EEG-Driven Prediction Model of Oxcarbazepine Treatment Outcomes in Patients With Newly-Diagnosed Focal Epilepsy

Diagnosing and tracking depression based on eye movement in response to virtual reality

Introduction

Depression is a prevalent mental illness that is primarily diagnosed using psychological and behavioral assessments. However, these assessments lack objective and quantitative indices, making rapid and objective detection challenging. In this study, we propose a novel method for depression detection based on eye movement data captured in response to virtual reality (VR).

Methods

Eye movement data was collected and used to establish high-performance classification and prediction models. Four machine learning algorithms, namely eXtreme Gradient Boosting (XGBoost), multilayer perceptron (MLP), Support Vector Machine (SVM), and Random Forest, were employed. The models were evaluated using five-fold cross-validation, and performance metrics including accuracy, precision, recall, area under the curve (AUC), and F1-score were assessed. The predicted error for the Patient Health Questionnaire-9 (PHQ-9) score was also determined.

Results

The XGBoost model achieved a mean accuracy of 76%, precision of 94%, recall of 73%, and AUC of 82%, with an F1-score of 78%. The MLP model achieved a classification accuracy of 86%, precision of 96%, recall of 91%, and AUC of 86%, with an F1-score of 92%. The predicted error for the PHQ-9 score ranged from -0.6 to 0.6.To investigate the role of computerized cognitive behavioral therapy (CCBT) in treating depression, participants were divided into intervention and control groups. The intervention group received CCBT, while the control group received no treatment. After five CCBT sessions, significant changes were observed in the eye movement indices of fixation and saccade, as well as in the PHQ-9 scores. These two indices played significant roles in the predictive model, indicating their potential as biomarkers for detecting depression symptoms.

Discussion

The results suggest that eye movement indices obtained using a VR eye tracker can serve as useful biomarkers for detecting depression symptoms. Specifically, the fixation and saccade indices showed promise in predicting depression. Furthermore, CCBT demonstrated effectiveness in treating depression, as evidenced by the observed changes in eye movement indices and PHQ-9 scores. In conclusion, this study presents a novel approach for depression detection using eye movement data captured in VR. The findings highlight the potential of eye movement indices as biomarkers and underscore the effectiveness of CCBT in treating depression.

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.

Increasing challenges to trial recruitment and conduct over time

OBJECTIVE

This study was undertaken to evaluate how the challenges in the recruitment and retention of participants in clinical trials for focal onset epilepsy have changed over time.

METHODS

In this systematic analysis of randomized clinical trials of adjunct antiseizure medications for medication-resistant focal onset epilepsy, we evaluated how the numbers of participants, sites, and countries have changed since the first such trial in 1990. We also evaluated the proportion of participants who completed each trial phase and their reasons for early trial exit. We analyzed these trends using mixed effects generalized linear models accounting for the influence of the number of trial sites and trial-specific variability.

RESULTS

The number of participants per site has steadily decreased over decades, with recent trials recruiting fewer than five participants per site (reduction by .16 participants/site/year, p < .0001). Fewer participants also progressed from recruitment to randomization over time (odds ratio = .94/year, p = .014). Concurrently, there has been an increase in the placebo response over time (increase in median percent reduction of .4%/year, p = .02; odds ratio of increase in 50% responder rate of 1.03/year, p = .02), which was not directly associated with the number of sites per trial (p > .20).

SIGNIFICANCE

This historical analysis highlights the increasing challenges with participant recruitment and retention, as well as increasing placebo response. It serves as a call to action to change clinical trial design to address these challenges.