Feasibility of video/audio monitoring in the analysis of motion and treatment effects on night-time seizures - Interventional study

The aim of the study: This pilot study assessed the ability of a video/audio-based seizure monitoring system to evaluate (I) baseline frequency and severity of nocturnal seizures with motor features in patients with drugresistant epilepsy (DRE) and (II) the individual effect of brivaracetam (BRV) treatment on number, duration and movement intensity of these seizure types. Algorithmic feature analysis was developed for assessment of qualitative changes in movement intensity measurements within seizure types before and after BRV intervention. Materials and methods: Night-time motor seizures of recruited patients were recorded in two separate four-week monitoring periods. The first period defined a prescreening phase (n = 13 patients) to establish a baseline, and the second period defined the intervention phase (n = 9 patients), with BRV initiated during the second week of the second monitoring period. All recorded nights were analyzed by an expert video reviewer, and all unequivocal seizures were classified by an epileptologist. Seizure frequencies using both seizure diaries and video monitoring were compared. The effect of BRV on both seizure duration and movement intensity was assessed by numerical comparison of visual features calculated from motion characteristics of the video, as well as spectral features from the recorded audio. The statistical significance of changes in seizure duration and intensity before and after the intervention were investigated by Wilcoxon rank-sum test and visual inspection of Kernel density estimation. Results: 8 patients marked seizures in their seizure diaries during the prescreening phase. During the three-week follow-up, three patients achieved > 50% seizure decrease, four patients did not respond to treatment, and two patients experienced worsening of seizures. Five patients were able to document 40-70% of their seizures compared to the video/audio monitoring system. According to the signal feature analysis the intervention decreased movement intensity with clear clinical significance in three patients, whereas statistically significant differences in features appeared in 8 out of 9 patients. Conclusions: The novel video/audio monitoring system improved the evaluation of treatment effect compared to the seizure diaries and succeeded in providing a comparative intra-patient assessment of the movement intensity and duration of the recorded seizures.Peer reviewe

Automatic classification of hyperkinetic, tonic, and tonic-clonic seizures using unsupervised clustering of video signals

IntroductionThis study evaluated the accuracy of motion signals extracted from video monitoring data to differentiate epileptic motor seizures in patients with drug-resistant epilepsy. 3D near-infrared video was recorded by the Nelli® seizure monitoring system (Tampere, Finland).Methods10 patients with 130 seizures were included in the training dataset, and 17 different patients with 98 seizures formed the testing dataset. Only seizures with unequivocal hyperkinetic, tonic, and tonic-clonic semiology were included. Motion features from the catch22 feature collection extracted from video were explored to transform the patients' videos into numerical time series for clustering and visualization.ResultsChanges in feature generation provided incremental discrimination power to differentiate between hyperkinetic, tonic, and tonic-clonic seizures. Temporal motion features showed the best results in the unsupervised clustering analysis. Using these features, the system differentiated hyperkinetic, tonic and tonic-clonic seizures with 91, 88, and 45% accuracy after 100 cross-validation runs, respectively. F1-scores were 93, 90, and 37%, respectively. Overall accuracy and f1-score were 74%.ConclusionThe selected features of motion distinguished semiological differences within epileptic seizure types, enabling seizure classification to distinct motor seizure types. Further studies are needed with a larger dataset and additional seizure types. These results indicate the potential of video-based hybrid seizure monitoring systems to facilitate seizure classification improving the algorithmic processing and thus streamlining the clinical workflow for human annotators in hybrid (algorithmic-human) seizure monitoring systems

PO-279 Bidirectional Associations Between Physical Activity and Adiposity From Childhood to Early Adulthood

Objective Inverse association between physical activity and adiposity in children and adolescents have been documented in numerous studies. However, few studies have examined the direction of causation between these two variables. We aimed to examine the prospective bidirectional associations between physical activity and adiposity from childhood to early adulthood. Methods A total of 396 girls (mean age, 11.2 years at baseline) participated in a longitudinal study with 1, 2, 4, and 7 year follow-ups. Body height and weight were measured, body composition was assessed by DXA and BMI and fat mass index (FMI) were calculated. Leisure-time physical activity (LTPA) and physical inactivity was obtained from questionnaire and physical activity score and inactivity time was calculated. A bivariate cross-lagged panel model was used to estimate the bidirectional associations between physical activity and measures of adiposity across follow-up waves. We further examined whether persistently high or persistently low physical activity or change of physical activity level from low to high and high to low during pubertal years had differential effects on adiposity. For this, the study participants were first divided into two groups according to the median values of their LTPA scores at baseline and at the 7 year follow-up visit. Then four activity groups were formed: consistently high (CH), consistently low (CL), change from high to low (HL), and change from low to high (LH). Analysis of variance (ANOVA) with least significant difference post hoc test was used to compare differences in adiposity between the LTPA groups. Results BMI at each measurement wave strongly predicted subsequent BMI (standardized path coefficients ranged from 0.87 to 0.95, p < 0.001 for all). Similar pattern was observed for LTPA and physical inactivity, though the path coefficients tended to be notably smaller. This auto-regressive part of the model indicates that the temporal stability of BMI from childhood to early adulthood is higher than the temporal stability of LTPA or physical inactivity over the same time period. The cross-lagged effects indicated that higher BMI at baseline and at 4-year follow-up predicted lower LTPA at 2-year and 7-year follow-ups, respectively (p<0.05 for both), but LTPA did not predict subsequent BMI at any time point. Similarly, higher FMI at baseline and at 2-year follow-up predicted lower LTPA at subsequent follow-up waves (p<0.05 for both). No associations were found between sedentary time and adiposity between any time points. The difference in participation in LTPA between consistently high and consistently low PA groups were on average 4 hours per week (p<0.001); however, no significant difference in FMI was found at baseline, 2-year or 7-year follow-up). Similarly, no significant difference in FMI was found between the groups whose LTPA level changed from high to low or from low to high.  Conclusions Our results suggest that reduced physical activity in children and adolescents is the result of increased fatness rather than its cause. Current physical activity recommendations may not be sufficient to combat pediatric obesity

Feasibility of video/audio monitoring in the analysis of motion and treatment effects on night-time seizures - Interventional study

The aim of the study: This pilot study assessed the ability of a video/audio-based seizure monitoring system to evaluate (I) baseline frequency and severity of nocturnal seizures with motor features in patients with drugresistant epilepsy (DRE) and (II) the individual effect of brivaracetam (BRV) treatment on number, duration and movement intensity of these seizure types. Algorithmic feature analysis was developed for assessment of qualitative changes in movement intensity measurements within seizure types before and after BRV intervention.Materials and methods: Night-time motor seizures of recruited patients were recorded in two separate four-week monitoring periods. The first period defined a prescreening phase (n = 13 patients) to establish a baseline, and the second period defined the intervention phase (n = 9 patients), with BRV initiated during the second week of the second monitoring period. All recorded nights were analyzed by an expert video reviewer, and all unequivocal seizures were classified by an epileptologist.Seizure frequencies using both seizure diaries and video monitoring were compared.The effect of BRV on both seizure duration and movement intensity was assessed by numerical comparison of visual features calculated from motion characteristics of the video, as well as spectral features from the recorded audio. The statistical significance of changes in seizure duration and intensity before and after the intervention were investigated by Wilcoxon rank-sum test and visual inspection of Kernel density estimation.Results: 8 patients marked seizures in their seizure diaries during the prescreening phase. During the three-week follow-up, three patients achieved > 50% seizure decrease, four patients did not respond to treatment, and two patients experienced worsening of seizures. Five patients were able to document 40-70% of their seizures compared to the video/audio monitoring system. According to the signal feature analysis the intervention decreased movement intensity with clear clinical significance in three patients, whereas statistically significant differences in features appeared in 8 out of 9 patients.Conclusions: The novel video/audio monitoring system improved the evaluation of treatment effect compared to the seizure diaries and succeeded in providing a comparative intra-patient assessment of the movement intensity and duration of the recorded seizures

PL - 036 Interactive effects of exercise and metformin on lactic metabolism in type 2 diabetes

Objective Lactic acidosis is typically caused by an imbalance in lactic metabolism. This may be attributed to several reasons and is usually a result of complex interactions. There may be an increased risk for lactic acidosis in type 2 diabetes mellitus (T2D) patients when metformin treatment and physical exercise are combined since both metformin and exercise acutely affect lactic metabolism. As timing of exercise following metformin ingestion may determine the magnitude of long-term metabolic adaptations, this study aimed to test the acute effects of exercise performed at different times following metformin ingestion on lactic metabolism in T2D patients with a randomized crossover time series study design. Methods Participants were recruited from two clinical health-care centers in China using a two-step screening procedure. First, approximately 2 523 patients with T2D were screened from the local diabetes database and clinical outpatient registration with inclusion criteria being men and women (30–65 years old) diagnosed with T2D no more than 5 years ago and treated with metformin (maximal daily dose of 2000 mg). Out of 100 potential participants who met the inclusion criteria, 56 were interested and invited to a laboratory visit. Finally, 34 patients participated in the study and of those, 26 patients (14 women and 12 men, mean age = 53.8 ± 8.6 years) completed all testing procedures. All patients visited the laboratory on 4 occasions, each separated by at least 48 hours. Initially a control visit was performed and consisted of metformin administration only (Metf) and a maximal incremental cycle ergometer test in the afternoon. Thereafter, all participants performed a high-intensity interval training session (HIIT, 3 minutes at 40% followed by 1 minute of 85% of maximum power output) 30 minutes (EX30), 60 minutes (EX60), and 90 minutes (EX90) post breakfast and metformin administration, respectively, in a randomized order. Serum lactate and glucose concentrations were assessed enzymatically, while insulin was assessed by an electrochemiluminescence immunoassay and superoxide dismutase (SOD) activity was determined by spectrophotometry. Measurements were performed before breakfast as well as both before and immediately after each exercise bout. In addition, capillary blood glucose concentrations were measured immediately after sampling using Omron AS1 glucose test strips (HGM-114) and lactate concentrations were assessed by ARKRAY Lactate Pro 2 test strips throughout each measurement day. Dietary intake was standardized on the evening prior to each laboratory day as well as between 8:00 a.m. and 4:00 p.m. during each testing day. This trial is registered with ChiCTR-IOR-16008469 on 13th of May 2016. Results During all three-exercise sessions, the capillary lactate concentrations were significantly increased to a similar extent. However, sixty minutes following metformin administration, serum lactate levels began to accumulate to the highest level, where 30% of patients showed lactate concentrations above resting values (≥2 mmol·L-1). The increased lactate concentrations were statistically associated with increased glucose when exercise was performed 60 minutes post metformin administration (r=0.384, p=0.048). Furthermore, in EX60 and EX90 lactate concentrations were 19% and 8% higher, respectively, compared to EX30. In addition, we found that after exercise but not before exercise, the lactate level was positively correlated with SOD (EX30 r=0.478 and p=0.012, EX60 r=0.562 and p=0.002, EX90 r=0.562 and p=0.003, respectively). Conclusions We found that the changes of lactate concentrations were related to the timing of exercise post meal and after metformin ingestion. Thus, timing of exercise appears to be an important factor to be considered when prescribing exercise for T2D patients treated with metformin. In the present study, the optimal timing of HIIT exercise was 30 minutes after metformin administration, which was indicated by a minimized fluctuation of both glucose and lactate levels in T2D patients. Our results also suggest that lactic metabolism and oxidative stress could be among the main underlying molecular mechanisms that elucidate the combinational therapy of exercise and metformin treatment on T2D. Since both acute exercise and metformin may induce opposite effects on ATP production and reactive oxygen species formation, it is important to conduct further studies in an attempt to define the “safe time” for exercise after metformin administration

Interactive effects of aging and aerobic capacity on energy metabolism-related metabolites of serum, skeletal muscle, and white adipose tissue

Aerobic capacity is a strong predictor of longevity. With aging, aerobic capacity decreases concomitantly with changes in whole body metabolism leading to increased disease risk. To address the role of aerobic capacity, aging, and their interaction on metabolism, we utilized rat models selectively bred for low and high intrinsic aerobic capacity (LCRs/HCRs) and compared the metabolomics of serum, muscle, and white adipose tissue (WAT) at two time points: Young rats were sacrificed at 9 months of age, and old rats were sacrificed at 21 months of age. Targeted and semi-quantitative metabolomics analysis was performed on the ultra-pressure liquid chromatography tandem mass spectrometry (UPLC-MS) platform. The effects of aerobic capacity, aging, and their interaction were studied via regression analysis. Our results showed that high aerobic capacity is associated with an accumulation of isovalerylcarnitine in muscle and serum at rest, which is likely due to more efficient leucine catabolism in muscle. With aging, several amino acids were downregulated in muscle, indicating more efficient amino acid metabolism, whereas in WAT less efficient amino acid metabolism and decreased mitochondrial beta-oxidation were observed. Our results further revealed that high aerobic capacity and aging interactively affect lipid metabolism in muscle and WAT, possibly combating unfavorable aging-related changes in whole body metabolism. Our results highlight the significant role of WAT metabolism for healthy aging.Peer reviewe

Effects of operational assessment of the 4:4 and 4:4/6:6 watch systems on sleepiness, fatigue, and stress responses during patrolling on a navy missile patrol boat

The operation of naval vessels involves watchkeeping 24 h per day, which is globally carried out by a variety of different watch systems. In this study, the rotating 4:4 and fixed 4:4/6:6 two-section watch systems were compared in terms of sleepiness, fatigue, and stress responses. The data collection took place on a Finnish Defence Forces' (FDF) Navy missile patrol boat with 15 crew members serving as study participants. The data collection periods lasted two separate weeks (7 days, 6 nights) with the different watch systems. The subjective sleepiness of the participants was assessed before and after every watch using the Karolinska Sleepiness Scale (KSS). Stress responses were assessed daily by the recorded levels of salivary alpha-amylase (sAA), cortisol (sCor), immunoglobulin A (sIgA), and dehydroepiandrosterone (sDHEA). The participants' sustained attention, inhibitory control, and working memory were assessed daily by cognitive tests (SART, N-Back). The heart rate variability (HRV) during an orthostatic test was used as an additional daily marker to assess the amount of psychological stress of the participants. In this study, the difference regarding sleepiness and fatigue between the study weeks was most visible in the subjective KSS, which clearly favored the 4:4/6:6 system. The results of sAA and sIgA also suggested that the subjects were psychologically less stressed during the study week with the 4:4/6:6 watch system. Cognitive test results (SART, N-Back) indicated that there were overall no significant differences in the subjects' sustained attention, inhibitory control, or working memory during the study weeks or between the study weeks. The results of the HRV data during the daily orthostatic tests were inconclusive but there was some indication that the subjects were less stressed during the study week with the 4:4/6:6 watch system. In conclusion, the present study indicates that in navy surface operations: working with the fixed 4:4/6:6 watch system causes less sleepiness, fatigue, and psychological stress than working with the rotating 4:4 watch system. The study result is well in line with previous research regarding watch systems

The Effects of Individual Characteristics of the Naval Personnel on Sleepiness and Stress during Two Different Watchkeeping Schedules

Background: Naval service can have a significant impact on the wellbeing of seafarers, and the operation of warships is highly dependent on the personnel on board. Nevertheless, there is a lack of knowledge concerning the impact of seafarers' individual characteristics on their wellbeing in a naval environment. Therefore, the aim of this study was to investigate individual characteristics of the naval personnel that may be associated with the amount of sleepiness, fatigue and stress responses experienced during shift work and irregular working hours in a naval environment. Methods: The study took place on a Finnish Defence Forces' Navy missile patrol boat on which 18 crewmembers served as study participants. The measurement periods lasted two separate weeks (seven days and six nights) during shift work with two different watchkeeping systems (4:4, 4:4/6:6). The onboard measurements consisted of the Karolinska Sleepiness Scale, salivary stress hormones, cognitive tests (Sustained Attention to Response Task and N-back Task) and heart rate variability. Results: Participants of older ages or with a longer history in naval service were associated with a greater amount of sleepiness, fatigue and stress responses on board. On the contrary, increased physical activity and a higher level of physical fitness, especially standing long jump, were associated with a lower amount of sleepiness, fatigue and fewer stress responses. In addition, an athletic body composition together with a healthy lifestyle may be beneficial, considering the stress responses on board. Conclusion: The present results are well in line with the previous literature regarding shift work and irregular working hours. The results highlight the importance of regular physical activity and good physical fitness during service in the naval environment

The Effects of Individual Characteristics of the Naval Personnel on Sleepiness and Stress during Two Different Watchkeeping Schedules

Background: Naval service can have a significant impact on the wellbeing of seafarers, and the operation of warships is highly dependent on the personnel on board. Nevertheless, there is a lack of knowledge concerning the impact of seafarers’ individual characteristics on their wellbeing in a naval environment. Therefore, the aim of this study was to investigate individual characteristics of the naval personnel that may be associated with the amount of sleepiness, fatigue and stress responses experienced during shift work and irregular working hours in a naval environment. Methods: The study took place on a Finnish Defence Forces’ Navy missile patrol boat on which 18 crewmembers served as study participants. The measurement periods lasted two separate weeks (seven days and six nights) during shift work with two different watchkeeping systems (4:4, 4:4/6:6). The onboard measurements consisted of the Karolinska Sleepiness Scale, salivary stress hormones, cognitive tests (Sustained Attention to Response Task and N-back Task) and heart rate variability. Results: Participants of older ages or with a longer history in naval service were associated with a greater amount of sleepiness, fatigue and stress responses on board. On the contrary, increased physical activity and a higher level of physical fitness, especially standing long jump, were associated with a lower amount of sleepiness, fatigue and fewer stress responses. In addition, an athletic body composition together with a healthy lifestyle may be beneficial, considering the stress responses on board. Conclusion: The present results are well in line with the previous literature regarding shift work and irregular working hours. The results highlight the importance of regular physical activity and good physical fitness during service in the naval environment.publishedVersionPeer reviewe