Automated real-time detection of tonic-clonic seizures using a wearable EMG device

Seizure detection: do current devices work? And when can they be useful?

PURPOSE OF REVIEW

The unpredictability and apparent randomness of epileptic seizures is one of the most vexing aspects of epilepsy. Methods or devices capable of detecting seizures may help prevent injury or even death and significantly improve quality of life. Here, we summarize and evaluate currently available, unimodal, or polymodal detection systems for epileptic seizures, mainly in the ambulatory setting.

RECENT FINDINGS

There are two broad categories of detection devices: EEG-based and non-EEG-based systems. Wireless wearable EEG devices are now available both in research and commercial arenas. Neuro-stimulation devices are currently evolving and initial experiences of these show potential promise. As for non-EEG devices, different detecting systems show different sensitivity according to the different patient and seizure types. Regardless, when used in combination, these modalities may complement each other to increase positive predictive value. Although some devices with high sensitivity are promising, practical widespread use of such detection systems is still some way away. More research and experience are needed to evaluate the most efficient and integrated systems, to allow for better approaches to detection and prediction of seizures. The concept of closed-loop systems and prompt intervention may substantially improve quality of life for patients and carers.

Epilepsy as a dynamic disease: A Bayesian model for differentiating seizure risk from natural variability

Objective

A fundamental challenge in treating epilepsy is that changes in observed seizure frequencies do not necessarily reflect changes in underlying seizure risk. Rather, changes in seizure frequency may occur due to probabilistic variation around an underlying seizure risk state caused by normal fluctuations from natural history, leading to seizure unpredictability and potentially suboptimal medication adjustments in epilepsy management. However, no rigorous statistical approach exists to systematically distinguish expected changes in seizure frequency due to natural variability from changes in underlying seizure risk.

Methods

Using data from SeizureTracker.com, a patient‐reported seizure diary tool containing over 1.2 million recorded seizures across 8 years, a novel epilepsy seizure risk assessment tool (EpiSAT) employing a Bayesian mixed‐effects hidden Markov model for zero‐inflated count data was developed to estimate changes in underlying seizure risk using patient‐reported seizure diary and clinical measurement data. Accuracy for correctly assessing underlying seizure risk was evaluated through a simulation comparison. Implications for the natural history of tuberous sclerosis complex (TSC) were assessed using data from SeizureTracker.com.

Results

EpiSAT led to significant improvement in seizure risk assessment compared to traditional approaches relying solely on observed seizure frequencies. Applied to TSC, four underlying seizure risk states were identified. The expected duration of each state was <12 months, providing a data‐driven estimate of the amount of time a person with TSC would be expected to remain at the same seizure risk level according to the natural course of epilepsy.

Significance

We propose a novel Bayesian statistical approach for evaluating seizure risk on an individual patient level using patient‐reported seizure diaries, which allows for the incorporation of external clinical variables to assess impact on seizure risk. This tool may improve the ability to distinguish true changes in seizure risk from natural variations in seizure frequency in clinical practice. Incorporation of systematic statistical approaches into antiepileptic drug (AED) management may help improve understanding of seizure unpredictability as well as timing of treatment interventions for people with epilepsy.

A Novel Feature Optimization for Wearable Human-Computer Interfaces Using Surface Electromyography Sensors

The novel human-computer interface (HCI) using bioelectrical signals as input is a valuable tool to improve the lives of people with disabilities. In this paper, surface electromyography (sEMG) signals induced by four classes of wrist movements were acquired from four sites on the lower arm with our designed system. Forty-two features were extracted from the time, frequency and time-frequency domains. Optimal channels were determined from single-channel classification performance rank. The optimal-feature selection was according to a modified entropy criteria (EC) and Fisher discrimination (FD) criteria. The feature selection results were evaluated by four different classifiers, and compared with other conventional feature subsets. In online tests, the wearable system acquired real-time sEMG signals. The selected features and trained classifier model were used to control a telecar through four different paradigms in a designed environment with simple obstacles. Performance was evaluated based on travel time (TT) and recognition rate (RR). The results of hardware evaluation verified the feasibility of our acquisition systems, and ensured signal quality. Single-channel analysis results indicated that the channel located on the extensor carpi ulnaris (ECU) performed best with mean classification accuracy of 97.45% for all movement’s pairs. Channels placed on ECU and the extensor carpi radialis (ECR) were selected according to the accuracy rank. Experimental results showed that the proposed FD method was better than other feature selection methods and single-type features. The combination of FD and random forest (RF) performed best in offline analysis, with 96.77% multi-class RR. Online results illustrated that the state-machine paradigm with a 125 ms window had the highest maneuverability and was closest to real-life control. Subjects could accomplish online sessions by three sEMG-based paradigms, with average times of 46.02, 49.06 and 48.08 s, respectively. These experiments validate the feasibility of proposed real-time wearable HCI system and algorithms, providing a potential assistive device interface for persons with disabilities.