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

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

Temporal Lobe Epilepsy Alters Auditory-motor Integration For Voice Control

Temporal lobe epilepsy (TLE) is the most common drug-refractory focal epilepsy in adults. Previous research has shown that patients with TLE exhibit decreased performance in listening to speech sounds and deficits in the cortical processing of auditory information. Whether TLE compromises auditory-motor integration for voice control, however, remains largely unknown. To address this question, event-related potentials (ERPs) and vocal responses to vocal pitch errors (1/2 or 2 semitones upward) heard in auditory feedback were compared across 28 patients with TLE and 28 healthy controls. Patients with TLE produced significantly larger vocal responses but smaller P2 responses than healthy controls. Moreover, patients with TLE exhibited a positive correlation between vocal response magnitude and baseline voice variability and a negative correlation between P2 amplitude and disease duration. Graphical network analyses revealed a disrupted neuronal network for patients with TLE with a significant increase of clustering coefficients and path lengths as compared to healthy controls. These findings provide strong evidence that TLE is associated with an atypical integration of the auditory and motor systems for vocal pitch regulation, and that the functional networks that support the auditory-motor processing of pitch feedback errors differ between patients with TLE and healthy controls

Deep learning approach for epileptic seizure detection

Abstract. Epilepsy is the most common brain disorder that affects approximately fifty million people worldwide, according to the World Health Organization. The diagnosis of epilepsy relies on manual inspection of EEG, which is error-prone and time-consuming. Automated epileptic seizure detection of EEG signal can reduce the diagnosis time and facilitate targeting of treatment for patients. Current detection approaches mainly rely on the features that are designed manually by domain experts. The features are inflexible for the detection of a variety of complex patterns in a large amount of EEG data. Moreover, the EEG is non-stationary signal and seizure patterns vary across patients and recording sessions. EEG data always contain numerous noise types that negatively affect the detection accuracy of epileptic seizures. To address these challenges deep learning approaches are examined in this paper. Deep learning methods were applied to a large publicly available dataset, the Children’s Hospital of Boston-Massachusetts Institute of Technology dataset (CHB-MIT). The present study includes three experimental groups that are grouped based on the pre-processing steps. The experimental groups contain 3–4 experiments that differ between their objectives. The time-series EEG data is first pre-processed by certain filters and normalization techniques, and then the pre-processed signal was segmented into a sequence of non-overlapping epochs. Second, time series data were transformed into different representations of input signals. In this study time-series EEG signal, magnitude spectrograms, 1D-FFT, 2D-FFT, 2D-FFT magnitude spectrum and 2D-FFT phase spectrum were investigated and compared with each other. Third, time-domain or frequency-domain signals were used separately as a representation of input data of VGG or DenseNet 1D. The best result was achieved with magnitude spectrograms used as representation of input data in VGG model: accuracy of 0.98, sensitivity of 0.71 and specificity of 0.998 with subject dependent data. VGG along with magnitude spectrograms produced promising results for building personalized epileptic seizure detector. There was not enough data for VGG and DenseNet 1D to build subject-dependent classifier.Epileptisten kohtausten havaitseminen syväoppimisella lähestymistavalla. Tiivistelmä. Epilepsia on yleisin aivosairaus, joka Maailman terveysjärjestön mukaan vaikuttaa noin viiteenkymmeneen miljoonaan ihmiseen maailmanlaajuisesti. Epilepsian diagnosointi perustuu EEG:n manuaaliseen tarkastamiseen, mikä on virhealtista ja aikaa vievää. Automaattinen epileptisten kohtausten havaitseminen EEG-signaalista voi potentiaalisesti vähentää diagnoosiaikaa ja helpottaa potilaan hoidon kohdentamista. Nykyiset tunnistusmenetelmät tukeutuvat pääasiassa piirteisiin, jotka asiantuntijat ovat määritelleet manuaalisesti, mutta ne ovat joustamattomia monimutkaisten ilmiöiden havaitsemiseksi suuresta määrästä EEG-dataa. Lisäksi, EEG on epästationäärinen signaali ja kohtauspiirteet vaihtelevat potilaiden ja tallennusten välillä ja EEG-data sisältää aina useita kohinatyyppejä, jotka huonontavat epilepsiakohtauksen havaitsemisen tarkkuutta. Näihin haasteisiin vastaamiseksi tässä diplomityössä tarkastellaan soveltuvatko syväoppivat menetelmät epilepsian havaitsemiseen EEG-tallenteista. Aineistona käytettiin suurta julkisesti saatavilla olevaa Bostonin Massachusetts Institute of Technology lastenklinikan tietoaineistoa (CHB-MIT). Tämän työn tutkimus sisältää kolme koeryhmää, jotka eroavat toisistaan esikäsittelyvaiheiden osalta: aikasarja-EEG-data esikäsiteltiin perinteisten suodattimien ja normalisointitekniikoiden avulla, ja näin esikäsitelty signaali segmentoitiin epookkeihin. Kukin koeryhmä sisältää 3–4 koetta, jotka eroavat menetelmiltään ja tavoitteiltaan. Kussakin niistä epookkeihin jaettu aikasarjadata muutettiin syötesignaalien erilaisiksi esitysmuodoiksi. Tässä tutkimuksessa tutkittiin ja verrattiin keskenään EEG-signaalia sellaisenaan, EEG-signaalin amplitudi-spektrogrammeja, 1D-FFT-, 2D-FFT-, 2D-FFT-amplitudi- ja 2D-FFT -vaihespektriä. Näin saatuja aika- ja taajuusalueen signaaleja käytettiin erikseen VGG- tai DenseNet 1D -mallien syötetietoina. Paras tulos saatiin VGG-mallilla kun syötetietona oli amplitudi-spektrogrammi ja tällöin tarkkuus oli 0,98, herkkyys 0,71 ja spesifisyys 0,99 henkilöstä riippuvaisella EEG-datalla. VGG yhdessä amplitudi-spektrogrammien kanssa tuottivat lupaavia tuloksia henkilökohtaisen epilepsiakohtausdetektorin rakentamiselle. VGG- ja DenseNet 1D -malleille ei ollut tarpeeksi EEG-dataa henkilöstä riippumattoman luokittelijan opettamiseksi