Elsevier

Clinical Neurophysiology

Volume 116, Issue 10, October 2005, Pages 2460-2472
Clinical Neurophysiology

An automatic warning system for epileptic seizures recorded on intracerebral EEGs

https://doi.org/10.1016/j.clinph.2005.05.020Get rights and content

Abstract

Objective

A new clinical seizure waning system for intracerebral EEG is proposed. It is aimed at a better performance than existing systems and at user tuneability.

Methods

The system employs data filtering in multiple bands, spectral feature extraction, Bayes' theorem, and spatio-temporal analysis. The a priori information in Bayes' theorem was provided by 407 h of EEG from 19 patients having 152 seizures.

Results

The testing data (19 patients, 389 h, 100 seizures, independent of the training data) yielded a sensitivity of 89.4%, a false detection rate of 0.22/h, and median delay time of 17.1 s when tuning was used, and 86%, 0.47/h and 16.2 s without tuning. Missed seizures were of short duration or had subtle seizure activity. False detections were caused by technical artefacts, non-epileptic large amplitude rhythmic bursts or very low amplitude activity. It was established that performance could easily be tuned. Results were also compared to the clinical system of Gotman (1990).

Conclusions

The system offers a performance that is acceptable for clinical use. User tuneability allows for reduction in false detection with minimal loss to sensitivity.

Significance

Epilepsy monitoring generates large amounts of recordings and requires intense observation. Automatic seizure detection and warning systems reduce review time and facilitate observation. We propose a method with high sensitivity and few false alarms.

Introduction

Long term electroencephalogram (EEG) monitoring is required to analyze and characterize seizures and other epileptic activity. This can often be prolonged, lasting several days or weeks, and can become time consuming and expensive, as it is difficult to have enough personnel available to monitor patients at all times or to review all EEGs. As a result, automatic seizure detection systems have become an important component of EEG monitoring because they improve the cost of prolonged monitoring by reducing the amount of data that need to be reviewed (Gotman et al., 1997). In addition to detection systems, warning systems have also become increasingly valuable as detections of seizures at an early stage cannot only warn the patient that a seizure is occurring, but also alert medical staff, and allow them to perform behavioural testing to further asses which specific functions may be impaired as a result of a seizure and help them in localizing the source of the seizure activity.

The task of designing a reliable automatic seizure detection and onset warning system is difficult. The systems not only require high sensitivity, but low false detection rates and short detection delays as well. Although numerous attempts have been made, their performances are far from ideal and can use significant improvement. Currently, the method most commonly used clinically for scalp and depth electrodes is that of Gotman, 1982, Gotman, 1990 with an overall sensitivity of 75.8% for both scalp and depth electrodes and a false detection rate of 0.84/h for scalp EEG and 1.35/h for depth EEG. A newer detection and onset warning system, designed by Saab and Gotman (in press), for scalp electrodes is based on determining the seizure probability of a section of EEG using Bayesian formulation. Designed specifically for clinical use, this system features a user-tuneable threshold, which allows for trade-off between sensitivity, detection delay, and rate of false detection. Results indicate a sensitivity of 76%, a false detection rate of 0.34/h and a median detection delay of 10 s.

The premise for the seizure detection and onset warning system proposed here is the work described by Saab and Gotman (in press). However, it is specifically designed for use with intracerebral electrodes. Differences between the two algorithms come into effect because of the differences between the two types of recordings. Unlike scalp EEG recordings, intracerebral recordings are relatively free of technical artefacts but contain seizures of a greater variety of morphologies, and lower and higher frequencies. In addition, the intracerebral EEG has a lot of non-epileptic activity with prominent rhythmic characteristics.

Section snippets

Data selection

The depth EEG data used in this study were all collected using the Stellate Harmonie System for EEG monitoring from the Epilepsy Telemetry Unit at the Montreal Neurological Institute and Hospital. Once filtered between 0.5 and 70 Hz, data were sampled at 200 Hz. All patients had predominantly stainless steel depth electrodes of nine contacts surgically inserted inside the brain with contacts located 5 mm apart. Some patients also had epidural peg electrodes. Patients were not pre-screened, but

Results

This section will present the results obtained for the training and testing data. Results will also be presented for the Gotman (1990) system, which is commonly used.

Results will be presented on a per-patient basis and as averages for all patients, to avoid biasing by one particular patient. There were three measures of performance: false detections, delay times and sensitivity. False detections were events identified by the automatic detection system but not by the EEG experts. Since the

Discussion

The purpose of this study was to develop an online automatic seizure detection and warning system for clinical use in patients with intracerebral electrodes. The goal was to design a system with high sensitivity, low false detection rate, and low delay times resulting in early detections. Unlike past systems, which employed patient-specific algorithms, this work was designed to run independently of patient-specific seizure data and no patient training at run time. Furthermore, rather than

Acknowledgements

This work was supported by grant number MOP-10189 from the Canadian Institutes of Health Research. J. Gotman is a major shareholder of Stellate, a company that makes equipment for long-term monitoring in epilepsy.

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