Toward automated prediction of sudden unexpected death in epilepsy

A Lightweight Convolutional Neural Network-Reformer Model for Efficient Epileptic Seizure Detection

A real-time and reliable automatic detection system for epileptic seizures holds significant value in assisting physicians with rapid diagnosis and treatment of epilepsy. Aiming to address this issue, a novel lightweight model called Convolutional Neural Network-Reformer (CNN-Reformer) is proposed for seizure detection on long-term EEG. The CNN-Reformer consists of two main parts: the Data Reshaping (DR) module and the Efficient Attention and Concentration (EAC) module. This framework reduces network parameters while retaining effective feature extraction of multi-channel EEGs, thereby improving model computational efficiency and real-time performance. Initially, the raw EEG signals undergo Discrete Wavelet Transform (DWT) for signal filtering, and then fed into the DR module for data compression and reshaping while preserving local features. Subsequently, these local features are sent to the EAC module to extract global features and perform categorization. Post-processing involving sliding window averaging, thresholding, and collar techniques is further deployed to reduce the false detection rate (FDR) and improve detection performance. On the CHB-MIT scalp EEG dataset, our method achieves an average sensitivity of 97.57%, accuracy of 98.09%, and specificity of 98.11% at segment-based level, and a sensitivity of 96.81%, along with FDR of 0.27/h, and latency of 17.81 s at the event-based level. On the SH-SDU dataset we collected, our method yielded segment-based sensitivity of 94.51%, specificity of 92.83%, and accuracy of 92.81%, along with event-based sensitivity of 94.11%. The average testing time for 1[Formula: see text]h of multi-channel EEG signals is 1.92[Formula: see text]s. The excellent results and fast computational speed of the CNN-Reformer model demonstrate its potential for efficient seizure detection.

Sparse Spike Feature Learning to Recognize Traceable Interictal Epileptiform Spikes

Interictal epileptiform spikes (spikes) and epileptogenic focus are strongly correlated. However, partial spikes are insensitive to epileptogenic focus, which restricts epilepsy neurosurgery. Therefore, identifying spike subtypes that are strongly associated with epileptogenic focus (traceable spikes) could facilitate their use as reliable signal sources for accurately tracing epileptogenic focus. However, the sparse firing phenomenon in the transmission of intracranial neuronal discharges leads to differences within spikes that cannot be observed visually. Therefore, neuro-electro-physiologists are unable to identify traceable spikes that could accurately locate epileptogenic focus. Herein, we propose a novel sparse spike feature learning method to recognize traceable spikes and extract discrimination information related to epileptogenic focus. First, a multilevel eigensystem feature representation was determined based on a multilevel feature representation module to express the intrinsic properties of a spike. Second, the sparse feature learning module expressed the sparse spike multi-domain context feature representation to extract sparse spike feature representations. Among them, a sparse spike encoding strategy was implemented to effectively simulate the sparse firing phenomenon for the accurate encoding of the activity of intracranial neurosources. The sensitivity of the proposed method was 97.1%, demonstrating its effectiveness and significant efficiency relative to other state-of-the-art methods.

Efficient EEG Feature Learning Model Combining Random Convolutional Kernel with Wavelet Scattering for Seizure Detection

Automatic seizure detection has significant value in epilepsy diagnosis and treatment. Although a variety of deep learning models have been proposed to automatically learn electroencephalography (EEG) features for seizure detection, the generalization performance and computational burden of such deep models remain the bottleneck of practical application. In this study, a novel lightweight model based on random convolutional kernel transform (ROCKET) is developed for EEG feature learning for seizure detection. Specifically, random convolutional kernels are embedded into the structure of a wavelet scattering network instead of original wavelet transform convolutions. Then the significant EEG features are selected from the scattering coefficients and convolutional outputs by analysis of variance (ANOVA) and minimum redundancy-maximum relevance (MRMR) methods. This model not only preserves the merits of the fast-training process from ROCKET, but also provides insight into seizure detection by retaining only the helpful channels. The extreme gradient boosting (XGboost) classifier was combined with this EEG feature learning model to build a comprehensive seizure detection system that achieved promising epoch-based results, with over 90% of both sensitivity and specificity on the scalp and intracranial EEG databases. The experimental comparisons showed that the proposed method outperformed other state-of-the-art methods for cross-patient and patient-specific seizure detection.

Unsupervised EEG-Based Seizure Anomaly Detection with Denoising Diffusion Probabilistic Models

While many seizure detection methods have demonstrated great accuracy, their training necessitates a substantial volume of labeled data. To address this issue, we propose a novel method for unsupervised seizure anomaly detection called SAnoDDPM, which uses denoising diffusion probabilistic models (DDPM). We designed a novel pipeline that uses a variable lower bound on Markov chains to identify potential values that are unlikely to occur in anomalous data. The model is first trained on normal data, then anomalous data is input to the trained model. The model resamples the anomalous data and converts it to normal data. Finally, the presence of seizures can be determined by comparing the before and after data. Moreover, the input 2D spectrograms are encoded into vector-quantized representations, which enables powerful and efficient DDPM while maintaining its quality. Experimental comparisons on the publicly available datasets, CHB-MIT and TUH, show that our method delivers better results, significantly reduces inference time, and is suitable for deployment in a clinical environments. As far as we are aware, this is the first DDPM-based method for seizure anomaly detection. This novel approach significantly contributes to the progression of seizure detection algorithms, thereby augmenting their practicality in clinical settings.

Epileptic Seizure Prediction Using Spatiotemporal Feature Fusion on EEG

Electroencephalography (EEG) plays a crucial role in epilepsy analysis, and epileptic seizure prediction has significant value for clinical treatment of epilepsy. Currently, prediction methods using Convolutional Neural Network (CNN) primarily focus on local features of EEG, making it challenging to simultaneously capture the spatial and temporal features from multi-channel EEGs to identify the preictal state effectively. In order to extract inherent spatial relationships among multi-channel EEGs while obtaining their temporal correlations, this study proposed an end-to-end model for the prediction of epileptic seizures by incorporating Graph Attention Network (GAT) and Temporal Convolutional Network (TCN). Low-pass filtered EEG signals were fed into the GAT module for EEG spatial feature extraction, and followed by TCN to capture temporal features, allowing the end-to-end model to acquire the spatiotemporal correlations of multi-channel EEGs. The system was evaluated on the publicly available CHB-MIT database, yielding segment-based accuracy of 98.71%, specificity of 98.35%, sensitivity of 99.07%, and F1-score of 98.71%, respectively. Event-based sensitivity of 97.03% and False Positive Rate (FPR) of 0.03/h was also achieved. Experimental results demonstrated this system can achieve superior performance for seizure prediction by leveraging the fusion of EEG spatiotemporal features without the need of feature engineering.

Combining EEG Features and Convolutional Autoencoder for Neonatal Seizure Detection

Neonatal epilepsy is a common emergency phenomenon in neonatal intensive care units (NICUs), which requires timely attention, early identification, and treatment. Traditional detection methods mostly use supervised learning with enormous labeled data. Hence, this study offers a semi-supervised hybrid architecture for detecting seizures, which combines the extracted electroencephalogram (EEG) feature dataset and convolutional autoencoder, called Fd-CAE. First, various features in the time domain and entropy domain are extracted to characterize the EEG signal, which helps distinguish epileptic seizures subsequently. Then, the unlabeled EEG features are fed into the convolutional autoencoder (CAE) for training, which effectively represents EEG features by optimizing the loss between the input and output features. This unsupervised feature learning process can better combine and optimize EEG features from unlabeled data. After that, the pre-trained encoder part of the model is used for further feature learning of labeled data to obtain its low-dimensional feature representation and achieve classification. This model is performed on the neonatal EEG dataset collected at the University of Helsinki Hospital, which has a high discriminative ability to detect seizures, with an accuracy of 92.34%, precision of 93.61%, recall rate of 98.74%, and F1-score of 95.77%, respectively. The results show that unsupervised learning by CAE is beneficial to the characterization of EEG signals, and the proposed Fd-CAE method significantly improves classification performance.

Seizure Detection Based on Lightweight Inverted Residual Attention Network

Timely and accurately seizure detection is of great importance for the diagnosis and treatment of epilepsy patients. Existing seizure detection models are often complex and time-consuming, highlighting the urgent need for lightweight seizure detection. Additionally, existing methods often neglect the key characteristic channels and spatial regions of electroencephalography (EEG) signals. To solve these issues, we propose a lightweight EEG-based seizure detection model named lightweight inverted residual attention network (LRAN). Specifically, we employ a four-stage inverted residual mobile block (iRMB) to effectively extract the hierarchical features from EEG. The convolutional block attention module (CBAM) is introduced to make the model focus on important feature channels and spatial information, thereby enhancing the discrimination of the learned features. Finally, convolution operations are used to capture local information and spatial relationships between features. We conduct intra-subject and inter-subject experiments on a publicly available dataset. Intra-subject experiments obtain 99.25% accuracy in segment-based detection and 0.36/h false detection rate (FDR) in event-based detection, respectively. Inter-subject experiments obtain 84.32% accuracy. Both sets of experiments maintain high classification accuracy with a low number of parameters, where the multiply accumulate operations (MACs) are 25.86[Formula: see text]M and the number of parameters is 0.57[Formula: see text]M.

Closing the Loop for Precise Seizure Control

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Machine Learning and Artificial Intelligence Applications to Epilepsy: a Review for the Practicing Epileptologist

PURPOSE OF REVIEW

Machine Learning (ML) and Artificial Intelligence (AI) are data-driven techniques to translate raw data into applicable and interpretable insights that can assist in clinical decision making. Some of these tools have extremely promising initial results, earning both great excitement and creating hype. This non-technical article reviews recent developments in ML/AI in epilepsy to assist the current practicing epileptologist in understanding both the benefits and limitations of integrating ML/AI tools into their clinical practice.

RECENT FINDINGS

ML/AI tools have been developed to assist clinicians in almost every clinical decision including (1) predicting future epilepsy in people at risk, (2) detecting and monitoring for seizures, (3) differentiating epilepsy from mimics, (4) using data to improve neuroanatomic localization and lateralization, and (5) tracking and predicting response to medical and surgical treatments. We also discuss practical, ethical, and equity considerations in the development and application of ML/AI tools including chatbots based on Large Language Models (e.g., ChatGPT). ML/AI tools will change how clinical medicine is practiced, but, with rare exceptions, the transferability to other centers, effectiveness, and safety of these approaches have not yet been established rigorously. In the future, ML/AI will not replace epileptologists, but epileptologists with ML/AI will replace epileptologists without ML/AI.

Deep Learning-Based Classification of Epileptic Electroencephalography Signals Using a Concentrated Time-Frequency Approach

ConceFT (concentration of frequency and time) is a new time-frequency (TF) analysis method which combines multitaper technique and synchrosqueezing transform (SST). This combination produces highly concentrated TF representations with approximately perfect time and frequency resolutions. In this paper, it is aimed to show the TF representation performance and robustness of ConceFT by using it for the classification of the epileptic electroencephalography (EEG) signals. Therefore, a signal classification algorithm which uses TF images obtained with ConceFT to feed the transfer learning structure has been presented. Epilepsy is a common neurological disorder that millions of people suffer worldwide. Daily lives of the patients are quite difficult because of the unpredictable time of seizures. EEG signals monitoring the electrical activity of the brain can be used to detect approaching seizures and make possible to warn the patient before the attack. GoogLeNet which is a well-known deep learning model has been preferred to classify TF images. Classification performance is directly related to the TF representation accuracy of the ConceFT. The proposed method has been tested for various classification scenarios and obtained accuracies between 95.83% and 99.58% for two and three-class classification scenarios. High results show that ConceFT is a successful and promising TF analysis method for non-stationary biomedical signals.

Hybrid Network for Patient-Specific Seizure Prediction from EEG Data

Seizure prediction can improve the quality of life for patients with drug-resistant epilepsy. With the rapid development of deep learning, lots of seizure prediction methods have been proposed. However, seizure prediction based on single convolution models is limited by the inherent defects of convolution itself. Convolution pays attention to the local features while underestimates the global features. The long-term dependence of the electroencephalogram (EEG) data cannot be captured. In view of these defects, a hybrid model called STCNN based on Swin transformer (ST) and 2D convolutional neural network (2DCNN) is proposed. Time-frequency features extracted by short-term Fourier transform (STFT) are taken as the input of STCNN. ST blocks are used in STCNN to capture the global information and long-term dependencies of EEGs. Meanwhile, the 2DCNN blocks are adopted to capture the local information and short-term dependent features. The combination of the two blocks can fully exploit the seizure-related information thus improve the prediction performance. Comprehensive experiments are performed on the CHB-MIT scalp EEG dataset. The average seizure prediction sensitivity, the area under the ROC curve (AUC) and the false positive rate (FPR) are 92.94%, 95.56% and 0.073, respectively.

A unified hypothesis of SUDEP: Seizure-induced respiratory depression induced by adenosine may lead to SUDEP but can be prevented by autoresuscitation and other restorative respiratory response mechanisms mediated by the action of serotonin on the periaqueductal gray

Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in people with epilepsy (PWE). Postictal apnea leading to cardiac arrest is the most common sequence of terminal events in witnessed cases of SUDEP, and postconvulsive central apnea has been proposed as a potential biomarker of SUDEP susceptibility. Research in SUDEP animal models has led to the serotonin and adenosine hypotheses of SUDEP. These neurotransmitters influence respiration, seizures, and lethality in animal models of SUDEP, and are implicated in human SUDEP cases. Adenosine released during seizures is proposed to be an important seizure termination mechanism. However, adenosine also depresses respiration, and this effect is mediated, in part, by inhibition of neuronal activity in subcortical structures that modulate respiration, including the periaqueductal gray (PAG). Drugs that enhance the action of adenosine increase postictal death in SUDEP models. Serotonin is also released during seizures, but enhances respiration in response to an elevated carbon dioxide level, which often occurs postictally. This effect of serotonin can potentially compensate, in part, for the adenosine-mediated respiratory depression, acting to facilitate autoresuscitation and other restorative respiratory response mechanisms. A number of drugs that enhance the action of serotonin prevent postictal death in several SUDEP models and reduce postictal respiratory depression in PWE. This effect of serotonergic drugs may be mediated, in part, by actions on brainstem sites that modulate respiration, including the PAG. Enhanced activity in the PAG increases respiration in response to hypoxia and other exigent conditions and can be activated by electrical stimulation. Thus, we propose the unifying hypothesis that seizure-induced adenosine release leads to respiratory depression. This can be reversed by serotonergic action on autoresuscitation and other restorative respiratory responses acting, in part, via the PAG. Therefore, we hypothesize that serotonergic or direct activation of this brainstem site may be a useful approach for SUDEP prevention.

Sudden unexpected death in epilepsy

PURPOSE OF REVIEW

Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death in patients with epilepsy. This review highlights the recent literature regarding epidemiology on a global scale, putative mechanisms and thoughts towards intervention and prevention.

RECENT FINDINGS

Recently, numerous population-based studies have examined the incidence of SUDEP in many countries. Remarkably, incidence is quite consistent across these studies, and is commensurate with the recent estimates of about 1.2 per 1000 patient years. These studies further continue to support that incidence is similar across the ages and that comparable factors portend heightened risk for SUDEP. Fervent research in patients and animal studies continues to hone the understanding of potential mechanisms for SUDEP, especially those regarding seizure-induced respiratory dysregulation. Many of these studies and others have begun to lay out a path towards identification of improved treatment and prevention means. However, continued efforts are needed to educate medical professionals about SUDEP risk and the need to disclose this to patients.

SUMMARY

SUDEP is a devastating potential outcome of epilepsy. More is continually learned about risk and mechanisms from clinical and preclinical studies. This knowledge can hopefully be leveraged into preventive measures in the near future.