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Nazari MJ, Shalbafan M, Eissazade N, Khalilian E, Vahabi Z, Masjedi N, Ghidary SS, Saadat M, Sadegh-Zadeh SA. A machine learning approach for differentiating bipolar disorder type II and borderline personality disorder using electroencephalography and cognitive abnormalities. PLoS One 2024; 19:e0303699. [PMID: 38905185 PMCID: PMC11192371 DOI: 10.1371/journal.pone.0303699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/29/2024] [Indexed: 06/23/2024] Open
Abstract
This study addresses the challenge of differentiating between bipolar disorder II (BD II) and borderline personality disorder (BPD), which is complicated by overlapping symptoms. To overcome this, a multimodal machine learning approach was employed, incorporating both electroencephalography (EEG) patterns and cognitive abnormalities for enhanced classification. Data were collected from 45 participants, including 20 with BD II and 25 with BPD. Analysis involved utilizing EEG signals and cognitive tests, specifically the Wisconsin Card Sorting Test and Integrated Cognitive Assessment. The k-nearest neighbors (KNN) algorithm achieved a balanced accuracy of 93%, with EEG features proving to be crucial, while cognitive features had a lesser impact. Despite the strengths, such as diverse model usage, it's important to note limitations, including a small sample size and reliance on DSM diagnoses. The study suggests that future research should explore multimodal data integration and employ advanced techniques to improve classification accuracy and gain a better understanding of the neurobiological distinctions between BD II and BPD.
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Affiliation(s)
- Mohammad-Javad Nazari
- Computer Science and Mathematics Department, Amirkabir University of Technology, Tehran, Iran
| | - Mohammadreza Shalbafan
- Department of Psychiatry, Psychosocial Health Research Institute (PHRI), Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Institute for Cognitive Sciences Studies, Brain and Cognition Clinic, Tehran, Iran
| | - Negin Eissazade
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Khalilian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Neuropsychiatry Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Masjedi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Shiry Ghidary
- Computer Science and Mathematics Department, Amirkabir University of Technology, Tehran, Iran
| | - Mozafar Saadat
- Department of Mechanical Engineering, School of Engineering, University of Birmingham, Birmingham, United Kingdom
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Deiber MP, Piguet C, Berchio C, Michel CM, Perroud N, Ros T. Resting-State EEG Microstates and Power Spectrum in Borderline Personality Disorder: A High-Density EEG Study. Brain Topogr 2024; 37:397-409. [PMID: 37776472 PMCID: PMC11026215 DOI: 10.1007/s10548-023-01005-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/30/2023] [Indexed: 10/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating psychiatric condition characterized by emotional dysregulation, unstable sense of self, and impulsive, potentially self-harming behavior. In order to provide new neurophysiological insights on BPD, we complemented resting-state EEG frequency spectrum analysis with EEG microstates (MS) analysis to capture the spatiotemporal dynamics of large-scale neural networks. High-density EEG was recorded at rest in 16 BPD patients and 16 age-matched neurotypical controls. The relative power spectrum and broadband MS spatiotemporal parameters were compared between groups and their inter-correlations were examined. Compared to controls, BPD patients showed similar global spectral power, but exploratory univariate analyses on single channels indicated reduced relative alpha power and enhanced relative delta power at parietal electrodes. In terms of EEG MS, BPD patients displayed similar MS topographies as controls, indicating comparable neural generators. However, the MS temporal dynamics were significantly altered in BPD patients, who demonstrated opposite prevalence of MS C (lower than controls) and MS E (higher than controls). Interestingly, MS C prevalence correlated positively with global alpha power and negatively with global delta power, while MS E did not correlate with any measures of spectral power. Taken together, these observations suggest that BPD patients exhibit a state of cortical hyperactivation, represented by decreased posterior alpha power, together with an elevated presence of MS E, consistent with symptoms of elevated arousal and/or vigilance. This is the first study to investigate resting-state MS patterns in BPD, with findings of elevated MS E and the suggestion of reduced posterior alpha power indicating a disorder-specific neurophysiological signature previously unreported in a psychiatric population.
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Affiliation(s)
- Marie-Pierre Deiber
- Department of Psychiatry, University Hospitals of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Camille Piguet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Cristina Berchio
- Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neuroscience, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Tomas Ros
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
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Endres D, Maier S, Feige B, Mokhtar NB, Nickel K, Goll P, Meyer SA, Matthies S, Ebert D, Philipsen A, Perlov E, Tebartz van Elst L. Increased rates of intermittent rhythmic delta and theta activity in the electroencephalographies of adult patients with attention-deficit hyperactivity disorder. Epilepsy Behav 2017; 75:60-65. [PMID: 28830028 DOI: 10.1016/j.yebeh.2017.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/22/2017] [Accepted: 06/30/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adult attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In subgroups of patients with a (para)epileptic pathomechanism, this might be due to intermittent rhythmic delta or theta activity (IRDA/IRTA). PARTICIPANTS AND METHODS Using a fully data-driven analysis, we compared the IRDA/IRTA rates in the resting electroencephalography (EEG) results of 97 adult patients with ADHD and 30 control subjects. The IRDA/IRTA rates before hyperventilation (HV) and for HV difference (difference between IRDA/IRTA rate after and before HV) were compared between groups using a linear model. RESULTS We detected significantly increased rates of IRDA/IRTA before HV (F=4.209, p=0.042) in patients with ADHD but no significant difference between the groups for HV-difference (F=2.46, p=0.119). DISCUSSION The increased IRDA/IRTA rates before HV in the group with ADHD might lead to (para)epileptic short-term effects (e.g., impulsivity) via local area network inhibition, and to long-term effects (e.g., cognitive deficits) via connectivistic brain restructuring.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Nora Bel Mokhtar
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Peter Goll
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Simon A Meyer
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Swantje Matthies
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Dieter Ebert
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Str. 7, 26160 Bad Zwischenahn, Germany.
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany; Clinic for Psychiatry Luzern, Schafmattstrasse 1, 4915 St. Urban, Switzerland.
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
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Endres D, Maier S, Feige B, Posielski NA, Nickel K, Ebert D, Riedel A, Philipsen A, Perlov E, Tebartz van Elst L. Altered Intermittent Rhythmic Delta and Theta Activity in the Electroencephalographies of High Functioning Adult Patients with Autism Spectrum Disorder. Front Hum Neurosci 2017; 11:66. [PMID: 28265243 PMCID: PMC5316544 DOI: 10.3389/fnhum.2017.00066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/31/2017] [Indexed: 12/27/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is often associated with epilepsy. Previous studies have also shown increased rates of electroencephalographic (EEG) alteration in ASD patients without epilepsy. The aim of this study was to compare the rate of intermittent rhythmic delta and theta activity (IRDA/IRTA) events between high-functioning adult patients with ASD and matched healthy controls. Materials and Methods: Routine EEG records of 19 ASD patients and 19 matched controls were screened for IRDA/IRTA using a fully data driven analysis with fixed thresholds. IRDA/IRTA rates before and after hyperventilation (HV) as well as the HV-induced difference in IRDA/IRTA rates (HV difference) were analyzed. For inter-group measures, we used the Wilcoxon rank sum test. Results: Significantly increased HV difference was detected in the ASD group (p = 0.0497). However, the groups showed no difference in IRDA/IRTA rates before HV (p = 0.564) and after HV (p = 0.163). Conclusions: The lack of any group differences regarding IRDA/IRTA before HV might be related to the fact that we only studied non-secondary high-functioning autism in a small sample of epilepsy-free adult patients. A significantly increased HV difference might be regarded as a marker of subtle neuronal network instability possibly causing short-term disturbances via local area network inhibition and long-term effects via epileptic encephalopathy.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Nicole A Posielski
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Dieter Ebert
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Andreas Riedel
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy-University Hospital, Karl-Jaspers-Klinik Bad Zwischenahn, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
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Endres D, Perlov E, Feige B, Altenmüller DM, Venhoff N, Tebartz van Elst L. Schizophrenia Associated with Epileptiform Discharges without Seizures Successfully Treated with Levetiracetam. Front Psychiatry 2017; 8:12. [PMID: 28228737 PMCID: PMC5296318 DOI: 10.3389/fpsyt.2017.00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Schizophrenia-like disorders can be divided into endogenic or primary, idiopathic, polygenetic forms, and different secondary, organic subgroups [e.g., (para)epileptic, immunological, degenerative]. Epileptic and paraepileptic explanatory approaches have a long tradition due to the high rate of electroencephalography (EEG) alterations in patients with schizophrenia. CASE PRESENTATION We present the case of a 23-year-old female patient suffering, since the age of 14 years, from a fluctuating paranoid-hallucinatory syndrome with formal thought disorder, fear, delusions of persecution, auditory, visual, and tactile hallucinations, as well as negative and cognitive symptoms. Laboratory measurements showed increased titers of antinuclear antibodies (ANAs) in the context of ulcerative colitis. While there was no clear history or evidence of epileptic seizures, the EEG showed generalized 3 Hz polyspike wave complexes. Under treatment with levetiracetam, the symptoms disappeared and the patient was able to complete vocational training. CONCLUSION The schizophrenia-like symptoms associated with epileptiform discharges but not overt seizures and the good response to antiepileptic treatment could be interpreted in the context of a (para)epileptic pathomechanism. The EEG alterations might be due to a polygenetic effect due to different genes. Mild immunological mechanisms in the framework of ulcerative colitis and increased ANA titers might have supported the network instability. This case report illustrates (1) the importance of EEG screenings in schizophrenia, (2) a potential pathogenetic role of epileptiform discharges in a subgroup of patients with schizophrenia-like symptoms, and (3) that antiepileptic medication with levetiracetam could be a successful treatment alternative in schizophrenia-like disorders with EEG alterations.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | - Dirk-Matthias Altenmüller
- Freiburg Epilepsy Center, Department of Neurosurgery, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany
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