Impaired brain-heart axis in focal epilepsy: Alterations in information flow and implications for seizure dynamics.

This study delves into functional brain-heart interplay (BHI) dynamics during interictal periods before and after seizure events in focal epilepsy. Our analysis focuses on elucidating the causal interaction between cortical and autonomic nervous system (ANS) oscillations, employing electroencephalography and heart rate variability series. The dataset for this investigation comprises 47 seizure events from 14 independent subjects, obtained from the publicly available Siena Dataset. Our findings reveal an impaired brain-heart axis especially in the heart-to-brain functional direction. This is particularly evident in bottom-up oscillations originating from sympathovagal activity during the transition between preictal and postictal periods. These results indicate a pivotal role of the ANS in epilepsy dynamics. Notably, the brain-to-heart information flow targeting cardiac oscillations in the low-frequency band does not display significant changes. However, there are noteworthy changes in cortical oscillations, primarily originating in central regions, influencing heartbeat oscillations in the high-frequency band. Our study conceptualizes seizures as a state of hyperexcitability and a network disease affecting both cortical and peripheral neural dynamics. Our results pave the way for a deeper understanding of BHI in epilepsy, which holds promise for the development of advanced diagnostic and therapeutic approaches also based on bodily neural activity for individuals living with epilepsy.

This study focuses on brain-heart interplay (BHI) during pre- and postictal periods surrounding seizures. Employing multichannel EEG and heart rate variability data from subjects with focal epilepsy, our analysis reveals a disrupted brain-heart axis dynamic, particularly in the heart-to-brain direction. Notably, sympathovagal activity alterations during preictal to postictal transitions underscore the autonomic nervous system's pivotal role in epilepsy dynamics. While brain-to-heart information flow targeting low-frequency band cardiac oscillations remains stable, significant changes occur in cortical oscillations, predominantly in central regions, influencing high-frequeny-band heartbeat oscillations, that is, vagal activity. Viewing seizures as states of hyperexcitability and confirming focal epilepsy as a network disease affecting both central and peripheral neural dynamics, our study enhances understanding of BHI in epilepsy. These findings offer potential for advanced diagnostic and therapeutic approaches grounded in bodily neural activity for individuals with epilepsy.

Real and Deepfake Face Recognition: An EEG Study on Cognitive and Emotive Implications.

The human brain's role in face processing (FP) and decision making for social interactions depends on recognizing faces accurately. However, the prevalence of deepfakes, AI-generated images, poses challenges in discerning real from synthetic identities. This study investigated healthy individuals' cognitive and emotional engagement in a visual discrimination task involving real and deepfake human faces expressing positive, negative, or neutral emotions. Electroencephalographic (EEG) data were collected from 23 healthy participants using a 21-channel dry-EEG headset; power spectrum and event-related potential (ERP) analyses were performed. Results revealed statistically significant activations in specific brain areas depending on the authenticity and emotional content of the stimuli. Power spectrum analysis highlighted a right-hemisphere predominance in theta, alpha, high-beta, and gamma bands for real faces, while deepfakes mainly affected the frontal and occipital areas in the delta band. ERP analysis hinted at the possibility of discriminating between real and synthetic faces, as N250 (200-300 ms after stimulus onset) peak latency decreased when observing real faces in the right frontal (LF) and left temporo-occipital (LTO) areas, but also within emotions, as P100 (90-140 ms) peak amplitude was found higher in the right temporo-occipital (RTO) area for happy faces with respect to neutral and sad ones.

Electroencephalographic Correlates in Synthetic and Real Emotional Face Stimulation.

This work reports on physiological electroencephalographic (EEG) correlates in cognitive and emotional processes within the discrimination between synthetic and real faces visual stimuli. Human perception of manipulated data has been addressed in the literature from several perspectives. Researchers have investigated how the use of deep fakes alters people's ability in face-processing tasks, such as face recognition. Although recent studies showed that humans, on average, are still able to correctly recognize synthetic faces, this study investigates whether those findings still hold considering the latest advancements in AI-based, synthetic image creation. Specifically, 18-channels EEG signals from 21 healthy subjects were analyzed during a visual experiment where synthetic and actual emotional stimuli were administered. According to recent literature, participants were able to discriminate the real faces from the synthetic ones, by correctly classifying about 77% of all images. Preliminary encouraging results showed statistical significant differences in brain activation in both stimuli (synthetic and real) classification and emotional response.

Eye-tracking correlates of the Implicit Association Test.

Raising awareness of environmental challenges represents an important issue for researchers and scientists. As public opinion remains ambiguous, implicit attitudes toward climate change must be investigated. A custom Single-Category Implicit Association Test, a version of the Implicit Association Test, was developed to assess climate change beliefs. It was administered to 20 subjects while eye movements were tracked using a smart glasses system. Eye gaze patterns were analysed to understand whether they could reflect implicit attitudes toward nature. Recurrence Quantification Analysis was performed to extract 13 features from the eye-tracking data, which were used to perform statistical analyses. Significant differences were found between target stimuli (words related to climate change) and bad attributes in reaction time, and between target stimuli and good attributes in diagonal length entropy, suggesting that eye-tracking may provide an alternative source of information to electroencephalography in modeling and predicting implicit attitudes.

Machine Learning Assessment of Spasmodic Dysphonia Based on Acoustical and Perceptual Parameters.

Adductor spasmodic dysphonia is a type of adult-onset focal dystonia characterized by involuntary spasms of laryngeal muscles. This paper applied machine learning techniques for the severity assessment of spasmodic dysphonia. To this aim, 7 perceptual indices and 48 acoustical parameters were estimated from the Italian word /a'jwɔle/ emitted by 28 female patients, manually segmented from a standardized sentence and used as features in two classification experiments. Subjects were divided into three severity classes (mild, moderate, severe) on the basis of the G (grade) score of the GRB scale. The first aim was that of finding relationships between perceptual and objective measures with the Local Interpretable Model-Agnostic Explanations method. Then, the development of a diagnostic tool for adductor spasmodic dysphonia severity assessment was investigated. Reliable relationships between G; R (Roughness); B (Breathiness); Spasmodicity; and the acoustical parameters: voiced percentage, F2 median, and F1 median were found. After data scaling, Bayesian hyperparameter optimization, and leave-one-out cross-validation, a k-nearest neighbors model provided 89% accuracy in distinguishing patients among the three severity classes. The proposed methods highlighted the best acoustical parameters that could be used jointly with GRB indices to support the perceptual evaluation of spasmodic dysphonia and provide a tool to help severity assessment of spasmodic dysphonia.

Artificial Intelligence Procedure for the Screening of Genetic Syndromes Based on Voice Characteristics.

Perceptual and statistical evidence has highlighted voice characteristics of individuals affected by genetic syndromes that differ from those of normophonic subjects. In this paper, we propose a procedure for systematically collecting such pathological voices and developing AI-based automated tools to support differential diagnosis. Guidelines on the most appropriate recording devices, vocal tasks, and acoustical parameters are provided to simplify, speed up, and make the whole procedure homogeneous and reproducible. The proposed procedure was applied to a group of 56 subjects affected by Costello syndrome (CS), Down syndrome (DS), Noonan syndrome (NS), and Smith-Magenis syndrome (SMS). The entire database was divided into three groups: pediatric subjects (PS; individuals < 12 years of age), female adults (FA), and male adults (MA). In line with the literature results, the Kruskal-Wallis test and post hoc analysis with Dunn-Bonferroni test revealed several significant differences in the acoustical features not only between healthy subjects and patients but also between syndromes within the PS, FA, and MA groups. Machine learning provided a k-nearest-neighbor classifier with 86% accuracy for the PS group, a support vector machine (SVM) model with 77% accuracy for the FA group, and an SVM model with 84% accuracy for the MA group. These preliminary results suggest that the proposed method based on acoustical analysis and AI could be useful for an effective, non-invasive automatic characterization of genetic syndromes. In addition, clinicians could benefit in the case of genetic syndromes that are extremely rare or present multiple variants and facial phenotypes.

Aggregate Channel Features for newborn face detection in Neonatal Intensive Care Units.

An efficient face detector could be very helpful to point out possible neurological dysfunctions such as seizure events in Neonatal Intensive Care Units. However, its development is still challenging because large public datasets of newborns' faces are missing. Over the years several studies introduced semi-automatic approaches. This study proposes a fully automated face detector for newborns in Neonatal Intensive Care Units, based on the Aggregate Channel Feature algorithm. The developed method is tested on a dataset of video recordings from 42 full-term newborns collected at the Neuro-physiopathology and Neonatology Clinical Units, AOU Careggi, Firenze, Italy. The proposed system showed promising results, giving (mean ± standard error): log-Average Miss Rate = 0.47 ± 0.05 and Average Precision Recall = 0.61 ± 0.05. Moreover, achieved results highlighted interesting differences between newborns without seizures, newborns with electro-clinical seizures, and newborns with electrographic-only seizures. For both metrics statistically significant differences were found between patients with electro-clinical seizures and the other two groups. Clinical Relevance- The proposed method, based on quantitative physio-pathological features of facial movements, is of clinical relevance as it could speed up pain or seizure assessment of newborns in Neonatal Intensive Care Units.

Analysis of Brain-Heart Interactions in newborns with and without seizures using the Convergent Cross Mapping approach.

In the last years, the characterization of brain-heart interactions (BHIs) in epilepsy has gained great interest. For some specific seizures there is still a lack of information about the mechanisms occurring during or close to ictal events between the central nervous system (CNS) and the autonomic nervous system (ANS). This is the case for neonatal seizures, one of the most common neurological emergencies in the first days of life. This paper evaluates possible differences in BHIs between newborns with seizures and seizure-free ones. We applied convergent cross mapping approaches to a cohort of 52 newborns from a public dataset. Preliminary results show that newborns with seizures have a lower degree of interaction between the CNS and the ANS than seizure-free ones (Mann-Whitney test: p-value <0.05). These results are of clinical relevance for future BHI-based approaches to better understand the neural mechanisms behind neonatal seizures. Clinical Relevance- The study of BHIs in newborns with seizures might be helpful to better characterize the disorder or the aetiologies behind ictal events. Moreover, BHI approaches may confirm the involvement of the ANS during or close to a neonatal seizure event.

Heart Rate Variability Analysis for Seizure Detection in Neonatal Intensive Care Units.

In Neonatal Intensive Care Units (NICUs), the early detection of neonatal seizures is of utmost importance for a timely clinical intervention. Over the years, several neonatal seizure detection systems were proposed to detect neonatal seizures automatically and speed up seizure diagnosis, most based on the EEG signal analysis. Recently, research has focused on other possible seizure markers, such as electrocardiography (ECG). This work proposes an ECG-based NSD system to investigate the usefulness of heart rate variability (HRV) analysis to detect neonatal seizures in the NICUs. HRV analysis is performed considering time-domain, frequency-domain, entropy and multiscale entropy features. The performance is evaluated on a dataset of ECG signals from 51 full-term babies, 29 seizure-free. The proposed system gives results comparable to those reported in the literature: Area Under the Receiver Operating Characteristic Curve = 62%, Sensitivity = 47%, Specificity = 67%. Moreover, the system's performance is evaluated in a real clinical environment, inevitably affected by several artefacts. To the best of our knowledge, our study proposes for the first time a multi-feature ECG-based NSD system that also offers a comparative analysis between babies suffering from seizures and seizure-free ones.

HRV analysis: a non-invasive approach to discriminate between newborns with and without seizures.

Early neonatal seizures detection is one of the most challenging issues in Neonatal Intensive Care Units. Several EEG-based Neonatal Seizure Detectors were proposed to support the clinical staff. However, less invasive and more easily interpretable methods than EEG are still missing. In this work, we investigated if Heart Rate Variability analysis and related measures as input features of supervised classifiers could be a valid support for discriminating between newborns with seizures and seizure-free ones. The proposed methods were validated on 52 subjects (33 with seizures and 19 seizure-free) of a public dataset collected at the Helsinki University Hospital. Encouraging results are achieved using a Linear Support Vector Machine, obtaining about 87% Area Under ROC Curve. This suggests that Heart Rate Variability analysis might be a non-invasive pre-screening tool to identify newborns with seizures.Clinical Relevance- Heart Rate Variability analysis for detecting newborns with seizures in NICUs could speed up the diagnosis process and appropriate treatments for a better neurodevelopmental outcome of the infant.

A Generalized Linear Model for an ECG-based Neonatal Seizure Detector.

Seizures represent one of the most challenging issues of the neonatal period's neurological emergency. Due to the heterogeneity of etiologies and clinical characteristics, seizures recognition is tricky and time-consuming. Currently, the gold standard for seizure diagnosis is Electroencephalography (EEG), whose correct interpretation requires a highly specialized team. Thus, to speed up and facilitate the detection of ictal events, several EEG-based Neonatal Seizure Detectors (NSDs) have been proposed in the literature. Research is currently exploiting more simple and less invasive approaches, such as Electrocardiography (ECG). This work aims at developing an ECG-based NSD using a Generalized Linear Model with features extracted from Heart Rate Variability (HRV) measures as input. The method is validated on a public dataset of 52 subjects (33 with seizures and 19 seizure-free). Achieved encouraging results show 69% Concatenated Area Under the ROC Curve (AUCcc) for the automatic detection of windows with seizure events, confirming that HRV features can be useful to catch the cardio-regulatory system alterations due to neonatal seizure events, particularly those related to Hypoxic-Ischaemic Encephalopathies. Thus, results suggest the use of ECG-based NSDs in clinical practice, especially when a timely diagnosis is needed and EEG technologies are not readily available.Clinical Relevance- An ECG-based Neonatal Seizure Detector could be a valid support to speed up the diagnosis of neonatal seizures, especially when EEG technologies for infants' neurological assessment are not readily available.

Multiscale Entropy Analysis of Heart Rate Variability in Neonatal Patients with and without Seizures.

The complex physiological dynamics of neonatal seizures make their detection challenging. A timely diagnosis and treatment, especially in intensive care units, are essential for a better prognosis and the mitigation of possible adverse effects on the newborn's neurodevelopment. In the literature, several electroencephalographic (EEG) studies have been proposed for a parametric characterization of seizures or their detection by artificial intelligence techniques. At the same time, other sources than EEG, such as electrocardiography, have been investigated to evaluate the possible impact of neonatal seizures on the cardio-regulatory system. Heart rate variability (HRV) analysis is attracting great interest as a valuable tool in newborns applications, especially where EEG technologies are not easily available. This study investigated whether multiscale HRV entropy indexes could detect abnormal heart rate dynamics in newborns with seizures, especially during ictal events. Furthermore, entropy measures were analyzed to discriminate between newborns with seizures and seizure-free ones. A cohort of 52 patients (33 with seizures) from the Helsinki University Hospital public dataset has been evaluated. Multiscale sample and fuzzy entropy showed significant differences between the two groups (p-value < 0.05, Bonferroni multiple-comparison post hoc correction). Moreover, interictal activity showed significant differences between seizure and seizure-free patients (Mann-Whitney Test: p-value < 0.05). Therefore, our findings suggest that HRV multiscale entropy analysis could be a valuable pre-screening tool for the timely detection of seizure events in newborns.

Multiparametric EEG analysis of brain network dynamics during neonatal seizures.

BACKGROUND: One of the most challenging issues in paediatric neurology is the diagnosis of neonatal seizures, whose delayed treatment may affect the neurodevelopment of the newborn. Formulation of the correct diagnosis is conditioned by the high number of perceptually or automatically detected false positives. NEW METHOD: New methodologies are proposed to assess neonatal seizures trend over time. Our approach is based on the analysis of standardized trends of two properties of the brain network: the Synchronizabilty (S) and the degree of phase synchronicity given by the Circular Omega Complexity (COC). Qualitative and quantitative methods based on network dynamics allow differentiating seizure events from interictal periods and seizure-free patients. RESULTS: The methods were tested on a public dataset of labelled neonatal seizures. COC shows significant differences among seizure and non-seizure events (p-value <0.001, Cohen's d 0.86). Combining S and COC in standardized temporal instants provided a reliable description of the physiological behaviour of the brain's network during neonatal seizures. COMPARISON WITH EXISTING METHOD(S): Few of the existing network methods propose an operative way for carrying their analytical approach into the diagnostic process of neonatal seizures. Our methods offer a simple representation of brain network dynamics easily implementable and understandable also by less experienced staff. CONCLUSIONS: Our findings confirm the usefulness of the evaluation of brain network dynamics over time for a better understanding and interpretation of the complex mechanisms behind neonatal seizures. The proposed methods could also reliably support existing seizure detectors as a post-processing step in doubtful cases.

Automatic detection and sonification of nonmotor generalized onset epileptic seizures: Preliminary results.

Long-term video-EEG monitoring has improved diagnosis and treatment of epilepsy, especially in children. However, the amount of data neurophysiologists must analyze has grown remarkably. The main purpose of this paper is to provide a diagnostic support to speed up and ease EEG interpretation for a specific application concerning absence seizures, a type of non-motor generalized epileptic seizures. The proposed method consists of a pre-processing step where signals are filtered through the Stationary Wavelet Transform for the reduction of possible artefacts. Subsequently, a supervised automatic classification method is implemented for seizure detection, based on the Support Vector Machine Fine Gaussian method. Finally, a post-processing step is implemented in which spatial and temporal thresholds are defined for both online and offline application. In addition, a method that applies sonification techniques is developed. Sonification techniques could speed up the process of interpreting information, allowing rapid clinical intervention and a continuous monitoring of the event. The dataset consists of 30 EEG recordings performed in 24 children with absence seizures, clinically evaluated at the Meyer Children's Hospital in Firenze, Italy. The method shows encouraging results both in terms of balanced accuracy (about 96%) and latency times (1.25 s on average), which might make it suitable for online clinical trials. In fact, it was implemented in the perspective of a possible real-time application in clinical practice.