Patient-specific early seizure detection from scalp electroencephalogram

Challenges and Prospects in Epilepsy Monitoring Units: A Comprehensive Review of Logistic Barriers

Epilepsy is one of the most common neurological diseases with a prevalence ranging from 0.5% to 2% in different sittings. The World Health Organization (WHO) estimated that nearly 80% of this burden is borne by resource-poor countries where even conventional electroencephalogram (EEG) coverage is dramatically short.  Video EEG monitoring applied for days as conducted in epilepsy monitoring units (EMUs) is aimed at seizure localization, anti-seizure medication (ASM) adjustment, or epilepsy surgery evaluation and planning. However, the EEG approach in EMUs has its obstacles. The present article is aimed to concentrate on the logistic challenges of EMUs, discussing existing data and limitations and offering suggestions for future planning to enhance the utilization of existing technology. Shortages of adult and pediatric epileptologists, qualified nurses, as well as EEG technologists have been reported in different countries. Moreover, injuries and falls, psychosis, status epilepticus, and unexpected death have been stated to be the most frequent safety issues in EMUs. Enhancements to mitigate logistical and healthcare system-related barriers in EMUs include the implementation of large cohort studies and the utilization of artificial intelligence (AI) for the identification and categorization of specific risks among EMU admissions. The establishment of EMUs and their associated challenges and barriers are best acknowledged through discussions and dialogue with various stakeholders.

Novel deep learning framework for detection of epileptic seizures using EEG signals

Introduction

Epilepsy is a chronic neurological disorder characterized by abnormal electrical activity in the brain, often leading to recurrent seizures. With 50 million people worldwide affected by epilepsy, there is a pressing need for efficient and accurate methods to detect and diagnose seizures. Electroencephalogram (EEG) signals have emerged as a valuable tool in detecting epilepsy and other neurological disorders. Traditionally, the process of analyzing EEG signals for seizure detection has relied on manual inspection by experts, which is time-consuming, labor-intensive, and susceptible to human error. To address these limitations, researchers have turned to machine learning and deep learning techniques to automate the seizure detection process.

Methods

In this work, we propose a novel method for epileptic seizure detection, leveraging the power of 1-D Convolutional layers in combination with Bidirectional Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) and Average pooling Layer as a single unit. This unit is repeatedly used in the proposed model to extract the features. The features are then passed to the Dense layers to predict the class of the EEG waveform. The performance of the proposed model is verified on the Bonn dataset. To assess the robustness and generalizability of our proposed architecture, we employ five-fold cross-validation. By dividing the dataset into five subsets and iteratively training and testing the model on different combinations of these subsets, we obtain robust performance measures, including accuracy, sensitivity, and specificity.

Results

Our proposed model achieves an accuracy of 99-100% for binary classifications into seizure and normal waveforms, 97.2%-99.2% accuracy for classifications into normal-interictal-seizure waveforms, 96.2%-98.4% accuracy for four class classification and accuracy of 95.81%-98% for five class classification.

Discussion

Our proposed models have achieved significant improvements in the performance metrics for the binary classifications and multiclass classifications. We demonstrate the effectiveness of the proposed architecture in accurately detecting epileptic seizures from EEG signals by using EEG signals of varying lengths. The results indicate its potential as a reliable and efficient tool for automated seizure detection, paving the way for improved diagnosis and management of epilepsy.

Sequential graph convolutional network and DeepRNN based hybrid framework for epileptic seizure detection from EEG signal

Automated epileptic seizure detection from ectroencephalogram (EEG) signals has attracted significant attention in the recent health informatics field. The serious brain condition known as epilepsy, which is characterized by recurrent seizures, is typically described as a sudden change in behavior caused by a momentary shift in the excessive electrical discharges in a group of brain cells, and EEG signal is primarily used in most cases to identify seizure to revitalize the close loop brain. The development of various deep learning (DL) algorithms for epileptic seizure diagnosis has been driven by the EEG's non-invasiveness and capacity to provide repetitive patterns of seizure-related electrophysiological information. Existing DL models, especially in clinical contexts where irregular and unordered structures of physiological recordings make it difficult to think of them as a matrix; this has been a key disadvantage to producing a consistent and appropriate diagnosis outcome due to EEG's low amplitude and nonstationary nature. Graph neural networks have drawn significant improvement by exploiting implicit information that is present in a brain anatomical system, whereas inter-acting nodes are connected by edges whose weights can be determined by either temporal associations or anatomical connections. Considering all these aspects, a novel hybrid framework is proposed for epileptic seizure detection by combined with a sequential graph convolutional network (SGCN) and deep recurrent neural network (DeepRNN). Here, DepRNN is developed by fusing a gated recurrent unit (GRU) with a traditional RNN; its key benefit is that it solves the vanishing gradient problem and achieve this hybrid framework greater sophistication. The line length feature, auto-covariance, auto-correlation, and periodogram are applied as a feature from the raw EEG signal and then grouped the resulting matrix into time-frequency domain as inputs for the SGCN to use for seizure classification. This model extracts both spatial and temporal information, resulting in improved accuracy, precision, and recall for seizure detection. Extensive experiments conducted on the CHB-MIT and TUH datasets showed that the SGCN-DeepRNN model outperforms other deep learning models for seizure detection, achieving an accuracy of 99.007%, with high sensitivity and specificity.

Seizure detection with reduced electroencephalogram channels: research trends and outlook

Epilepsy is a prevalent condition characterized by recurrent, unpredictable seizures. Monitoring with surface electroencephalography (EEG) is the gold standard for diagnosing epilepsy, but a time-consuming, uncomfortable and sometimes ineffective process for patients. Further, using EEG over a brief monitoring period has variable success, dependent on patient tolerance and seizure frequency. The availability of hospital resources and hardware and software specifications inherently restrict the options for comfortable, long-term data collection, resulting in limited data for training machine-learning models. This mini-review examines the current patient journey, providing an overview of the current state of EEG monitoring with reduced electrodes and automated channel reduction methods. Opportunities for improving data reliability through multi-modal data fusion are suggested. We assert the need for further research in electrode reduction to advance brain monitoring solutions towards portable, reliable devices that simultaneously offer patient comfort, perform ultra-long-term monitoring and expedite the diagnosis process.

Estimation of ANT-DBS Electrodes on Target Positioning Based on a New PerceptTM PC LFP Signal Analysis

Deep brain stimulation of the Anterior Nucleus of the Thalamus (ANT-DBS) is an effective therapy in epilepsy. Poorer surgical outcomes are related to deviations of the lead from the ANT-target. The target identification relies on the visualization of anatomical structures by medical imaging, which presents some disadvantages. This study aims to research whether ANT-LFPs recorded with the Percept^TM PC neurostimulator can be an asset in the identification of the DBS-target. For this purpose, 17 features were extracted from LFPs recorded from a single patient, who stayed at an Epilepsy Monitoring Unit for a 5-day period. Features were then integrated into two machine learning (ML)-based methodologies, according to different LFP bipolar montages: Pass1 (nonadjacent channels) and Pass2 (adjacent channels). We obtained an accuracy of 76.6% for the Pass1-classifier and 83.33% for the Pass2-classifier in distinguishing locations completely inserted in the target and completely outside. Then, both classifiers were used to predict the target percentage of all combinations, and we found that contacts 3 (left hemisphere) and 2 and 3 (right hemisphere) presented higher signatures of the ANT-target, which agreed with the medical images. This result opens a new window of opportunity for the use of LFPs in the guidance of DBS target identification.

Weak self-supervised learning for seizure forecasting: a feasibility study

This paper proposes an artificial intelligence system that continuously improves over time at event prediction using initially unlabelled data by using self-supervised learning. Time-series data are inherently autocorrelated. By using a detection model to generate weak labels on the fly, which are concurrently used as targets to train a prediction model on a time-shifted input data stream, this autocorrelation can effectively be harnessed to reduce the burden of manual labelling. This is critical in medical patient monitoring, as it enables the development of personalized forecasting models without demanding the annotation of long sequences of physiological signal recordings. We perform a feasibility study on seizure prediction, which is identified as an ideal test case, as pre-ictal brainwaves are patient-specific, and tailoring models to individual patients is known to improve forecasting performance significantly. Our self-supervised approach is used to train individualized forecasting models for 10 patients, showing an average relative improvement in sensitivity by 14.30% and a reduction in false alarms by 19.61% in early seizure forecasting. This proof-of-concept on the feasibility of using a continuous stream of time-series neurophysiological data paves the way towards a low-power neuromorphic neuromodulation system.

Dynamic training of a novelty classifier algorithm for real-time detection of early seizure onset

OBJECTIVE

To develop an adaptive framework for seizure detection in real-time that is practical to use in the Epilepsy Monitoring Unit (EMU) as a warning signal, and whose output helps characterize epileptiform activity.

METHODS

Our algorithm was tested on intracranial EEG from epilepsy patients admitted to the EMU for presurgical evaluation. Our framework uses a one-class Support Vector Machine (SVM) that is being trained dynamically according to past activity in all available channels to classify the novelty of the current activity. In this study we compared multiple configurations using a one-class SVM to assess if there is significance over specific neural features or electrode locations.

RESULTS

Our results show that the algorithm reaches a sensitivity of 87% for early-onset seizure detection and of 97.7% as a generic seizure detection.

CONCLUSIONS

Our algorithm is capable of running in real-time and achieving a high performance for early seizure-onset detection with a low false positive rate and robustness in detection of different type of seizure-onset patterns.

SIGNIFICANCE

This algorithm offers a solution to warning systems in the EMU as well as a tool for seizure characterization during post-hoc analysis of intracranial EEG data for surgical resection of the epileptogenic network.

Neuromorphic Architecture Accelerated Automated Seizure Detection in Multi-Channel Scalp EEG

Epileptic focal seizures can be localized in the brain using tracer injections during or immediately after the incidence of a seizure. A real-time automated seizure detection system with minimal latency can help time the injection properly to find the seizure origin accurately. Reliable real-time seizure detection systems have not been clinically reported yet. We developed an anomaly detection-based automated seizure detection system, using scalp-electroencephalogram (EEG) data, which can be trained using a few seizure sessions, and implemented it on commercially available hardware with parallel, neuromorphic architecture—the NeuroStack. We extracted nonlinear, statistical, and discrete wavelet decomposition features, and we developed a graphical user interface and traditional feature selection methods to select the most discriminative features. We investigated Reduced Coulomb Energy (RCE) networks and K-Nearest Neighbors (k-NN) for its several advantages, such as fast learning no local minima problem. We obtained a maximum sensitivity of 91.14%±1.77% and a specificity of 98.77%±0.57% with 5 s epoch duration. The system’s latency was 12 s, which is within most seizure event windows, which last for an average duration of 60 s. Our results showed that the CD feature consumes large computation resources and excluding it can reduce the latency to 3.6 s but at the cost of lower performance 80% sensitivity and 97% specificity. We demonstrated that the proposed methodology achieves a high specificity and an acceptable sensitivity within a short delay. Our results indicated also that individual-based RCE are superior to population-based RCE. The proposed RCE networks has been compared to SVM and ANN as a baseline for comparison as they are the most common machine learning seizure detection methods. SVM and ANN-based systems were trained on the same data as RCE and K-NN with features optimized specifically for them. RCE nets are superior to SVM and ANN. The proposed model also achieves comparable performance to the state-of-the-art deep learning techniques while not requiring a sizeable database, which is often expensive to build. These numbers indicate that the system is viable as a trigger mechanism for tracer injection.

Epileptic-Net: An Improved Epileptic Seizure Detection System Using Dense Convolutional Block with Attention Network from EEG

Epilepsy is a complex neurological condition that affects a large number of people worldwide. Electroencephalography (EEG) measures the electrical activity of the brain and is widely used in epilepsy diagnosis, but it usually requires manual inspection, which can be hours long, by a neurologist. Several automatic systems have been proposed to detect epilepsy but still have some unsolved issues. In this study, we proposed a dynamic method using a deep learning model (Epileptic-Net) to detect an epileptic seizure. The proposed method is largely heterogeneous and comprised of the dense convolutional blocks (DCB), feature attention modules (FAM), residual blocks (RB), and hypercolumn technique (HT). Firstly, DCB is used to get the discriminative features from the EEG samples. Then, FAM extracts the essential features from the samples. After that, RB learns more vital parts as it entirely uses information in the convolutional layer. Finally, HT retains the efficient local features extracted from the layers situated at the different levels of the model. Its performance has been evaluated on the University of Bonn EEG dataset, divided into five distinct classes. The proposed Epileptic-Net achieves the average accuracy of 99.95% in the two-class classification, 99.98% in the three-class classification, 99.96% in the four-class classification, and 99.96% in classifying the complicated five-class problem. Thus the proposed approach shows more competitive results than the existing model to detect epileptic seizures. We also hope that this method can support experts in achieving objective and reliable results, lowering the misdiagnosis rate, and assisting in decision-making.

An Overview of EEG-based Machine Learning Methods in Seizure Prediction and Opportunities for Neurologists in this Field

The unpredictability of epileptic seizures is one of the most problematic aspects of the field of epilepsy. Methods or devices capable of detecting seizures minutes before they occur may help prevent injury or even death and significantly improve the quality of life. Machine learning (ML) is an emerging technology that can markedly enhance algorithm performance by interpreting data. ML has gained increasing attention from medical researchers in recent years. Its epilepsy applications range from the localization of the epileptic region, predicting the medical or surgical outcome of epilepsy, and automated electroencephalography (EEG) analysis to seizure prediction. While ML has good prospects with regard to detecting epileptic seizures via EEG signals, many clinicians are still unfamiliar with this field. This work briefly summarizes the history and recent significant progress made in this field and clarifies the essential components of the automatic seizure detection system using ML methodologies for clinicians. This review also proposes how neurologists can actively contribute to ensure improvements in seizure prediction using EEG-based ML.

A Recent Investigation on Detection and Classification of Epileptic Seizure Techniques Using EEG Signal

The benefits of early detection and classification of epileptic seizures in analysis, monitoring and diagnosis for the realization and actualization of computer-aided devices and recent internet of medical things (IoMT) devices can never be overemphasized. The success of these applications largely depends on the accuracy of the detection and classification techniques employed. Several methods have been investigated, proposed and developed over the years. This paper investigates various seizure detection algorithms and classifications in the last decade, including conventional techniques and recent deep learning algorithms. It also discusses epileptiform detection as one of the steps towards advanced diagnoses of disorders of consciousness (DOCs) and their understanding. A performance comparison was carried out on the different algorithms investigated, and their advantages and disadvantages were explored. From our survey, much attention has recently been paid to exploring the efficacy of deep learning algorithms in seizure detection and classification, which are employed in other areas such as image processing and classification. Hybrid deep learning has also been explored, with CNN-RNN being the most popular.

Prediction of Seizure Recurrence. A Note of Caution

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.

Performance Evaluation of Epileptic Seizure Prediction Using Time, Frequency, and Time–Frequency Domain Measures

The prediction of epileptic seizures is crucial to aid patients in gaining early warning and taking effective intervention. Several features have been explored to predict the onset via electroencephalography signals, which are typically non-stationary, dynamic, and varying from person-to-person. In the former literature, features applied in the classification have shared similar contributions to all patients. Therefore, in this paper, we analyze the impact of the specific combination of feature and channel from time, frequency, and time–frequency domains on prediction performance of disparate patients. Based on the minimal-redundancy-maximal-relevance criterion, the proposed framework uses a sequential forward selection approach to individually find the optimal features and channels. Trained models could discriminate the pre-ictal and inter-ictal electroencephalography with a sensitivity of 90.2% and a false prediction rate of 0.096/h. We also present the comparison between the classification accuracy obtained by the optimal features, several features summarized from optimal features, and the complete set of features from three domains. The results indicate that various patient interpretations have a certain specificity in the selection of feature-channel. Furthermore, the detailed list of optimal features and summarized features are proffered for reference to those who research the corresponding database.

Seizure Onset Detection Using Empirical Mode Decomposition and Common Spatial Pattern

Automatic seizure onset detection plays an important role in epilepsy diagnosis. In this paper, a novel seizure onset detection method is proposed by combining empirical mode decomposition (EMD) of long-term scalp electroencephalogram (EEG) with common spatial pattern (CSP). First, wavelet transform (WT) and EMD are employed on EEG recordings respectively for filtering pre-processing and time-frequency decomposition. Then CSP is applied to reduce the dimension of multi-channel time-frequency representation, and the variance is extracted as the only feature. Afterwards, a support vector machine (SVM) group consisting of ten SVMs is served as a robust classifier. Finally, the post-processing is adopted to acquire a higher recognition rate and reduce the false detection rate. The results obtained from CHB-MIT database of 977 h scalp EEG recordings reveal that the proposed system can achieve a segment-based sensitivity of 97.34% with a specificity of 97.50% and an event-based sensitivity of 98.47% with a false detection rate of 0.63/h. This proposed detection system was also validated on a clinical scalp EEG database from the Second Hospital of Shandong University, and the system yielded a sensitivity of 93.67% and a specificity of 96.06%. At the event-based level, a sensitivity of 99.39% and a false detection rate of 0.64/h were obtained. Furthermore, this work showed that the CSP spatial filter was helpful to identify EEG channels involved in seizure onsets. These satisfactory results indicate that the proposed system may provide a reference for seizure onset detection in clinical applications.

Machine learning and wearable devices of the future

Machine learning (ML) is increasingly recognized as a useful tool in healthcare applications, including epilepsy. One of the most important applications of ML in epilepsy is seizure detection and prediction, using wearable devices (WDs). However, not all currently available algorithms implemented in WDs are using ML. In this review, we summarize the state of the art of using WDs and ML in epilepsy, and we outline future development in these domains. There is published evidence for reliable detection of epileptic seizures using implanted electroencephalography (EEG) electrodes and wearable, non-EEG devices. Application of ML using the data recorded with WDs from a large number of patients could change radically the way we diagnose and manage patients with epilepsy.

Machine-learning-based diagnostics of EEG pathology

Machine learning (ML) methods have the potential to automate clinical EEG analysis. They can be categorized into feature-based (with handcrafted features), and end-to-end approaches (with learned features). Previous studies on EEG pathology decoding have typically analyzed a limited number of features, decoders, or both. For a I) more elaborate feature-based EEG analysis, and II) in-depth comparisons of both approaches, here we first develop a comprehensive feature-based framework, and then compare this framework to state-of-the-art end-to-end methods. To this aim, we apply the proposed feature-based framework and deep neural networks including an EEG-optimized temporal convolutional network (TCN) to the task of pathological versus non-pathological EEG classification. For a robust comparison, we chose the Temple University Hospital (TUH) Abnormal EEG Corpus (v2.0.0), which contains approximately 3000 EEG recordings. The results demonstrate that the proposed feature-based decoding framework can achieve accuracies on the same level as state-of-the-art deep neural networks. We find accuracies across both approaches in an astonishingly narrow range from 81 to 86%. Moreover, visualizations and analyses indicated that both approaches used similar aspects of the data, e.g., delta and theta band power at temporal electrode locations. We argue that the accuracies of current binary EEG pathology decoders could saturate near 90% due to the imperfect inter-rater agreement of the clinical labels, and that such decoders are already clinically useful, such as in areas where clinical EEG experts are rare. We make the proposed feature-based framework available open source and thus offer a new tool for EEG machine learning research.

Epilepsy Detection in EEG Using Grassmann Discriminant Analysis Method

Epilepsy is marked by seizures stemming from abnormal electrical activity in the brain, causing involuntary movement or behavior. Many scientists have been working hard to explore the cause of epilepsy and seek the prevention and treatment. In the field of machine learning, epileptic diagnosis based on EEG signal has been a very hot research topic; many methods have been proposed, and considerable progress has been achieved. However, resorting the epileptic diagnosis techniques based on EEG to the reality applications still faces many challenges. Low signal-to-noise ratio (SNR) is one of the most important methodological challenges for EEG data collection and analysis. This paper discusses an automated diagnostic method for epileptic detection using a Fréchet Mean embedded in the Grassmann manifold analysis. Fréchet mean-based Grassmann discriminant analysis (FMGDA) algorithm to implement the EEG data dimensionality reduction and clustering task. The method is resorted to reduce Grassmann data from high-dimensional data to a relative lower-dimensional data and maximize between-class distance and minimize within-class distance simultaneously. Every EEG feature is mapped into the Grassmann manifold space first and then resort the Fréchet mean to represent the clustering center to carry out the clustering work. We designed a detailed experimental scheme to test the performance of our proposed algorithm; the test is assessed on several benchmark datasets. Experimental results have delivered that our approach leads to a significant improvement over state-of-the-art Grassmann manifold methods.

Cross-database evaluation of EEG based epileptic seizures detection driven by adaptive median feature baseline correction

OBJECTIVE

In long-term electroencephalogram (EEG) signals, automated classification of epileptic seizures is desirable in diagnosing epilepsy patients, as it otherwise depends on visual inspection. To the best of the author's knowledge, existing studies have validated their algorithms using cross-validation on the same database and less number of attempts have been made to extend their work on other databases to test the generalization capability of the developed algorithms. In this study, we present the algorithm for cross-database evaluation for classification of epileptic seizures using five EEG databases collected from different centers. The cross-database framework helps when sufficient epileptic seizures EEG data are not available to build automated seizure detection model.

METHODS

Two features, namely successive decomposition index and matrix determinant were extracted at a segmentation length of 4 s (50% overlap). Then, adaptive median feature baseline correction (AM-FBC) was applied to overcome the inter-patient and inter-database variation in the feature distribution. The classification was performed using a support vector machine classifier with leave-one-database-out cross-validation. Different classification scenarios were considered using AM-FBC, smoothing of the train and test data, and post-processing of the classifier output.

RESULTS

Simulation results revealed the highest area under the curve-sensitivity-specificity-false detections (per hour) of 1-1-1-0.15, 0.89-0.99-0.82-2.5, 0.99-0.73-1-1, 0.95-0.97-0.85-1.7, 0.99-0.99-0.92-1.1 using the Ramaiah Medical College and Hospitals, Children's Hospital Boston-Massachusetts Institute of Technology, Temple University Hospital, Maastricht University Medical Centre, and University of Bonn databases respectively.

CONCLUSIONS

We observe that the AM-FBC plays a significant role in improving seizure detection results by overcoming inter-database variation of feature distribution.

SIGNIFICANCE

To the best of the author's knowledge, this is the first study reporting on the cross-database evaluation of classification of epileptic seizures and proven to be better generalization capability when evaluated using five databases and can contribute to accurate and robust detection of epileptic seizures in real-time.

A strategy combining intrinsic time-scale decomposition and a feedforward neural network for automatic seizure detection

Epilepsy is a common neurological disorder which can occur in people of all ages globally. For the clinical treatment of epileptic patients, the detection of epileptic seizures is of great significance.

OBJECTIVE

Electroencephalography (EEG) is an essential component in the diagnosis of epileptic seizures, from which brain surgeons can detect important pathological information about patient epileptiform discharges. This paper focuses on adaptive seizure detection from EEG recordings. We propose a new feature extraction model based on an adaptive decomposition method, named intrinsic time-scale decomposition (ITD), which is suitable for analyzing non-linear and non-stationary data.

APPROACH

Firstly, using the ITD technique, every EEG recording is decomposed into several proper rotation components (PRCs). Secondly, the instantaneous amplitudes and frequencies of these PRCs can be calculated and then we extract their statistical indices. Furthermore, we combine all these statistical indices of the corresponding five PRCs as the feature vector of each EEG signal. Finally, these feature vectors are fed into a feedforward neural network (FNN) classifier for EEG classification. The whole process of feature extraction proposed in this paper only involves one parameter and the role of the ITD method is based on a piecewise linear function, which makes the computation of the model simple and fast. More useful information for classification can be obtained since we take advantage of both instantaneous amplitude and instantaneous frequency for feature extraction.

MAIN RESULTS

We consider the 17 classification problems which contain normal versus epileptic, non-seizure versus seizure and normal versus interictal versus ictal using a FNN classifier which only contains one hidden layer. Experimental results show that the proposed method can catch the discriminative features of EEG signals and obtain comparable results when compared with state-of-the-art detection methods.

SIGNIFICANCE

Therefore, the proposed system has a great potential in real-time seizure detection and provides physicians with a real-time diagnostic aid in their practice.

Improved Patient-Independent System for Detection of Electrical Onset of Seizures

PURPOSE

To design a non-patient-specific system to detect the electrical onset of seizures in patients with temporal lobe epilepsy.

METHODS

We used EEG data from 29 seizures of 18 temporal lobe epilepsy patients who underwent multiday video-scalp EEG monitoring as part of their presurgical evaluations. We segmented each data set into preictal and ictal phases, and identified spectral entropy, spectral energy, and signal energy as useful features for discriminating normal and seizure conditions. The performance of five different classifiers was analyzed using these features to design an automated detection system.

RESULTS

Among the five classifiers, decision tree, k-nearest neighbor, and support vector machine performed with sensitivity (specificity) of 79% (81%), 75% (85%), and 80% (86%), respectively. The other two, linear discriminant algorithm and Naive Bayes classifiers, performed with sensitivity (specificity) of 54% (94%), 47% (96%), respectively.

CONCLUSIONS

The support vector machine-based seizure detection system showed better detection capability in terms of sensitivity and specificity measures as compared to linear discriminant algorithm, Naive Bayes, decision tree, and k-nearest neighbor classifiers.

CONCLUSIONS

Our study shows that a generalized system to detect the electrical onset of seizures in temporal lobe epilepsy using scalp-recorded EEG is possible. If confirmed on a larger data set, our findings may have significant implications for the management of seizures, especially in patients with drug-resistant epilepsy.

Onset Detection of Epileptic Seizures From Accelerometry Signal

Epileptic seizures are the result of any abnormal asynchronous firing of cortical neurons. Seizures are abrupt and pose a risk of injury and fatal harm to the patient. Epilepsy affects patients quality of life (QOL) and imposes financial, social, and physical burden on the patient. The unpredictability associated with seizures further adds to the reduced QOL and increases dependence on caregivers and family members. A seizure triggered alarm system can reduce the risk of seizure-related injuries and aid in improving patient's QOL. This study presents real-time onset detection of seizures from accelerometry signal. An automated approach based on statistical machine learning is employed to learn the onset of seizures. To search for the optimal parameter that simultaneously maximizes detection sensitivity (sens) while minimizing false alarm rate (FAR) and latency, the epoch length is varied from $t=\{1,~10s\}$. Linear and non-linear time-varying dynamical patterns were extracted from every epoch using Poincaré plot analysis. The correlation patterns were learned using a kernalized support vector data descriptor. The preliminary analysis on accelerometry data collected from 8 epileptic patients with 9 generalized tonicclonic seizures (GTCS) shows promising results. The proposed algorithm detected all GTCS events (sens: 100%, FAR: 1. 09/24h) at 8s from onset. The proposed algorithm can lead to a sensitive, specific, and a relatively short-latency detection system for real-time remote monitoring of epileptic patients.

Automatic Computer-Based Detection of Epileptic Seizures

Automatic computer-based seizure detection and warning devices are important for objective seizure documentation, for SUDEP prevention, to avoid seizure related injuries and social embarrassments as a consequence of seizures, and to develop on demand epilepsy therapies. Automatic seizure detection systems can be based on direct analysis of epileptiform discharges on scalp-EEG or intracranial EEG, on the detection of motor manifestations of epileptic seizures using surface electromyography (sEMG), accelerometry (ACM), video detection systems and mattress sensors and finally on the assessment of changes of physiologic parameters accompanying epileptic seizures measured by electrocardiography (ECG), respiratory monitors, pulse oximetry, surface temperature sensors, and electrodermal activity. Here we review automatic seizure detection based on scalp-EEG, ECG, and sEMG. Different seizure types affect preferentially different measurement parameters. While EEG changes accompany all types of seizures, sEMG and ACM are suitable mainly for detection of seizures with major motor manifestations. Therefore, seizure detection can be optimized by multimodal systems combining several measurement parameters. While most systems provide sensitivities over 70%, specificity expressed as false alarm rates still needs to be improved. Patients' acceptance and comfort of a specific device are of critical importance for its long-term application in a meaningful clinical way.

Enhanced theta-gamma coupling associated with hippocampal volume increase following high-frequency left prefrontal repetitive transcranial magnetic stimulation in patients with major depression

The underlying mechanism of repetitive transcranial magnetic stimulation (rTMS) effects on cognition has not been fully examined. Previously, we have reported the left hippocampal volume increase and theta-gamma coupling (TGC) enhancement associated with working memory improvement following rTMS in depression. This study was aimed to examine whether there is a structure-function relationship in hippocampal neuroplasticity induced by prefrontal rTMS. Thirty-one patients with major depression underwent longitudinal MRI scans and resting-state EEG recordings with the 10-20 system using averaged ear-lobes reference, following 10 sessions of high-frequency rTMS over the left dorsolateral prefrontal cortex. Pearson's correlation analyses were applied for the longitudinal changes among the left and right hippocampal volumes as measured by manual volumetry, theta and gamma spectral powers, and TGC as measured by resting-state EEG. The analyses demonstrated that the left hippocampus volume increases correlated with TGC increases at the left central area (r = 0.576, p = 0.001, N = 31), whereas no significant correlations were observed among changes of right hippocampal volume, right central TGC, bilateral gamma or theta powers. These finding suggests structure-function relationship in rTMS-induced neuroplastic changes mediated through the hippocampus and prefrontal network at the stimulated side. Therefore, high-frequency prefrontal rTMS may exert its cognitive effect through the hippocampal structural-functional neuroplasticity.

Epileptic seizure onset detection based on EEG and ECG data fusion

This paper presents a novel method for seizure onset detection using fused information extracted from multichannel electroencephalogram (EEG) and single-channel electrocardiogram (ECG). In existing seizure detectors, the analysis of the nonlinear and nonstationary ECG signal is limited to the time-domain or frequency-domain. In this work, heart rate variability (HRV) extracted from ECG is analyzed using a Matching-Pursuit (MP) and Wigner-Ville Distribution (WVD) algorithm in order to effectively extract meaningful HRV features representative of seizure and nonseizure states. The EEG analysis relies on a common spatial pattern (CSP) based feature enhancement stage that enables better discrimination between seizure and nonseizure features. The EEG-based detector uses logical operators to pool SVM seizure onset detections made independently across different EEG spectral bands. Two fusion systems are adopted. In the first system, EEG-based and ECG-based decisions are directly fused to obtain a final decision. The second fusion system adopts an override option that allows for the EEG-based decision to override the fusion-based decision in the event that the detector observes a string of EEG-based seizure decisions. The proposed detectors exhibit an improved performance, with respect to sensitivity and detection latency, compared with the state-of-the-art detectors. Experimental results demonstrate that the second detector achieves a sensitivity of 100%, detection latency of 2.6s, and a specificity of 99.91% for the MAJ fusion case.

Classification of 5-S Epileptic EEG Recordings Using Distribution Entropy and Sample Entropy

Epilepsy is an electrophysiological disorder of the brain, the hallmark of which is recurrent and unprovoked seizures. Electroencephalogram (EEG) measures electrical activity of the brain that is commonly applied as a non-invasive technique for seizure detection. Although a vast number of publications have been published on intelligent algorithms to classify interictal and ictal EEG, it remains an open question whether they can be detected using short-length EEG recordings. In this study, we proposed three protocols to select 5 s EEG segment for classifying interictal and ictal EEG from normal. We used the publicly-accessible Bonn database, which consists of normal, interical, and ictal EEG signals with a length of 4097 sampling points (23.6 s) per record. In this study, we selected three segments of 868 points (5 s) length from each recordings and evaluated results for each of them separately. The well-studied irregularity measure—sample entropy (SampEn)—and a more recently proposed complexity measure—distribution entropy (DistEn)—were used as classification features. A total of 20 combinations of input parameters m and τ for the calculation of SampEn and DistEn were selected for compatibility. Results showed that SampEn was undefined for half of the used combinations of input parameters and indicated a large intra-class variance. Moreover, DistEn performed robustly for short-length EEG data indicating relative independence from input parameters and small intra-class fluctuations. In addition, it showed acceptable performance for all three classification problems (interictal EEG from normal, ictal EEG from normal, and ictal EEG from interictal) compared to SampEn, which showed better results only for distinguishing normal EEG from interictal and ictal. Both SampEn and DistEn showed good reproducibility and consistency, as evidenced by the independence of results on analysing protocol.

Band-sensitive seizure onset detection via CSP-enhanced EEG features

This paper presents two novel epileptic seizure onset detectors. The detectors rely on a common spatial pattern (CSP)-based feature enhancement stage that increases the variance between seizure and nonseizure scalp electroencephalography (EEG). The proposed feature enhancement stage enables better discrimination between seizure and nonseizure features. The first detector adopts a conventional classification stage using a support vector machine (SVM) that feeds the energy features extracted from different subbands to an SVM for seizure onset detection. The second detector uses logical operators to pool SVM seizure onset detections made independently across different EEG spectral bands. The proposed detectors exhibit an improved performance, with respect to sensitivity and detection latency, compared with the state-of-the-art detectors. Experimental results have demonstrated that the first detector achieves a sensitivity of 95.2%, detection latency of 6.43s, and false alarm rate of 0.59perhour. The second detector achieves a sensitivity of 100%, detection latency of 7.28s, and false alarm rate of 1.2per hour for the MAJORITY fusion method.

Technical and clinical analysis of microEEG: a miniature wireless EEG device designed to record high-quality EEG in the emergency department

BACKGROUND

We describe and characterize the performance of microEEG compared to that of a commercially available and widely used clinical EEG machine. microEEG is a portable, battery-operated, wireless EEG device, developed by Bio-Signal Group to overcome the obstacles to routine use of EEG in emergency departments (EDs).

METHODS

The microEEG was used to obtain EEGs from healthy volunteers in the EEG laboratory and ED. The standard system was used to obtain EEGs from healthy volunteers in the EEG laboratory, and studies recorded from patients in the ED or ICU were also used for comparison. In one experiment, a signal splitter was used to record simultaneous microEEG and standard EEG from the same electrodes.

RESULTS

EEG signal analysis techniques indicated good agreement between microEEG and the standard system in 66 EEGs recorded in the EEG laboratory and the ED. In the simultaneous recording the microEEG and standard system signals differed only in a smaller amount of 60 Hz noise in the microEEG signal. In a blinded review by a board-certified clinical neurophysiologist, differences in technical quality or interpretability were insignificant between standard recordings in the EEG laboratory and microEEG recordings from standard or electrode cap electrodes in the ED or EEG laboratory. The microEEG data recording characteristics such as analog-to-digital conversion resolution (16 bits), input impedance (>100MΩ), and common-mode rejection ratio (85 dB) are similar to those of commercially available systems, although the microEEG is many times smaller (88 g and 9.4 × 4.4 × 3.8 cm).

CONCLUSIONS

Our results suggest that the technical qualities of microEEG are non-inferior to a standard commercially available EEG recording device. EEG in the ED is an unmet medical need due to space and time constraints, high levels of ambient electrical noise, and the cost of 24/7 EEG technologist availability. This study suggests that using microEEG with an electrode cap that can be applied easily and quickly can surmount these obstacles without compromising technical quality.

Automatic detection of childhood absence epilepsy seizures: toward a monitoring device

Automatic detections of paroxysms in patients with childhood absence epilepsy have been neglected for several years. We acquire reliable detections using only a single-channel brainwave monitor, allowing for unobtrusive monitoring of antiepileptic drug effects. Ultimately we seek to obtain optimal long-term prognoses, balancing antiepileptic effects and side effects. The electroencephalographic appearance of paroxysms in childhood absence epilepsy is fairly homogeneous, making it feasible to develop patient-independent automatic detection. We implemented a state-of-the-art algorithm to investigate the performance of paroxysm detection. Using only a single scalp electroencephalogram channel from 20 patients with a total of 125 paroxysms >2 seconds, 97.2% of paroxysms could be detected with no false detections. This result leads us to recommend further investigations of tiny, one-channel electroencephalogram systems in an ambulatory setting.

Model-based seizure detection for intracranial EEG recordings

This paper presents a novel model-based patient-specific method for automatic detection of seizures in the intracranial EEG recordings. The proposed method overcomes the complexities in the practical implementation of the patient-specific approach of seizure detection. The method builds a seizure model (set of basis functions) for a priori known seizure (the template seizure pattern), and uses the statistically optimal null filters as a building block for the detection of similar seizures. The process of modeling the template seizure is fully automatic. Overall, the detection method involves the segmentation of the template seizure pattern, rejection of the redundant and noisy segments, extraction of features from the segments to generate a set of models, selection of the best seizure model, and training of the classifier. The trained classifier is used to detect similar seizures in the remaining data. The resulting seizure detection method was evaluated on a total of 304 h of single-channel depth EEG recordings from 14 patients. The system performance is further compared to the Qu-Gotman patient-specific system using the same data. A significant improvement in the proposed system, in terms of specificity, is observed over the compared method.

Quickest detection of drug-resistant seizures: an optimal control approach

Epilepsy affects 50 million people worldwide, and seizures in 30% of the cases remain drug resistant. This has increased interest in responsive neurostimulation, which is most effective when administered during seizure onset. We propose a novel framework for seizure onset detection that involves (i) constructing statistics from multichannel intracranial EEG (iEEG) to distinguish nonictal versus ictal states; (ii) modeling the dynamics of these statistics in each state and the state transitions; you can remove this word if there is no room. (iii) developing an optimal control-based "quickest detection" (QD) strategy to estimate the transition times from nonictal to ictal states from sequential iEEG measurements. The QD strategy minimizes a cost function of detection delay and false positive probability. The solution is a threshold that non-monotonically decreases over time and avoids responding to rare events that normally trigger false positives. We applied QD to four drug resistant epileptic patients (168 hour continuous recordings, 26-44 electrodes, 33 seizures) and achieved 100% sensitivity with low false positive rates (0.16 false positive/hour). This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.

The role of high-quality EEG databases in the improvement and assessment of seizure prediction methods

Initially, seizure prediction was based on the analysis of brief EEG segments preceding clinically manifest seizures. Whereas such approaches suggested that the sensitivities of various EEG-derived features in predicting seizures were high, the inclusion of longer interictal periods and the combined assessment of sensitivity and specificity and the application of statistical validation methods have put into question the validity of such claims. We here show that the duration of EEG on which analyses are based and the number of seizures assessed negatively correlate with the reported sensitivities of prediction studies. Methodological aspects of seizure prediction are discussed in the framework of currently existing databases and of the newly established European Union database. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.

A machine-learning algorithm for detecting seizure termination in scalp EEG

Efforts to develop algorithms that can robustly detect the cessation of seizure activity within scalp EEGs are now underway. Such algorithms can facilitate novel clinical applications such as the estimation of a seizure's duration; the delivery of therapies designed to mitigate postictal period symptoms; or detection of the presence of status epilepticus. In this article, we present and evaluate a novel, machine learning-based method for detecting the termination of electrographic seizure activity. When tested on 133 seizures from a public database, our method successfully detected the end of 132 seizures within 10.3 ± 5.5 seconds of the time determined by an electroencephalographer to represent the electrographic end of seizure. Furthermore, by pairing our seizure end detector with a previously published seizure onset detector, we could automatically estimate the duration of 85% of test electrographic seizures within a 15-second error margin compared with electroencephalographer determinations. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.

An algorithm for detecting seizure termination in scalp EEG

Little effort has been devoted to developing algorithms that can detect the cessation of seizure activity in scalp EEG. Such algorithms could facilitate clinical applications such as the estimation of seizure duration or the delivery of therapies designed to mitigate postictal period symptoms. In this paper, we present a method for detecting the termination of seizure activity. When tested on 133 seizures from a public database, our method detected the end of 132 seizures with a mean absolute error of 10.3 ± 5.5 seconds of the time marked by an electroencephalographer. Furthermore, by pairing our seizure end detector with a previously published seizure onset detector, we could automatically estimate the duration of 85% of test seizures within a 15 second error margin.