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Joyner M, Hsu SH, Martin S, Dwyer J, Chen DF, Sameni R, Waters SH, Borodin K, Clifford GD, Levey AI, Hixson J, Winkel D, Berent J. Using a standalone ear-EEG device for focal-onset seizure detection. Bioelectron Med 2024; 10:4. [PMID: 38321561 PMCID: PMC10848360 DOI: 10.1186/s42234-023-00135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/04/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Seizure detection is challenging outside the clinical environment due to the lack of comfortable, reliable, and practical long-term neurophysiological monitoring devices. We developed a novel, discreet, unobstructive in-ear sensing system that enables long-term electroencephalography (EEG) recording. This is the first study we are aware of that systematically compares the seizure detection utility of in-ear EEG with that of simultaneously recorded intracranial EEG. In addition, we present a similar comparison between simultaneously recorded in-ear EEG and scalp EEG. METHODS In this foundational research, we conducted a clinical feasibility study and validated the ability of the ear-EEG system to capture focal-onset seizures against 1255 hrs of simultaneous ear-EEG data along with scalp or intracranial EEG in 20 patients with refractory focal epilepsy (11 with scalp EEG, 8 with intracranial EEG, and 1 with both). RESULTS In a blinded, independent review of the ear-EEG signals, two epileptologists were able to detect 86.4% of the seizures that were subsequently identified using the clinical gold standard EEG modalities, with a false detection rate of 0.1 per day, well below what has been reported for ambulatory monitoring. The few seizures not detected on the ear-EEG signals emanated from deep within the mesial temporal lobe or extra-temporally and remained very focal, without significant propagation. Following multiple sessions of recording for a median continuous wear time of 13 hrs, patients reported a high degree of tolerance for the device, with only minor adverse events reported by the scalp EEG cohort. CONCLUSIONS These preliminary results demonstrate the potential of using ear-EEG to enable routine collection of complementary, prolonged, and remote neurophysiological evidence, which may permit real-time detection of paroxysmal events such as seizures and epileptiform discharges. This study suggests that the ear-EEG device may assist clinicians in making an epilepsy diagnosis, assessing treatment efficacy, and optimizing medication titration.
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Affiliation(s)
| | | | | | | | - Denise Fay Chen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Reza Sameni
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Samuel H Waters
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Gari D Clifford
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - John Hixson
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Winkel
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Yarici M, Von Rosenberg W, Hammour G, Davies H, Amadori P, Ling N, Demiris Y, Mandic DP. Hearables: feasibility of recording cardiac rhythms from single in-ear locations. ROYAL SOCIETY OPEN SCIENCE 2024; 11:221620. [PMID: 38179073 PMCID: PMC10762432 DOI: 10.1098/rsos.221620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
The ear is well positioned to accommodate both brain and vital signs monitoring, via so-called hearable devices. Consequently, ear-based electroencephalography has recently garnered great interest. However, despite the considerable potential of hearable based cardiac monitoring, the biophysics and characteristic cardiac rhythm of ear-based electrocardiography (ECG) are not yet well understood. To this end, we map the cardiac potential on the ear through volume conductor modelling and measurements on multiple subjects. In addition, in order to demonstrate real-world feasibility of in-ear ECG, measurements are conducted throughout a long-time simulated driving task. As a means of evaluation, the correspondence between the cardiac rhythms obtained via the ear-based and standard Lead I measurements, with respect to the shape and timing of the cardiac rhythm, is verified through three measures of similarity: the Pearson correlation, and measures of amplitude and timing deviations. A high correspondence between the cardiac rhythms obtained via the ear-based and Lead I measurements is rigorously confirmed through agreement between simulation and measurement, while the real-world feasibility was conclusively demonstrated through efficacious cardiac rhythm monitoring during prolonged driving. This work opens new avenues for seamless, hearable-based cardiac monitoring that extends beyond heart rate detection to offer cardiac rhythm examination in the community.
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Affiliation(s)
- Metin Yarici
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Wilhelm Von Rosenberg
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Ghena Hammour
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Harry Davies
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Pierluigi Amadori
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Nico Ling
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Yiannis Demiris
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
| | - Danilo P. Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK
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