Accelerometry based detection of epileptic seizures

Epilepsy is one of the most common neurological disorders. Epileptic seizures are the manifestation of abnormal hypersynchronous discharges of cortical neurons that impair brain function. Most of the people affected can be treated successfully with drug therapy or neurosurgical procedures. But there is still a large group of epilepsy patients that continues to have frequent seizures. For these patients automated detection of epileptic seizures can be of great clinical importance. Seizure detection can influence daily care or can be used to evaluate treatment effect. Furthermore automated detection can be used to trigger an alarm system during seizures that might be harmful to the patient. This thesis focusses on accelerometry (ACM) based seizure detection. A detailed overview is provided, on the perspectives for long-term epilepsy monitoring and automated seizure detection. The value of accelerometry for seizure detection is shown by means of a clinical evaluation and the first steps are made towards automatic detection of epileptic seizures based on ACM. With accelerometers movements are recorded. A large group of epileptic seizures manifest in specific movement patterns, so called motor seizures. Chapter 2 of this thesis presents an overview of the published literature on available methods for epileptic seizure detection in a long-term monitoring context. Based on this overview recommendations are formulated that should be used in seizure detection research and development. It is shown that for seizure detection in home environments, other sensor modalities besides EEG become more important. The use of alternative sensor modalities (such as ACM) is relatively new and so is the algorithm development for seizure detection based on these measures. It was also found that for both the adaptation of existing techniques and the development of new algorithms, clinical information should be taken more into account. The value of ACM for seizure detection is shown by means of a clinical evaluation in chapter 3. Here 3-D ACM- and EEG/video-recordings of 18 patients with severe epilepsy are visually analyzed. A striking outcome presented in this chapter is the large number of visually detected seizures versus the number of seizures that was expected on forehand and the number of seizures that was observed by the nurses. These results underscore the need for an automatic seizure detection device even more, since in the current situation many seizures are missed and therefore it is possible that patients do not get the right (medical) treatment. It was also observed that 95% of the ACM-patterns during motor seizures are sequences of three elementary patterns: myoclonic, tonic and clonic patterns. These characteristic patterns are a starting point for the development of methods for automated seizure detection based on ACM. It was decided to use a modular approach for the detection methodology and develop algorithms separately for motor activity in general, myoclonic seizures and tonic seizures. Furthermore, clinical information is incorporated in the detection methodology. Therefore in this thesis features were used that are either based on the shape of the patterns of interest as described in clinical practice (chapter 4 and 7), or the features were based on a physiological model with parameters that are related to seizure duration and intensity (chapter 5 and 6). In chapter 4 an algorithm is developed to distinguish periods with and without movement from ACM-data. Hence, when there is no movement there is no motor seizure. The amount of data that needs further analysis for seizure detection is thus reduced. From 15 ACM-signals (measured on five positions on the body), two features are computed, the variance and the jerk. In the resulting 2-D feature space a linear threshold function is used for classification. For training and testing the algorithm ACM data along with video data are used from nocturnal recordings in mentally retarded patients with severe epilepsy. Using this algorithm the amount of data that needs further analysis is reduced considerably. The results also indicate that the algorithm is robust for fluctuations across patients and thus there is no need for training the algorithm for each new patient. For the remaining data it needs to be established whether the detected movement is seizure related or not. To this purpose a model is developed for the accelerometer pattern measured on the arm during a myoclonic seizure (chapter 5). The model consists of a mechanical and an electrophysiological part. This model is used as a matched wavelet filter to detect myoclonic seizures. In chapter 6 the model based wavelet is compared to three other time frequency measures: the short time Fourier transform, the Wigner distribution and the continuous wavelet transform using a Daubechies wavelet. All four time-frequency methods are evaluated in a linear classification setup. Data from mentally retarded patients with severe epilepsy are used for training and evaluation. The results show that both wavelets are useful for detection of myoclonic seizures. On top of that, our model based wavelet has the advantage that it consists of parameters that are related to seizure duration and intensity that are physiological meaningful. Besides myoclonic seizures, the model is also useful for the detection of clonic seizures; physiologically these are repetitive myoclonic seizures. Finally for the detection of tonic seizures, in chapter 7 a set of features is studied that incorporate the mean characteristics of ACM-patterns associated with tonic seizures. Linear discriminant analysis is used for classification in the multi-dimensional feature space. For training and testing the algorithm, again data are used from recordings in mentally retarded patients with severe epilepsy. The results show that our approach is useful for the automated detection of tonic seizures based on 3-D ACM and that it is a promising contribution in a complete multi-sensor seizure detection setup

Seizure Detection, Seizure Prediction, and Closed-Loop Warning Systems in Epilepsy

Nearly one-third of patients with epilepsy continue to have seizures despite optimal medication management. Systems employed to detect seizures may have the potential to improve outcomes in these patients by allowing more tailored therapies and might, additionally, have a role in accident and SUDEP prevention. Automated seizure detection and prediction require algorithms which employ feature computation and subsequent classification. Over the last few decades, methods have been developed to detect seizures utilizing scalp and intracranial EEG, electrocardiography, accelerometry and motion sensors, electrodermal activity, and audio/video captures. To date, it is unclear which combination of detection technologies yields the best results, and approaches may ultimately need to be individualized. This review presents an overview of seizure detection and related prediction methods and discusses their potential uses in closed-loop warning systems in epilepsy

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Objective New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy (SUDEP). They must be unobtrusive and automated, and provide false alarm rates (FARs) bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. Methods Hand-annotated video-electroencephalographic seizure events were collected from 69 patients at six clinical sites. Three different wristbands were used to record electrodermal activity (EDA) and accelerometer (ACM) signals, obtaining 5,928 h of data, including 55 convulsive epileptic seizures (six focal tonic–clonic seizures and 49 focal to bilateral tonic–clonic seizures) from 22 patients. Recordings were analyzed offline to train and test two new machine learning classifiers and a published classifier based on EDA and ACM. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. Results The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and an FAR of 0.2 events/day. No nocturnal seizures were missed. Most patients had <1 false alarm every 4 days, with an FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures), the FAR is up to 13 times lower than with the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median = 29.3 s, range = 14.8–151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of postictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. Significance The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behavior and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning

Continuous assessment of epileptic seizures with wrist-worn biosensors

Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, 2011.Cataloged from PDF version of thesis.Includes bibliographical references (p. 145-159).Epilepsy is a neurological disorder characterized predominantly by an enduring predisposition to generate epileptic seizures. The apprehension about injury, or even death, resulting from a seizure often overshadows the lives of those unable to achieve complete seizure control. Moreover, the risk of sudden death in people with epilepsy is 24 times higher compared to the general population and the pathophysiology of sudden unexpected death in epilepsy (SUDEP) remains unclear. This thesis describes the development of a wearable electrodermal activity (EDA) and accelerometry (ACM) biosensor, and demonstrates its clinical utility in the assessment of epileptic seizures. The first section presents the development of a wrist-worn sensor that can provide comfortable and continuous measurements of EDA, a sensitive index of sympathetic activity, and ACM over extensive periods of time. The wearable biosensor achieved high correlations with a Food and Drug Administration (FDA) approved system for the measurement of EDA during various classic arousal experiments. This device offers the unprecedented ability to perform comfortable, long-term, and in situ assessment of EDA and ACM. The second section describes the autonomic alterations that accompany epileptic seizures uncovered using the wearable EDA biosensor and time-frequency mapping of heart rate variability. We observed that the post-ictal period was characterized by a surge in sympathetic sudomotor and cardiac activity coinciding with vagal withdrawal and impaired reactivation. The impact of autonomic dysregulation was more pronounced after generalized tonic-clonic seizures compared to complex partial seizures. Importantly, we found that the intensity of both sympathetic activation and parasympathetic suppression increased approximately linearly with duration of post-ictal EEG suppression, a possible marker for the risk of SUDEP. These results highlight a critical window of post-ictal autonomic dysregulation that may be relevant in the pathogenesis of SUDEP and hint at the possibility for assessment of SUDEP risk by autonomic biomarkers. Lastly, this thesis presents a novel algorithm for generalized tonic-clonic seizure detection with the use of EDA and ACM. The algorithm was tested on 4213 hours (176 days) of recordings from 80 patients containing a wide range of ordinary daily activities and detected 15/16 (94%) tonic-clonic seizures with a low rate of false alarms (<; 1 per 24 h). It is anticipated that the proposed wearable biosensor and seizure detection algorithm will provide an ambulatory seizure alarm and improve the quality of life of patients with uncontrolled tonic-clonic seizures.by Ming-Zher Poh.Ph.D

Optimal Inertial Sensor Placement and Motion Detection for Epileptic Seizure Patient Monitoring

Use of inertial sensory systems to monitor and detect seizure episodes in patients suffering from epilepsy is investigated via numerical simulations and experiments. Numerical simulations employ a mathematical model that is able to predict human body dynamic responses during a typical epileptic seizure. An optimized inertial sensor placement procedure is developed to address achievement of highest possible sensing resolution in determining angular accelerations with minimal errors. In addition, a joint torque estimation procedure is formulated to assist in the future development of a possible detection scheme. Experimental motion data obtained from an epileptic seizure patient as well as a healthy subject via a cluster of inertial measurement sensors formed a basis for proposing a suitable detection scheme based on non-linear response analysis. In particular, preliminary experimental data analysis has shown that the proposed modified Poincaré Map based scheme can become an effective tool in detecting of seizure via inertial measurements