Dispositivos médicos na abordagem de doentes com epilepsia

O número crescente de dispositivos médicos desenvolvidos e comercializados para melhorar a gestão de doentes com epilepsia reflete o crescente interesse em traduzir os avanços tecnológicos e o conhecimento sobre epilepsia numa melhor prestação de cuidados de saúde a esta população. O objetivo desta revisão narrativa da literatura é analisar as opções de dispositivos médicos disponíveis para deteção, tratamento e registo de crises epiléticas e a sua possível aplicação clínica. Os artigos incluídos foram selecionados através da base de dados PubMed, utilizando a query "(Epilepsy[MeSH Terms]) AND (SUDEP)) AND (Medical Device)) AND (English[Language])". A deteção de crises epiléticas é essencial para a intervenção precoce e para otimizar a terapêutica de cada doente. No ambulatório, essa deteção é um desafiado devido à sua imprevisibilidade. Tradicionalmente, o eletroencefalograma é o método direto de deteção utilizado em contexto hospitalar. Métodos indiretos de deteção, como eletrocardiograma, fotopletismografia, oxímetro, atividade eletrodérmica, acelerómetro e eletromiografia, mostraram potencial para detetar crises epiléticas em ambulatório. Vários dispositivos médicos foram desenvolvidos com base nos métodos mencionados, com o objetivo de fornecer aos doentes soluções que possam usar no seu dia-a-dia. Alguns dos designs disponíveis são o eletroencefalograma com elétrodos retroauriculares, pulseiras, braçadeiras e sensores de pressão na cama. Equipados com diferentes funções, esses dispositivos podem ajudar na deteção precoce de crises epiléticas e melhorar a qualidade de vida de doentes e cuidadores. Existem também dispositivos disponíveis para o tratamento de crises epiléticas. Por meio de técnicas de neuromodulação, como a estimulação do nervo vago, a estimulação cerebral profunda e a neuroestimulação responsiva, esses dispositivos são apresentados como soluções para doentes com epilepsias refratárias não elegíveis para cirurgia ressetiva. Os doentes com epilepsia têm várias aplicações disponíveis online para o registo adequado de crises epiléticas. Essas aplicações ajudam os médicos na otimização da terapêutica com base na evolução clínica. A ampla gama de dispositivos disponíveis cria a oportunidade de personalizar a abordagem às necessidades específicas do doente. O conhecimento das características de cada dispositivo pode ajudar os médicos a melhorar a abordagem dos doentes com epilepsia.The increasing number of medical devices developed and marketed towards management of patients with epilepsy reflects the growing interest in translating technological advances and knowledge about epilepsy into better healthcare for this population. The objective of this narrative literature review is to analyze the available options of medical devices for detecting, treating, and recording epileptic seizures, and their potential clinical application. The included articles were selected from the PubMed database using the query "(Epilepsy[MeSH Terms]) AND (SUDEP)) AND (Medical Device)) AND (English[Language])" The detection of epileptic seizures is essential for early intervention and to optimize the therapy for each patient. In outpatient settings, this detection is further challenging due to their unpredictability. Traditionally electroencephalography is the direct detection method used in a hospital environment. Indirect methods, such as electrocardiogram, photoplethysmography, oximeter, electrodermal activity, accelerometer, and electromyography, have shown potential for detecting seizures in the outpatient setting. Several medical devices have been developed based on the mentioned methods, with the aim of providing patients with solutions they can use in their daily lives. Behind-the-ear EEG, wristbands, armbands and bed sensors are some of the designs available. Equipped with different features, these devices can answer the need for early seizure detection and improve patients' and caregivers' quality of life. There are also devices available for the treatment of epileptic seizures. Through neuromodulation techniques such as vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation, these devices are presented as solutions for patients with refractory epilepsy not eligible for ressective surgery. Patients with epilepsy have several apps available online for proper recording of seizures. These apps help doctors optimize therapy based on clinical evolution. The wide range of devices available creates the opportunity to personalize the approach to patient's specific needs. Understanding each device's characteristics can help clinicians improve management of patients with epilepsy

Ambulatory biopotential measurement

Biopotential signals measure the electrical activity of different parts of the body. Conventional bedside monitors only provide information about the body under restricted conditions. Observation and documentation of biopotential signal during daily activities and the relation to patient symptoms may be important factors for clinical decision-making. Ambulatory monitoring helps to monitor the biopotential signal of a patient in the natural environment. The effective ambulatory system can help a physician to diagnose the patient\u27s abnormality. In this project, a low cost and flexible ambulatory biopotential system, compared to the commercially available systems, was designed and tested. Concurrently a software program was developed for data acquisition and analysis with a Personal Data Assistant (PDA). The data was analyzed in real time using the Lab VIEW PDA. Pilot data was collected using the developed hardware during different normal activities to confirm the accuracy and reliability of the developed hardware and data was collected simultaneously from both a standard ECU machine and the developed system. It was shown that during some activities the system performed as designed, however under extreme conditions where there was more motion artifact, the number of missing R waves increased. The quality of raw ECU from the developed system was as good as the standard ECU during low motion artifact. It has been demonstrated that this newly developed biopotential system is less expensive, flexible, accurate, and more reliable than the commercially available systems and could be used in different clinical and research studies

An interactive, real-time, high precision and portable monitoring system of obstructive sleep apnea

Obstructive sleep apnea (OSA) is the most common type of sleep apnea which is defined as the suspension of breathing. OSA is generally caused by complete or partial obstruction of airway during sleep, making the breathing pattern irregular and abnormal for prolonged periods of time. Apnea can contribute to a variety of life threatening medical conditions, and can be deadly if left untreated. Nowadays, out of 18 to 50 million people in the US, most cases remain undiagnosed due to the cost, cumbersome and resource limitations of overnight polysomnography (PSG) at sleep labs. Currently PSG relies on a doctor's experience. In order to improve the medical service efficiency, reduce diagnosis time and ensure a more accurate diagnosis, a quantitative and objective method is needed. In this dissertation, an innovative method in characterizing bio-signals for detecting epochs of sleep apnea with high accuracy is presented. Three data channels that are related to breath defect; respiratory sound, ECG and SpO2 are investigated, in order to extract physiological indicators that characterize sleep apnea. An automated method was used to analyze the respiratory sound to find pauses in breathing. Furthermore, the automated method analyzed ECG to find irregular heartbeats and SpO 2 to find rises and drops. The system consists of three main parts which are signal segmentation, features extraction and features classification. Feature extractions process is based on statistical measures. Features classification process is learned through Support Vector Machines (SVMs) and Neural Network (NN) classifiers. Moreover, a preprocessing technique is carried out to distinguish the R-wave from the other waves of the ECG signal. The approach presented in this dissertation was tested using downloaded polysomnographic ECG and SpO2 data from the Physionet database. In addition, to identifying sleep apnea using the acoustic signal of respiration; the characterization of breathing sound was carried by Voice Activity Detection (VAD) algorithm. VAD was used to measure the energy of the acoustic respiratory signal during breath and silence segments. From the experimental results for the three signals, it was concluded that the precision of classifying sleep apnea has an accuracy of 97%. This result offers a clinical reference value for identifying OSA instead of expensive PSG visual scoring method which is commonly used to asses sleep apnea, and could reduce diagnostic time and improve medical service efficiency

Intelligent Biosignal Processing in Wearable and Implantable Sensors

This reprint provides a collection of papers illustrating the state-of-the-art of smart processing of data coming from wearable, implantable or portable sensors. Each paper presents the design, databases used, methodological background, obtained results, and their interpretation for biomedical applications. Revealing examples are brain–machine interfaces for medical rehabilitation, the evaluation of sympathetic nerve activity, a novel automated diagnostic tool based on ECG data to diagnose COVID-19, machine learning-based hypertension risk assessment by means of photoplethysmography and electrocardiography signals, Parkinsonian gait assessment using machine learning tools, thorough analysis of compressive sensing of ECG signals, development of a nanotechnology application for decoding vagus-nerve activity, detection of liver dysfunction using a wearable electronic nose system, prosthetic hand control using surface electromyography, epileptic seizure detection using a CNN, and premature ventricular contraction detection using deep metric learning. Thus, this reprint presents significant clinical applications as well as valuable new research issues, providing current illustrations of this new field of research by addressing the promises, challenges, and hurdles associated with the synergy of biosignal processing and AI through 16 different pertinent studies. Covering a wide range of research and application areas, this book is an excellent resource for researchers, physicians, academics, and PhD or master students working on (bio)signal and image processing, AI, biomaterials, biomechanics, and biotechnology with applications in medicine

Smart Sensors for Healthcare and Medical Applications

This book focuses on new sensing technologies, measurement techniques, and their applications in medicine and healthcare. Specifically, the book briefly describes the potential of smart sensors in the aforementioned applications, collecting 24 articles selected and published in the Special Issue “Smart Sensors for Healthcare and Medical Applications”. We proposed this topic, being aware of the pivotal role that smart sensors can play in the improvement of healthcare services in both acute and chronic conditions as well as in prevention for a healthy life and active aging. The articles selected in this book cover a variety of topics related to the design, validation, and application of smart sensors to healthcare

Study of applications of bio-space technology to patient monitoring systems Final report

Investigation of application of NASA developed technology to cardiovascular and pulmonary patient monitoring to improve availability of data for medical diagnosi

Design and Development of Smart Brain-Machine-Brain Interface (SBMIBI) for Deep Brain Stimulation and Other Biomedical Applications

Machine collaboration with the biological body/brain by sending electrical information back and forth is one of the leading research areas in neuro-engineering during the twenty-first century. Hence, Brain-Machine-Brain Interface (BMBI) is a powerful tool for achieving such machine-brain/body collaboration. BMBI generally is a smart device (usually invasive) that can record, store, and analyze neural activities, and generate corresponding responses in the form of electrical pulses to stimulate specific brain regions. The Smart Brain-Machine-Brain-Interface (SBMBI) is a step forward with compared to the traditional BMBI by including smart functions, such as in-electrode local computing capabilities, and availability of cloud connectivity in the system to take the advantage of powerful cloud computation in decision making. In this dissertation work, we designed and developed an innovative form of Smart Brain-Machine-Brain Interface (SBMBI) and studied its feasibility in different biomedical applications. With respect to power management, the SBMBI is a semi-passive platform. The communication module is fully passive—powered by RF harvested energy; whereas, the signal processing core is battery-assisted. The efficiency of the implemented RF energy harvester was measured to be 0.005%. One of potential applications of SBMBI is to configure a Smart Deep-Brain-Stimulator (SDBS) based on the general SBMBI platform. The SDBS consists of brain-implantable smart electrodes and a wireless-connected external controller. The SDBS electrodes operate as completely autonomous electronic implants that are capable of sensing and recording neural activities in real time, performing local processing, and generating arbitrary waveforms for neuro-stimulation. A bidirectional, secure, fully-passive wireless communication backbone was designed and integrated into this smart electrode to maintain contact between the smart electrodes and the controller. The standard EPC-Global protocol has been modified and adopted as the communication protocol in this design. The proposed SDBS, by using a SBMBI platform, was demonstrated and tested through a hardware prototype. Additionally the SBMBI was employed to develop a low-power wireless ECG data acquisition device. This device captures cardiac pulses through a non-invasive magnetic resonance electrode, processes the signal and sends it to the backend computer through the SBMBI interface. Analysis was performed to verify the integrity of received ECG data

Computer modeling and signal analysis of cardiovascular physiology

This dissertation aims to study cardiovascular physiology from the cellular level to the whole heart level to the body level using numerical approaches. A mathematical model was developed to describe electromechanical interaction in the heart. The model integrates cardio-electrophysiology and cardiac mechanics through excitation-induced contraction and deformation-induced currents. A finite element based parallel simulation scheme was developed to investigate coupled electrical and mechanical functions. The developed model and numerical scheme were utilized to study cardiovascular dynamics at cellular, tissue and organ levels. The influence of ion channel blockade on cardiac alternans was investigated. It was found that the channel blocker may significantly change the critical pacing period corresponding to the onset of alternans as well as the alternans’ amplitude. The influence of electro-mechanical coupling on cardiac alternans was also investigated. The study supported the earlier assumptions that discordant alternans is induced by the interaction of conduction velocity and action potential duration restitution at high pacing rates. However, mechanical contraction may influence the spatial pattern and onset of discordant alternans. Computer algorithms were developed for analysis of human physiology. The 12-lead electrocardiography (ECG) is the gold standard for diagnosis of various cardiac abnormalities. However, disturbances and mistakes may modify physiological waves in ECG and lead to wrong diagnoses. This dissertation developed advanced signal analysis techniques and computer software to detect and suppress artifacts and errors in ECG. These algorithms can help to improve the quality of health care when integrated into medical devices or services. Moreover, computer algorithms were developed to predict patient mortality in intensive care units using various physiological measures. Models and analysis techniques developed here may help to improve the quality of health care