Dynamic classifiers for neonatal brain monitoring

Brain injury due to lack of oxygen or impaired blood flow around the time of birth, may cause long term neurological dysfunction or death in severe cases. The treatments need to be initiated as soon as possible and tailored according to the nature of the injury to achieve best outcomes. The Electroencephalogram (EEG) currently provides the best insight into neurological activities. However, its interpretation presents formidable challenge for the neurophsiologists. Moreover, such expertise is not widely available particularly around the clock in a typical busy Neonatal Intensive Care Unit (NICU). Therefore, an automated computerized system for detecting and grading the severity of brain injuries could be of great help for medical staff to diagnose and then initiate on-time treatments. In this study, automated systems for detection of neonatal seizures and grading the severity of Hypoxic-Ischemic Encephalopathy (HIE) using EEG and Heart Rate (HR) signals are presented. It is well known that there is a lot of contextual and temporal information present in the EEG and HR signals if examined at longer time scale. The systems developed in the past, exploited this information either at very early stage of the system without any intelligent block or at very later stage where presence of such information is much reduced. This work has particularly focused on the development of a system that can incorporate the contextual information at the middle (classifier) level. This is achieved by using dynamic classifiers that are able to process the sequences of feature vectors rather than only one feature vector at a time

Multimodal image analysis of the human brain

Gedurende de laatste decennia heeft de snelle ontwikkeling van multi-modale en niet-invasieve hersenbeeldvorming technologieën een revolutie teweeg gebracht in de mogelijkheid om de structuur en functionaliteit van de hersens te bestuderen. Er is grote vooruitgang geboekt in het beoordelen van hersenschade door gebruik te maken van Magnetic Reconance Imaging (MRI), terwijl Elektroencefalografie (EEG) beschouwd wordt als de gouden standaard voor diagnose van neurologische afwijkingen. In deze thesis focussen we op de ontwikkeling van nieuwe technieken voor multi-modale beeldanalyse van het menselijke brein, waaronder MRI segmentatie en EEG bronlokalisatie. Hierdoor voegen we theorie en praktijk samen waarbij we focussen op twee medische applicaties: (1) automatische 3D MRI segmentatie van de volwassen hersens en (2) multi-modale EEG-MRI data analyse van de hersens van een pasgeborene met perinatale hersenschade. We besteden veel aandacht aan de verbetering en ontwikkeling van nieuwe methoden voor accurate en ruisrobuuste beeldsegmentatie, dewelke daarna succesvol gebruikt worden voor de segmentatie van hersens in MRI van zowel volwassen als pasgeborenen. Daarenboven ontwikkelden we een geïntegreerd multi-modaal methode voor de EEG bronlokalisatie in de hersenen van een pasgeborene. Deze lokalisatie wordt gebruikt voor de vergelijkende studie tussen een EEG aanval bij pasgeborenen en acute perinatale hersenletsels zichtbaar in MRI

Advanced analyses of physiological signals and their role in Neonatal Intensive Care

Preterm infants admitted to the neonatal intensive care unit (NICU) face an array of life-threatening diseases requiring procedures such as resuscitation and invasive monitoring, and other risks related to exposure to the hospital environment, all of which may have lifelong implications. This thesis examined a range of applications for advanced signal analyses in the NICU, from identifying of physiological patterns associated with neonatal outcomes, to evaluating the impact of certain treatments on physiological variability. Firstly, the thesis examined the potential to identify infants at risk of developing intraventricular haemorrhage, often interrelated with factors leading to preterm birth, mechanical ventilation, hypoxia and prolonged apnoeas. This thesis then characterised the cardiovascular impact of caffeine therapy which is often administered to prevent and treat apnoea of prematurity, finding greater pulse pressure variability and enhanced responsiveness of the autonomic nervous system. Cerebral autoregulation maintains cerebral blood flow despite fluctuations in arterial blood pressure and is an important consideration for preterm infants who are especially vulnerable to brain injury. Using various time and frequency domain correlation techniques, the thesis found acute changes in cerebral autoregulation of preterm infants following caffeine therapy. Nutrition in early life may also affect neurodevelopment and morbidity in later life. This thesis developed models for identifying malnutrition risk using anthropometry and near-infrared interactance features. This thesis has presented a range of ways in which advanced analyses including time series analysis, feature selection and model development can be applied to neonatal intensive care. There is a clear role for such analyses in early detection of clinical outcomes, characterising the effects of relevant treatments or pathologies and identifying infants at risk of later morbidity

Mining Biomarkers Of Epilepsy From Large-Scale Intracranial Electroencephalography

Epilepsy is a chronic neurological disorder characterized by seizures. Affecting over 50 million people worldwide, the quality of life of a patient with uncontrolled epilepsy is degraded by medical, social, cognitive, and psychological dysfunction. Fortunately, two-thirds of these patients can achieve adequate seizure control through medications. Unfortunately, one-third cannot. Improving treatment for this patient population depends upon improving our understanding of the underlying epileptic network. Clinical therapies modulate this network to some degree of success, including surgery to remove the seizure onset zone or neuromodulation to alter the brain\u27s dynamics. High resolution intracranial EEG (iEEG) is often employed to study the dynamics of cortical networks, from interictal patterns to more complex quantitative features. These interictal patterns include epileptiform biomarkers whose detection and mapping, along with seizures and neuroimaging, form the mainstay of data for clinical decision making around drug therapy, surgery, and devices. They are also increasingly important to assess the effects of epileptic physiology on brain functions like behavior and cognition, which are not well characterized. In this work, we investigate the significance and trends of epileptiform biomarkers in animal and human models of epilepsy. We develop reliable methods to quantify interictal patterns, applying state of the art techniques from machine learning, signal processing, and EEG analysis. We then validate these tools in three major applications: 1. We study the effect of interictal spikes on human cognition, 2. We assess trends of interictal epileptiform bursts and their relationship to seizures in prolonged recordings from canines and rats, and 3. We assess the stability of long-term iEEG spanning several years. These findings have two main impacts: (1) they inform the interpretation of interictal iEEG patterns and elucidate the timescale of post-implantation changes. These findings have important implications for research and clinical care, particularly implantable devices and evaluating patients for epilepsy surgery. (2) They provide an analytical framework to enable others to mine large-scale iEEG datasets. In this way we hope to make a lasting contribution to accelerate collaborative research not only in epilepsy, but also in the study of animal and human electrophysiology in acute and chronic conditions

Non Invasive Tools for Early Detection of Autism Spectrum Disorders

Autism Spectrum Disorders (ASDs) describe a set of neurodevelopmental disorders. ASD represents a significant public health problem. Currently, ASDs are not diagnosed before the 2nd year of life but an early identification of ASDs would be crucial as interventions are much more effective than specific therapies starting in later childhood. To this aim, cheap an contact-less automatic approaches recently aroused great clinical interest. Among them, the cry and the movements of the newborn, both involving the central nervous system, are proposed as possible indicators of neurological disorders. This PhD work is a first step towards solving this challenging problem. An integrated system is presented enabling the recording of audio (crying) and video (movements) data of the newborn, their automatic analysis with innovative techniques for the extraction of clinically relevant parameters and their classification with data mining techniques. New robust algorithms were developed for the selection of the voiced parts of the cry signal, the estimation of acoustic parameters based on the wavelet transform and the analysis of the infant’s general movements (GMs) through a new body model for segmentation and 2D reconstruction. In addition to a thorough literature review this thesis presents the state of the art on these topics that shows that no studies exist concerning normative ranges for newborn infant cry in the first 6 months of life nor the correlation between cry and movements. Through the new automatic methods a population of control infants (“low-risk”, LR) was compared to a group of “high-risk” (HR) infants, i.e. siblings of children already diagnosed with ASD. A subset of LR infants clinically diagnosed as newborns with Typical Development (TD) and one affected by ASD were compared. The results show that the selected acoustic parameters allow good differentiation between the two groups. This result provides new perspectives both diagnostic and therapeutic

Changes in neuronal firing and synchrony precede recruitment of mesial temporal networks into generalizing seizures

Despite extensive study, the mechanisms underlying seizure generation and propagation are poorly understood. One approach is to study changes in the neuronal activity (of inhibitory and excitatory subpopulations) that occur during the recruitment of networks into a propagating seizure, to gain insight into mechanisms by which seizures spread across the brain. Recent work, comparing intra- and extracelluar recordings in ex-vivo preparations of human neocortex has implicated a failure in feed-forward inhibition underlying the spread of seizure. However, direct in-vivo study of inhibitory and excitatory population dynamics in the neocortex is difficult, due to an inability to separate single neuron activity into excitatory and inhibitory subpopulations. In the mesial temporal lobe (MTL) it is considerably easier to isolate these subpopulations, and several studies in the rodent MTL have, indeed, demonstrated an intricate spatiotemporal interplay between inhibitory and excitatory neuron firing and their corresponding synchrony to local field potentials during the transition to seizure. While this work suggests potential mechanisms for network recruitment into seizure, no direct observations have been made in the MTL of epileptic patients. This report provides methods to prolong the longevity of single neuron recordings in the human MTL. Using these recordings, evidence is presented that supports the hypothesis that recruitment of MTL networks into seizures of neocortical origin is preceded by specific spatiotemporal increases in synchrony. In detail, within the MTL there is a decrease in inhibitory interneuron firing that coincides with the inhibitory population becoming more coherent to their local field potentials. This increased synchrony between neurons and the local field occurs at frequencies similar to those of regional synchrony between MTL networks and the seizure focus. These results suggest a mechanism by which downstream networks are prepared for recruitment into generalizing seizures. Interestingly, these spatiotemporal changes occur prior to the first electrographic manifestation of seizure in the brain, implying that in addition to their role in seizure propagation, changes in interneuron firing and interneuron-field synchrony in the MTL may be reflective of early seizure activity in other brain structures as well, and may thus be a useful tool in developing improved early detection algorithms.Ph.D., Biomedical Engineering -- Drexel University, 201

Developing new techniques to analyse and classify EEG signals

A massive amount of biomedical time series data such as Electroencephalograph (EEG), electrocardiography (ECG), Electromyography (EMG) signals are recorded daily to monitor human performance and diagnose different brain diseases. Effectively and accurately analysing these biomedical records is considered a challenge for researchers. Developing new techniques to analyse and classify these signals can help manage, inspect and diagnose these signals. In this thesis novel methods are proposed for EEG signals classification and analysis based on complex networks, a statistical model and spectral graph wavelet transform. Different complex networks attributes were employed and studied in this thesis to investigate the main relationship between behaviours of EEG signals and changes in networks attributes. Three types of EEG signals were investigated and analysed; sleep stages, epileptic and anaesthesia. The obtained results demonstrated the effectiveness of the proposed methods for analysing these three EEG signals types. The methods developed were applied to score sleep stages EEG signals, and to analyse epileptic, as well as anaesthesia EEG signals. The outcomes of the project will help support experts in the relevant medical fields and decrease the cost of diagnosing brain diseases

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

Holographic Fourier domain diffuse correlation spectroscopy

Diffuse correlation spectroscopy (DCS) is a non-invasive optical modality which can be used to measure cerebral blood flow (CBF) in real-time. It has important potential applications in clinical monitoring, as well as in neuroscience and the development of a non-invasive brain-computer interface. However, a trade-off exists between the signal-to-noise ratio (SNR) and imaging depth, and thus CBF sensitivity, of this technique. Additionally, as DCS is a diffuse optical technique, it is limited by a lack of inherent depth discrimination within the illuminated region of each source-detector pair, and the CBF signal is therefore also prone to contamination by the extracerebral tissues which the light traverses. Placing a particular emphasis on scalability, affordability, and robustness to ambient light, in this work I demonstrate a novel approach which fuses the fields of digital holography and DCS: holographic Fourier domain DCS (FD-DCS). The mathematical formalism of FD-DCS is derived and validated, followed by the construction and validation (for both in vitro and in vivo experiments) of a holographic FD-DCS instrument. By undertaking a systematic SNR performance assessment and developing a novel multispeckle denoising algorithm, I demonstrate the highest SNR gain reported in the DCS literature to date, achieved using scalable and low-cost camera-based detection. With a view to generating a forward model for holographic FD-DCS, in this thesis I propose a novel framework to simulate statistically accurate time-integrated dynamic speckle patterns in biomedical optics. The solution that I propose to this previously unsolved problem is based on the Karhunen-Loève expansion of the electric field, and I validate this technique against novel expressions for speckle contrast for different forms of homogeneous field. I also show that this method can readily be extended to cases with spatially varying sample properties, and that it can also be used to model optical and acoustic parameters