A novel wavelet-based algorithm for real-time detection of epileptic seizures using scalp EEG is proposed. In a moving-window analysis, the EEG from each channel is decomposed by wavelet packet transform. Using wavelet coefficients from seizure and nonseizure references, a patient-specific measure is developed to quantify the separation between seizure and nonseizure states for the frequency range of 1-30 Hz. Utilizing this measure, a frequency band representing the maximum separation between the two states is determined and employed to develop a normalized index, called combined seizure index (CSI). CSI is derived for each epoch of every EEG channel based on both rhythmicity and relative energy of that epoch as well as consistency among different channels. Increasing significantly during ictal states, CSI is inspected using one-sided cumulative sum test to generate proper channel alarms. Analyzing alarms from all channels, a seizure alarm is finally generated. The algorithm was tested on scalp EEG recordings from 14 patients, totaling approximately 75.8 h with 63 seizures. Results revealed a high sensitivity of 90.5%, a false detection rate of 0.51 h(-1) and a median detection delay of 7 s. The algorithm could also lateralize the focus side for patients with temporal lobe epilepsy.
In this study we evaluated a technique for tremor suppression with functional electrical stimulation (FES), the technical details of which were described in the previous paper. Three groups of patients were investigated: those with essential tremor, parkinsonian tremor, and cerebellar tremor associated with multiple sclerosis. In each group, tremor was attenuated by significant amounts (essential tremor: 73%; parkinsonian tremor: 62%; cerebellar tremor: 38%). These attenuations were in good accord with predictions based on the dynamic analyses and filter designs derived in the previous paper. With filters "tuned" to the lower mean tremor frequency encountered in the cerebellar patients, more attenuation was possible in this group as well. We identified some practical limitations in the clinical application of the technique in its present form. The most important was that in daily use, only one antagonist pair of muscles can realistically be controlled. At first sight, this restricts the usefulness of the system to patients with single-joint tremors. However, the concomitant use of mechanical orthoses may broaden the scope of application.
The rate of occurrence of NCSE in patients with decreased level of consciousness was 9.3%. The cohort represented a group of patients who were comatose and required assisted ventilation or had altered level of consciousness. Hypoxic brain injury was the most responsible etiology of NCSE in the cohort studied.
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