Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder®), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilizing cycles in EA and previous seizure times. The procedures and devices were well-tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as visually confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88), which is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.
We suggest that a sensory neuronopathy should be sought in cerebellar and/or vestibular ataxias, particularly where the degree of ataxia is out of proportion to the clinically identified cerebellar and/or vestibular dysfunction.
This paper analyses seizure detection features and their combinations using a probability-based scalp EEG seizure detection framework developed by Marc Saab and Jean Gotman. Our method was evaluated on 525 h of data, including 88 seizures in 21 patients. The individual performances of the three features used by Saab and Gotman were compared to six alternative features, and combinations of these nine features were analyzed in order to find a superior detector. On a testing set with the combination of their three features, Saab and Gotman reported a sensitivity of 0.78, a false positive rate of 0.86/h, and a median detection delay of 9.8 s. Based on 10-fold cross-validation the testing performance of our implementation of their method achieved a sensitivity of 0.79, a false positive rate of 0.62/h, and a median detection delay of 21.3 s. A detector based on an alternative combination of features achieved sensitivity of 0.81, a false positive rate of 0.60/h, and a median detection delay of 16.9 s. By including filtering techniques, it was possible to achieve performance levels similar to Saab and Gotman using our implementation of their method, although this involved increases in detection delays. Of the seizure detection measures investigated, relative average amplitude, relative power, relative derivative, and coefficent of variation of amplitude provided the best performing combinations. These better-performing features can be employed together to make robust and reliable seizure detectors.
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