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Register a new userSeizure pathways and seizure durations can vary independently within individual patients with focal epilepsy
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A seizures electrographic dynamics are characterised by its spatiotemporal evolution, also termed dynamical pathway and the time it takes to complete that pathway, which results in the seizures duration. Both seizure pathways and durations can vary within the same patient, producing seizures with different dynamics, severity, and clinical implications. However, it is unclear whether seizures following the same pathway will have the same duration or if these features can vary independently. We compared within-subject variability in these seizure features using 1) epilepsy monitoring unit intracranial EEG (iEEG) recordings of 31 patients (mean 6.7 days, 16.5 seizures/subject), 2) NeuroVista chronic iEEG recordings of 10 patients (mean 521.2 days, 252.6 seizures/subject), and 3) chronic iEEG recordings of 3 dogs with focal-onset seizures (mean 324.4 days, 62.3 seizures/subject). While the strength of the relationship between seizure pathways and durations was highly subject-specific, in most subjects, changes in seizure pathways were only weakly to moderately associated with differences in seizure durations. The relationship between seizure pathways and durations was weakened by seizures that 1) had a common pathway, but different durations (elastic pathways), or 2) had similar durations, but followed different pathways (duplicate durations). Even in subjects with distinct populations of short and long seizures, seizure durations were not a reliable indicator of different seizure pathways. These findings suggest that seizure pathways and durations are modulated by different processes. Uncovering such modulators may reveal novel therapeutic targets for reducing seizure duration and severity.
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Understanding brain dynamics in epilepsy is critical for establishing rigorous control objectives that enable new therapeutic methods to mitigate seizure occurrence. In multichannel electrocorticography (ECoG) recordings acquired in 21 subjects during a total of 94 seizures, we apply dynamical systems stability analysis to assess the balance versus imbalance of seizure dynamics across different timescales and brain regions. Specifically, we consider a sliding time window multivariate autoregressive linear approximation of the data captured by the ECoG channels, where eigendecomposition of the estimated matrix of coefficients describes the contribution of different regions to the spatiotemporal process (eigenvectors) associated with a particular timescale (eigenvalues). Interestingly, we observe a pattern of eigenvalue evolution and slowly changing (or approximately time-invariant) eigenvectors across both seizures and subjects. The seizure-onset is marked by an increase in high frequency spatial information to which a few regions contribute for a long period. By contrast, the seizure termination is characterized by a sudden, small time period change in dynamics to which many regions contribute. As the seizure terminates, the relatively stable ictal dynamics rapidly transition into the post-ictal regime, marked by relatively fast-damping oscillations. Our methodology offers a subject-specific characterization of the spatiotemporal behavior of the seizure, providing new insights into the dynamic patterns and functional interactions between brain regions that occur over different timescales. More generally, our approach informs the development of engineering objectives that can be used to deploy new control strategies to prevent seizure evolution or to hasten seizure termination.
Epileptic seizure forecasting, combined with the delivery of preventative therapies, holds the potential to greatly improve the quality of life for epilepsy patients and their caregivers. Forecasting seizures could prevent some potentially catastrophic consequences such as injury and death in addition to a long list of potential clinical benefits it may provide for patient care in hospitals. The challenge of seizure forecasting lies within the seemingly unpredictable transitions of brain dynamics into the ictal state. The main body of computational research on determining seizure risk has been focused solely on prediction algorithms, which involves a remarkable issue of balancing accuracy and false-alarms. In this paper, we developed a seizure-risk warning system that employs Bayesian convolutional neural network (BCNN) to provide meaningful information to the patient and provide a greater opportunity for him/her to be potentially more in charge of his/her health. We use scalp electroencephalogram (EEG) signals and release information on the certainty of our automatic seizure-risk assessment. In the process, we pave the ground-work towards incorporating auxiliary signals to improve our EEG-based seizure-risk assessment system. Our previous CNN results show an average AUC of 74.65% while we could achieve on an EEG-only BCNN an average AUC of 68.70%. This drop in performance is the cost of providing richer information to the patient at this stage of this research.
Electroencephalogram (EEG) is a prominent way to measure the brain activity for studying epilepsy, thereby helping in predicting seizures. Seizure prediction is an active research area with many deep learning based approaches dominating the recent literature for solving this problem. But these models require a considerable number of patient-specific seizures to be recorded for extracting the preictal and interictal EEG data for training a classifier. The increase in sensitivity and specificity for seizure prediction using the machine learning models is noteworthy. However, the need for a significant number of patient-specific seizures and periodic retraining of the model because of non-stationary EEG creates difficulties for designing practical device for a patient. To mitigate this process, we propose a Siamese neural network based seizure prediction method that takes a wavelet transformed EEG tensor as an input with convolutional neural network (CNN) as the base network for detecting change-points in EEG. Compared to the solutions in the literature, which utilize days of EEG recordings, our method only needs one seizure for training which translates to less than ten minutes of preictal and interictal data while still getting comparable results to models which utilize multiple seizures for seizure prediction.
Objective: To identify if whole-brain structural network alterations in patients with temporal lobe epilepsy (TLE) and focal to bilateral tonic-clonic seizures (FBTCS) differ from alterations in patients without FBTCS. Methods: We dichotomized a cohort of 83 drug-resistant patients with TLE into those with and without FBTCS and compared each group to 29 healthy controls. For each subject, we used diffusion MRI to construct whole-brain structural networks. First, we measured the extent of alterations by performing FBTCS-negative (FBTCS-) versus control and FBTCS-positive (FBTCS+) versus control comparisons, thereby delineating altered sub-networks of the whole-brain structural network. Second, by standardising networks of each patient using control networks, we measured the subject-specific abnormality at every brain region in the network, thereby quantifying the spatial localisation and the amount of abnormality in every patient. Results: Both FBTCS+ and FBTCS- patient groups had altered sub-networks with reduced fractional anisotropy (FA) and increased mean diffusivity (MD) compared to controls. The altered subnetwork in FBTCS+ patients was more widespread than in FBTCS- patients (441 connections altered at t>3, p<0.001 in FBTCS+ compared to 21 connections altered at t>3, p=0.01 in FBTCS-). Significantly greater abnormalities-aggregated over the entire brain network as well as assessed at the resolution of individual brain areas-were present in FBTCS+ patients (p<0.001, d=0.82). In contrast, the fewer abnormalities present in FBTCS- patients were mainly localised to the temporal and frontal areas. Significance: The whole-brain structural network is altered to a greater and more widespread extent in patients with TLE and FBTCS. We suggest that these abnormal networks may serve as an underlying structural basis or consequence of the greater seizure spread observed in FBTCS.
Automated seizure detection and classification from electroencephalography (EEG) can greatly improve the diagnosis and treatment of seizures. While prior studies mainly used convolutional neural networks (CNNs) that assume image-like structure in EEG signals or spectrograms, this modeling choice does not reflect the natural geometry of or connectivity between EEG electrodes. In this study, we propose modeling EEGs as graphs and present a graph neural network for automated seizure detection and classification. In addition, we leverage unlabeled EEG data using a self-supervised pre-training strategy. Our graph model with self-supervised pre-training significantly outperforms previous state-of-the-art CNN and Long Short-Term Memory (LSTM) models by 6.3 points (7.8%) in Area Under the Receiver Operating Characteristic curve (AUROC) for seizure detection and 6.3 points (9.2%) in weighted F1-score for seizure type classification. Ablation studies show that our graph-based modeling approach significantly outperforms existing CNN or LSTM models, and that self-supervision helps further improve the model performance. Moreover, we find that self-supervised pre-training substantially improves model performance on combined tonic seizures, a low-prevalence seizure type. Furthermore, our model interpretability analysis suggests that our model is better at identifying seizure regions compared to an existing CNN. In summary, our graph-based modeling approach integrates domain knowledge about EEG, sets a new state-of-the-art for seizure detection and classification on a large public dataset (5,499 EEG files), and provides better ability to identify seizure regions.
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