-free before seizure onset). Using generalized estimating equation (GEE) and linear regression, we analyzed all seizures and single episodes per patient. RESULTS We included 30 patients (median age 13.8 ± 3.6 years, 46.7% females) and 53 seizures. With GEE, GTCS 1 was associated with longer PGES duration compared to GTCS 2 (Estimate (β) = -26.32 s, 95% Confidence Interval (CI): -36.46 to -16.18, p < 0.001), and the presence of PGES was associated with greater EDA change (β = 429604 μS, 95% CI: 3550.96 to 855657.04, p = 0.048). With single-episode analysis, GTCS 1 had greater EDA change than GTCS 2 ((β = -601339 μS, 95% CI: -1167016.56 to -35661.44, p = 0.047). EDA increased with PGES presence (β = 637500 μS, 95% CI: 183571.84 to 1091428.16, p = 0.01) and duration (β = 16794 μS, 95% CI: 5729.8 to 27858.2, p = 0.006). Patients with GTCS 1 had longer PGES duration compared to GTCS 2 (β = -30.53 s, 95% CI: -44.6 to -16.46, p < 0.001) and GTCS 3 (β = -22.07 s, 95% CI: -38.95 to -5.19, p = 0.016). CONCLUSION In children with epilepsy, PGES correlates with greater ictal EDA. GTCS 1 correlated with longer PGES duration and may indirectly correlate with greater ictal EDA. Our study suggests potential applications in monitoring and preventing SUDEP in these patients.
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Affiliation(s)
- Rima El Atrache
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Marta Amengual-Gual
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fatemeh Mohammadpour Touserkani
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Yonghua Yang
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaofan Wang
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Claire Ufongene
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore Sheehan
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Cantley
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rani A Sarkis
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Tang J, El Atrache R, Yu S, Asif U, Jackson M, Roy S, Mirmomeni M, Cantley S, Sheehan T, Schubach S, Ufongene C, Vieluf S, Meisel C, Harrer S, Loddenkemper T. Seizure detection using wearable sensors and machine learning: Setting a benchmark. Epilepsia 2021; 62:1807-1819. [PMID: 34268728 PMCID: PMC8457135 DOI: 10.1111/epi.16967] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Tracking seizures is crucial for epilepsy monitoring and treatment evaluation. Current epilepsy care relies on caretaker seizure diaries, but clinical seizure monitoring may miss seizures. Wearable devices may be better tolerated and more suitable for long-term ambulatory monitoring. This study evaluates the seizure detection performance of custom-developed machine learning (ML) algorithms across a broad spectrum of epileptic seizures utilizing wrist- and ankle-worn multisignal biosensors. METHODS We enrolled patients admitted to the epilepsy monitoring unit and asked them to wear a wearable sensor on either their wrists or ankles. The sensor recorded body temperature, electrodermal activity, accelerometry (ACC), and photoplethysmography, which provides blood volume pulse (BVP). We used electroencephalographic seizure onset and offset as determined by a board-certified epileptologist as a standard comparison. We trained and validated ML for two different algorithms: Algorithm 1, ML methods for developing seizure type-specific detection models for nine individual seizure types; and Algorithm 2, ML methods for building general seizure type-agnostic detection, lumping together all seizure types. RESULTS We included 94 patients (57.4% female, median age = 9.9 years) and 548 epileptic seizures (11 066 h of sensor data) for a total of 930 seizures and nine seizure types. Algorithm 1 detected eight of nine seizure types better than chance (area under the receiver operating characteristic curve [AUC-ROC] = .648-.976). Algorithm 2 detected all nine seizure types better than chance (AUC-ROC = .642-.995); a fusion of ACC and BVP modalities achieved the best AUC-ROC (.752) when combining all seizure types together. SIGNIFICANCE Automatic seizure detection using ML from multimodal wearable sensor data is feasible across a broad spectrum of epileptic seizures. Preliminary results show better than chance seizure detection. The next steps include validation of our results in larger datasets, evaluation of the detection utility tool for additional clinical seizure types, and integration of additional clinical information.
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Affiliation(s)
- Jianbin Tang
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Rima El Atrache
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shuang Yu
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Umar Asif
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Michele Jackson
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Subhrajit Roy
- IBM Research Australia, Melbourne, Victoria, Australia.,Google Brain, London, UK
| | | | - Sarah Cantley
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore Sheehan
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Schubach
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Ufongene
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Solveig Vieluf
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Meisel
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Stefan Harrer
- IBM Research Australia, Melbourne, Victoria, Australia.,Digital Health Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Tobias Loddenkemper
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Sethy PK, Panigrahi M, Vijayakumar K, Behera SK. Machine learning based classification of EEG signal for detection of child epileptic seizure without snipping. INTERNATIONAL JOURNAL OF SPEECH TECHNOLOGY 2021. [DOI: 10.1007/s10772-021-09855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/21/2021] [Indexed: 08/02/2023]
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Bosl WJ, Leviton A, Loddenkemper T. Prediction of Seizure Recurrence. A Note of Caution. Front Neurol 2021; 12:675728. [PMID: 34054713 PMCID: PMC8155381 DOI: 10.3389/fneur.2021.675728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/20/2021] [Indexed: 12/31/2022] Open
Abstract
Great strides have been made recently in documenting that machine-learning programs can predict seizure occurrence in people who have epilepsy. Along with this progress have come claims that appear to us to be a bit premature. We anticipate that many people will benefit from seizure prediction. We also doubt that all will benefit. Although machine learning is a useful tool for aiding discovery, we believe that the greatest progress will come from deeper understanding of seizures, epilepsy, and the EEG features that enable seizure prediction. In this essay, we lay out reasons for optimism and skepticism.
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Affiliation(s)
- William J Bosl
- Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Health Informatics Program, University of San Francisco, San Francisco, CA, United States
| | - Alan Leviton
- Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Tobias Loddenkemper
- Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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12
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Biondi A, Laiou P, Bruno E, Viana PF, Schreuder M, Hart W, Nurse E, Pal DK, Richardson MP. Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study. JMIR Res Protoc 2021; 10:e25309. [PMID: 33739290 PMCID: PMC8088854 DOI: 10.2196/25309] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 01/06/2023] Open
Abstract
Background Epileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy. Objective EEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk. Methods A total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King’s College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk. Results The EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022. Conclusions With the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence. International Registered Report Identifier (IRRID) PRR1-10.2196/25309
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Affiliation(s)
- Andrea Biondi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Petroula Laiou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Elisa Bruno
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Pedro F Viana
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Faculty of Medicine, University of Lisbon, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | - Ewan Nurse
- Seer Medical Inc, Melbourne, Australia.,Department of Medicine, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Deb K Pal
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mark P Richardson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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13
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Amengual-Gual M, Barcia Aguilar C, Loddenkemper T. Author Response: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus. Neurology 2021; 96:503. [PMID: 33686008 DOI: 10.1212/wnl.0000000000011560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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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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15
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Gonçalves J, Alves G, Fonseca C, Carona A, Bicker J, Falcão A, Fortuna A. Is intranasal administration an opportunity for direct brain delivery of lacosamide? Eur J Pharm Sci 2020; 157:105632. [PMID: 33152466 DOI: 10.1016/j.ejps.2020.105632] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
Lacosamide is well-known as an effective and safe anticonvulsant drug. Nevertheless, there is also evidence of anti-epileptogenic, neuroprotective and antinociceptive properties of lacosamide. It is currently available as oral and intravenous (IV) formulations, and its brain concentrations and therapeutic effects depend on its passage across the blood-brain barrier (BBB). Therefore, to circumvent the restrictive BBB, we herein evaluated the intranasal (IN) administration of lacosamide. Nasal thermoreversible gels were screened in vitro for their influence on the viability of human nasal septum (RPMI 2650) and lung adenocarcinoma (Calu-3) cells. According to the Alamar Blue test, the in situ gel composed of Pluronic F-127 (22.5%, w/v) and Carbopol 974P (0.2%, w/v) did not affect cell viability, which remained higher than 85%, within the concentration range of lacosamide. The in situ gel was intranasally administered to healthy male CD-1 mice (8.33 mg/kg) to describe the pharmacokinetic profiles of lacosamide in plasma, brain, lung and kidney and compare them with those obtained after IV administration of the same dose. Accordingly, IN administration allowed a fast (tmax in plasma: 5 min) and complete systemic absorption of lacosamide (absolute bioavailability: 120.46%). Interestingly, IN lacosamide demonstrated higher exposure (given by the AUCt) in the brain (425.44 µg.min/mL versus 274.49 µg.min/mL), but lower exposure in kidneys (357.56 µg.min/mL versus 762.61 µg.min/mL), in comparison to IV administration. These findings, together with the tmax in brain of 15 min, a drug targeting efficiency (DTE) of 128.67% and a direct transport percentage of 22.28%, evidence that part of lacosamide reaches the brain directly after nasal administration, even though penetration into the brain from the systemic circulation seems to be the major determinant of brain exposure. Importantly, lacosamide concentrations found in lungs following IN administration were considerably higher than those observed after IV injection, until 30 min post-dosing (p < 0.05). Nevertheless, attained drug concentrations were lower than those tested in vitro in the Calu-3 cell line (1-100 µM), indicating that adverse effects are unlikely to occur in vivo. Hence, it seems that the proposed IN route has potential to be a suitable and valuable strategy for the brain delivery of lacosamide in emergency conditions and for the chronic treatment of epilepsy and other neurological diseases.
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Affiliation(s)
- Joana Gonçalves
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Carla Fonseca
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Andreia Carona
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Joana Bicker
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Amílcar Falcão
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Ana Fortuna
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.
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16
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Seizure prediction and intervention. Neuropharmacology 2019; 172:107898. [PMID: 31839204 DOI: 10.1016/j.neuropharm.2019.107898] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 12/29/2022]
Abstract
Epilepsy treatment is challenging due to a lack of essential diagnostic tools, including methods for reliable seizure detection in the ambulatory setting, to assess seizure risk over time and to monitor treatment efficacy. This lack of objective diagnostics constitutes a significant barrier to better treatments, raises methodological concerns about the antiseizure medication evaluation process and, to patients, is a main issue contributing to the disease burden. Recent years have seen rapid progress towards better diagnostics that meet these needs of epilepsy patients and clinicians. Availability of comprehensive data and the rise of more powerful computational analysis methods have driven progress in this area. Here, we provide an overview on data- and theory-driven approaches aimed at identifying methods to reliably detect and forecast seizures as well as to monitor brain excitability and treatment efficacy in epilepsy. We provide a particular account on neural criticality, the hypothesis that cortical networks may be poised in a critical state at the boundary between different types of dynamics, and discuss its role in informing diagnostics to track cortex excitability and seizure risk in recent experiments. With the further expansion of digitalization in medicine, tele-medicine and long-term, ambulatory monitoring, these computationally based methods may gain more relevance in epilepsy in the future. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
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Abbasi B, Goldenholz DM. Machine learning applications in epilepsy. Epilepsia 2019; 60:2037-2047. [PMID: 31478577 PMCID: PMC9897263 DOI: 10.1111/epi.16333] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/25/2019] [Accepted: 08/12/2019] [Indexed: 02/05/2023]
Abstract
Machine learning leverages statistical and computer science principles to develop algorithms capable of improving performance through interpretation of data rather than through explicit instructions. Alongside widespread use in image recognition, language processing, and data mining, machine learning techniques have received increasing attention in medical applications, ranging from automated imaging analysis to disease forecasting. This review examines the parallel progress made in epilepsy, highlighting applications in automated seizure detection from electroencephalography (EEG), video, and kinetic data, automated imaging analysis and pre-surgical planning, prediction of medication response, and prediction of medical and surgical outcomes using a wide variety of data sources. A brief overview of commonly used machine learning approaches, as well as challenges in further application of machine learning techniques in epilepsy, is also presented. With increasing computational capabilities, availability of effective machine learning algorithms, and accumulation of larger datasets, clinicians and researchers will increasingly benefit from familiarity with these techniques and the significant progress already made in their application in epilepsy.
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Affiliation(s)
- Bardia Abbasi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215
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