Ambulatory seizure detection.

PURPOSE OF REVIEW: To review recent advances in the field of seizure detection in ambulatory patients with epilepsy. RECENT FINDINGS: Recent studies have shown that wrist or arm wearable sensors, using 3D-accelerometry, electrodermal activity or photoplethysmography, in isolation or in combination, can reliably detect focal-to-bilateral and generalized tonic-clonic seizures (GTCS), with a sensitivity over 90%, and false alarm rates varying from 0.1 to 1.2 per day. A headband EEG has also demonstrated a high sensitivity for detecting and help monitoring generalized absence seizures. In contrast, no appropriate solution is yet available to detect focal seizures, though some promising findings were reported using ECG-based heart rate variability biomarkers and subcutaneous EEG. SUMMARY: Several FDA and/or EU-certified solutions are available to detect GTCS and trigger an alarm with acceptable rates of false alarms. However, data are still missing regarding the impact of such intervention on patients' safety. Noninvasive solutions to reliably detect focal seizures in ambulatory patients, based on either EEG or non-EEG biosignals, remain to be developed. To this end, a number of challenges need to be addressed, including the performance, but also the transparency and interpretability of machine learning algorithms.

SzCORE: Seizure Community Open-Source Research Evaluation framework for the validation of electroencephalography-based automated seizure detection algorithms.

The need for high-quality automated seizure detection algorithms based on electroencephalography (EEG) becomes ever more pressing with the increasing use of ambulatory and long-term EEG monitoring. Heterogeneity in validation methods of these algorithms influences the reported results and makes comprehensive evaluation and comparison challenging. This heterogeneity concerns in particular the choice of datasets, evaluation methodologies, and performance metrics. In this paper, we propose a unified framework designed to establish standardization in the validation of EEG-based seizure detection algorithms. Based on existing guidelines and recommendations, the framework introduces a set of recommendations and standards related to datasets, file formats, EEG data input content, seizure annotation input and output, cross-validation strategies, and performance metrics. We also propose the EEG 10-20 seizure detection benchmark, a machine-learning benchmark based on public datasets converted to a standardized format. This benchmark defines the machine-learning task as well as reporting metrics. We illustrate the use of the benchmark by evaluating a set of existing seizure detection algorithms. The SzCORE (Seizure Community Open-Source Research Evaluation) framework and benchmark are made publicly available along with an open-source software library to facilitate research use, while enabling rigorous evaluation of the clinical significance of the algorithms, fostering a collective effort to more optimally detect seizures to improve the lives of people with epilepsy.

Visual seizure annotation and automated seizure detection using behind-the-ear electroencephalographic channels.

OBJECTIVE: Seizure diaries kept by patients are unreliable. Automated electroencephalography (EEG)-based seizure detection systems are a useful support tool to objectively detect and register seizures during long-term video-EEG recording. However, this standard full scalp-EEG recording setup is of limited use outside the hospital, and a discreet, wearable device is needed for capturing seizures in the home setting. We are developing a wearable device that records EEG with behind-the-ear electrodes. In this study, we determined whether the recognition of ictal patterns using only behind-the-ear EEG channels is possible. Second, an automated seizure detection algorithm was developed using only those behind-the-ear EEG channels. METHODS: Fifty-four patients with a total of 182 seizures, mostly temporal lobe epilepsy (TLE), and 5284 hours of data, were recorded with a standard video-EEG at University Hospital Leuven. In addition, extra behind-the-ear EEG channels were recorded. First, a neurologist was asked to annotate behind-the-ear EEG segments containing selected seizure and nonseizure fragments. Second, a data-driven algorithm was developed using only behind-the-ear EEG. This algorithm was trained using data from other patients (patient-independent model) or from the same patient (patient-specific model). RESULTS: The visual recognition study resulted in 65.7% sensitivity and 94.4% specificity. By using those seizure annotations, the automated algorithm obtained 64.1% sensitivity and 2.8 false-positive detections (FPs)/24 hours with the patient-independent model. The patient-specific model achieved 69.1% sensitivity and 0.49 FPs/24 hours. SIGNIFICANCE: Visual recognition of ictal EEG patterns using only behind-the-ear EEG is possible in a significant number of patients with TLE. A patient-specific seizure detection algorithm using only behind-the-ear EEG was able to detect more seizures automatically than what patients typically report, with 0.49 FPs/24 hours. We conclude that a large number of refractory TLE patients can benefit from using this device.

Comparison between Scalp EEG and Behind-the-Ear EEG for Development of a Wearable Seizure Detection System for Patients with Focal Epilepsy.

A wearable electroencephalogram (EEG) device for continuous monitoring of patients suffering from epilepsy would provide valuable information for the management of the disease. Currently no EEG setup is small and unobtrusive enough to be used in daily life. Recording behind the ear could prove to be a solution to a wearable EEG setup. This article examines the feasibility of recording epileptic EEG from behind the ear. It is achieved by comparison with scalp EEG recordings. Traditional scalp EEG and behind-the-ear EEG were simultaneously acquired from 12 patients with temporal, parietal, or occipital lobe epilepsy. Behind-the-ear EEG consisted of cross-head channels and unilateral channels. The analysis on Electrooculography (EOG) artifacts resulting from eye blinking showed that EOG artifacts were absent on cross-head channels and had significantly small amplitudes on unilateral channels. Temporal waveform and frequency content during seizures from behind-the-ear EEG visually resembled that from scalp EEG. Further, coherence analysis confirmed that behind-the-ear EEG acquired meaningful epileptic discharges similarly to scalp EEG. Moreover, automatic seizure detection based on support vector machine (SVM) showed that comparable seizure detection performance can be achieved using these two recordings. With scalp EEG, detection had a median sensitivity of 100% and a false detection rate of 1.14 per hour, while, with behind-the-ear EEG, it had a median sensitivity of 94.5% and a false detection rate of 0.52 per hour. These findings demonstrate the feasibility of detecting seizures from EEG recordings behind the ear for patients with focal epilepsy.

Sparse asynchronous cortical generators can produce measurable scalp EEG signals.

We investigate to what degree the synchronous activation of a smooth patch of cortex is necessary for observing EEG scalp activity. We perform extensive simulations to compare the activity generated on the scalp by different models of cortical activation, based on intracranial EEG findings reported in the literature. The spatial activation is modeled as a cortical patch of constant activation or as random sets of small generators (0.1 to 3cm(2) each) concentrated in a cortical region. Temporal activation models for the generation of oscillatory activity are either equal phase or random phase across the cortical patches. The results show that smooth or random spatial activation profiles produce scalp electric potential distributions with the same shape. Also, in the generation of oscillatory activity, multiple cortical generators with random phase produce scalp activity attenuated on average only 2 to 4 times compared to generators with equal phase. Sparse asynchronous cortical generators can produce measurable scalp EEG. This is a possible explanation for seemingly paradoxical observations of simultaneous disorganized intracranial activity and scalp EEG signals. Thus, the standard interpretation of scalp EEG might constitute an oversimplification of the underlying brain activity.

KID-PPG: Knowledge Informed Deep Learning for Extracting Heart Rate from a Smartwatch.

Accurate extraction of heart rate from photoplethysmography (PPG) signals remains challenging due to motion artifacts and signal degradation. Although deep learning methods trained as a data-driven inference problem offer promising solutions, they often underutilize existing knowledge from the medical and signal processing community. In this paper, we address three shortcomings of deep learning models: motion artifact removal, degradation assessment, and physiologically plausible analysis of the PPG signal. We propose KID-PPG, a knowledge-informed deep learning model that integrates expert knowledge through adaptive linear filtering, deep probabilistic inference, and data augmentation. We evaluate KID-PPG on the PPGDalia dataset, achieving an average mean absolute error of 2.85 beats per minute, surpassing existing reproducible methods. Our results demonstrate a significant performance improvement in heart rate tracking through the incorporation of prior knowledge into deep learning models. This approach shows promise in enhancing various biomedical applications by incorporating existing expert knowledge in deep learning models.

Sensor selection and miniaturization limits for detection of interictal epileptiform discharges with wearable EEG.

Objective.The goal of this paper is to investigate the limits of electroencephalography (EEG) sensor miniaturization in a set-up consisting of multiple galvanically isolated EEG units to record interictal epileptiform discharges (IEDs), referred to as 'spikes', in people with epilepsy.Approach.A dataset of high-density EEG recordings (257 channels) was used to emulate local EEG sensor units with short inter-electrode distances. A computationally efficient sensor selection and interictal spike detection algorithm was developed and used to assess the influence of the inter-electrode distance and the number of such EEG units on spike detection performance. Signal-to-noise ratio, correlation with a clinical-grade IEDs detector and Cohen's kappa coefficient of agreement were used to quantify performance. Bayesian statistics were used to confirm the statistical significance of the observed results.Main results.We found that EEG recording equipment should be specifically designed to measure the small signal power at short inter-electrode distance by providing an input referred noise<300 nV. We also found that an inter-electrode distance of minimum 5 cm between electrodes in a setup with a minimum of two EEG units is required to obtain near equivalent performance in interictal spike detection to standard EEG.Significance.These findings provide design guidelines for miniaturizing EEG systems for long term ambulatory monitoring of interictal spikes in epilepsy patients.

Multiscale entropy as a metric of brain maturation in a large cohort of typically developing children born preterm using longitudinal high-density EEG in the first two years of life.

Objective.We aimed to analyze whether complexity of brain electrical activity (EEG) measured by multiscale entropy (MSE) increases with brain maturation during the first two years of life. We also aimed to investigate whether this complexity shows regional differences across the brain, and whether changes in complexity are influenced by extrauterine life experience duration.Approach.We measured MSE of EEG signals recorded longitudinally using a high-density setup (64 or 128 electrodes) in 84 typically developing infants born preterm (<32 weeks' gestation) from term age to two years. We analyzed the complexity index and maximum value of MSE over increasing age, across brain regions, and in function of extrauterine life duration, and used correlation matrices as a metric of functional connectivity of the cerebral cortex.Main results.We found an increase of strong inter-channel correlation of MSE (R > 0.8) with increasing age. Regional analysis showed significantly increased MSE between 3 and 24 months of corrected age in the posterior and middle regions with respect to the anterior region. We found a weak relationship (adjusted R2= 0.135) between MSE and extrauterine life duration.Significance.These findings suggest that brain functional connectivity increases with maturation during the first two years of life. EEG complexity shows regional differences with earlier maturation of the visual cortex and brain regions involved in joint attention than of regions involved in cognitive analysis, abstract thought, and social behavior regulation. Finally, our MSE analysis suggested only a weak influence of early extrauterine life experiences (prior to term age) on EEG complexity.

Computationally-Efficient Algorithm for Real-Time Absence Seizure Detection in Wearable Electroencephalography.

Advances in electroencephalography (EEG) equipment now allow monitoring of people with epilepsy in their daily-life environment. The large volumes of data that can be collected from long-term out-of-clinic monitoring require novel algorithms to process the recordings on board of the device to identify and log or transmit only relevant data epochs. Existing seizure-detection algorithms are generally designed for post-processing purposes, so that memory and computing power are rarely considered as constraints. We propose a novel multi-channel EEG signal processing method for automated absence seizure detection which is specifically designed to run on a microcontroller with minimal memory and processing power. It is based on a linear multi-channel filter that is precomputed offline in a data-driven fashion based on the spatial-temporal signature of the seizure and peak interference statistics. At run-time, the algorithm requires only standard linear filtering operations, which are cheap and efficient to compute, in particular on microcontrollers with a multiply-accumulate unit (MAC). For validation, a dataset of eight patients with juvenile absence epilepsy was collected. Patients were equipped with a 20-channel mobile EEG unit and discharged for a day-long recording. The algorithm achieves a median of 0.5 false detections per day at 95% sensitivity. We compare our algorithm with state-of-the-art absence seizure detection algorithms and conclude it performs on par with these at a much lower computational cost.