Software tool for visualization of a probabilistic map of the epileptogenic zone from seizure semiologies

Around one third of epilepsies are drug-resistant. For these patients, seizures may be reduced or cured by surgically removing the epileptogenic zone (EZ), which is the portion of the brain giving rise to seizures. If noninvasive data are not sufficiently lateralizing or localizing, the EZ may need to be localized by precise implantation of intracranial electroencephalography (iEEG) electrodes. The choice of iEEG targets is influenced by clinicians' experience and personal knowledge of the literature, which leads to substantial variations in implantation strategies across different epilepsy centers. The clinical diagnostic pathway for surgical planning could be supported and standardized by an objective tool to suggest EZ locations, based on the outcomes of retrospective clinical cases reported in the literature. We present an open-source software tool that presents clinicians with an intuitive and data-driven visualization to infer the location of the symptomatogenic zone, that may overlap with the EZ. The likely EZ is represented as a probabilistic map overlaid on the patient's images, given a list of seizure semiologies observed in that specific patient. We demonstrate a case study on retrospective data from a patient treated in our unit, who underwent resective epilepsy surgery and achieved 1-year seizure freedom after surgery. The resected brain structures identified as EZ location overlapped with the regions highlighted by our tool, demonstrating its potential utility

Probabilistic landscape of seizure semiology localising values

Semiology describes the evolution of symptoms and signs during epileptic seizures and contributes to the evaluation of individuals with focal drug-resistant epilepsy for curative resection. Semiology varies in complexity from elementary sensorimotor seizures arising from primary cortex to complex behaviours and automatisms emerging from distributed cerebral networks. Detailed semiology interpreted by expert epileptologists may point towards the likely site of seizure onset, but this process is subjective. No study has captured the variances in semiological localising values in a data-driven manner to allow objective and probabilistic determinations of implicated networks and nodes. We curated an open dataset from the epilepsy literature, in accordance with PRISMA guidelines, linking semiology to hierarchical brain localisations. A total of 11230 datapoints were collected from 4643 patients across 309 articles, labelled using ground-truths (postoperative seizure-freedom, concordance of imaging and neurophysiology, and/or invasive EEG) and a designation method that distinguished between semiologies arising from a predefined cortical region and descriptions of neuroanatomical localisations responsible for generating a particular semiology. This allowed us to mitigate temporal lobe publication bias by filtering studies that preselected patients based on prior knowledge of their seizure-foci. Using this dataset, we describe the probabilistic landscape of semiological localising values as forest plots at the resolution of seven major brain regions: temporal, frontal, cingulate, parietal, occipital, insula, and hypothalamus, and five temporal subregions. We evaluated the intrinsic value of any one semiology over all other ictal manifestations. For example, epigastric auras implicated the temporal lobe with 83% probability when not accounting for the publication bias that favoured temporal lobe epilepsies. Unbiased results for a prior distribution of cortical localisations revised the prevalence of temporal lobe epilepsies from 66% to 44%. Therefore, knowledge about the presence of epigastric auras updates localisation to the temporal lobe with an odds ratio (OR) of 2.4 (CI_{95%} [1.9, 2.9]; and specifically, mesial temporal structures OR 2.8[2.3, 2.9]), attesting the value of epigastric auras. As a further example, although head version is thought to implicate the frontal lobes, it did not add localising value compared to the prior distribution of cortical localisations (OR 0.9[0.7, 1.2]). Objectification of the localising values of the twelve most common semiologies provides a complementary view of brain dysfunction to that of lesion-deficit mappings, as instead of linking brain regions to phenotypic-deficits, semiological phenotypes are linked back to brain sources. This work enables coupling of seizure-propagation with ictal-manifestations, and clinical support algorithms for localising seizure phenotypes

Can italian healthcare administrative databases be used to compare regions with respect to compliance with standards of care for chronic diseases?

BACKGROUND: Italy has a population of 60 million and a universal coverage single-payer healthcare system, which mandates collection of healthcare administrative data in a uniform fashion throughout the country. On the other hand, organization of the health system takes place at the regional level, and local initiatives generate natural experiments. This is happening in particular in primary care, due to the need to face the growing burden of chronic diseases. Health services research can compare and evaluate local initiatives on the basis of the common healthcare administrative data.However reliability of such data in this context needs to be assessed, especially when comparing different regions of the country. In this paper we investigated the validity of healthcare administrative databases to compute indicators of compliance with standards of care for diabetes, ischaemic heart disease (IHD) and heart failure (HF). METHODS: We compared indicators estimated from healthcare administrative data collected by Local Health Authorities in five Italian regions with corresponding estimates from clinical data collected by General Practitioners (GPs). Four indicators of diagnostic follow-up (two for diabetes, one for IHD and one for HF) and four indicators of appropriate therapy (two each for IHD and HF) were considered. RESULTS: Agreement between the two data sources was very good, except for indicators of laboratory diagnostic follow-up in one region and for the indicator of bioimaging diagnostic follow-up in all regions, where measurement with administrative data underestimated quality. CONCLUSION: According to evidence presented in this study, estimating compliance with standards of care for diabetes, ischaemic heart disease and heart failure from healthcare databases is likely to produce reliable results, even though completeness of data on diagnostic procedures should be assessed first. Performing studies comparing regions using such indicators as outcomes is a promising development with potential to improve quality governance in the Italian healthcare system

A novel underdetermined source recovery algorithm based on k-sparse component analysis

Sparse component analysis (SCA) is a popular method for addressing underdetermined blind source separation in array signal processing applications. We are motivated by problems that arise in the applications where the sources are densely sparse (i.e. the number of active sources is high and very close to the number of sensors). The separation performance of current underdetermined source recovery (USR) solutions, including the relaxation and greedy families, reduces with decreasing the mixing system dimension and increasing the sparsity level (k). In this paper, we present a k-SCA-based algorithm that is suitable for USR in low-dimensional mixing systems. Assuming the sources is at most (m−1) sparse where m is the number of mixtures; the proposed method is capable of recovering the sources from the mixtures given the mixing matrix using a subspace detection framework. Simulation results show that the proposed algorithm achieves better separation performance in k-SCA conditions compared to state-of-the-art USR algorithms such as basis pursuit, minimizing norm-L1, smoothed L0, focal underdetermined system solver and orthogonal matching pursuit