Accurate identification of EEG recordings with interictal epileptiform discharges using a hybrid approach: Artificial intelligence supervised by human experts

Kural, Mustafa Aykut; Jin, Jing; Fürbass, Franz; Perko, Hannes; Qerama, Erisela; Johnsen, Birger; Fuchs, Steffen; Westover, M. Brandon; Beniczky, Sándor

doi:10.1111/epi.17206

Cited by 37 publications

(28 citation statements)

References 46 publications

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“…Refs. 86 , 87 ) would ease the objective comparison of the performance of both MEG systems, yet this was beyond the scope of the current manuscript.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive measurements of ictal and interictal epileptiform activity using optically pumped magnetometers

Hillebrand

Holmes

Sijsma

et al. 2023

Sci Rep

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Magneto- and electroencephalography (MEG/EEG) are important techniques for the diagnosis and pre-surgical evaluation of epilepsy. Yet, in current cryogen-based MEG systems the sensors are offset from the scalp, which limits the signal-to-noise ratio (SNR) and thereby the sensitivity to activity from deep structures such as the hippocampus. This effect is amplified in children, for whom adult-sized fixed-helmet systems are typically too big. Moreover, ictal recordings with fixed-helmet systems are problematic because of limited movement tolerance and/or logistical considerations. Optically Pumped Magnetometers (OPMs) can be placed directly on the scalp, thereby improving SNR and enabling recordings during seizures. We aimed to demonstrate the performance of OPMs in a clinical population. Seven patients with challenging cases of epilepsy underwent MEG recordings using a 12-channel OPM-system and a 306-channel cryogen-based whole-head system: three adults with known deep or weak (low SNR) sources of interictal epileptiform discharges (IEDs), along with three children with focal epilepsy and one adult with frequent seizures. The consistency of the recorded IEDs across the two systems was assessed. In one patient the OPMs detected IEDs that were not found with the SQUID-system, and in two patients no IEDs were found with either system. For the other patients the OPM data were remarkably consistent with the data from the cryogenic system, noting that these were recorded in different sessions, with comparable SNRs and IED-yields overall. Importantly, the wearability of OPMs enabled the recording of seizure activity in a patient with hyperkinetic movements during the seizure. The observed ictal onset and semiology were in agreement with previous video- and stereo-EEG recordings. The relatively affordable technology, in combination with reduced running and maintenance costs, means that OPM-based MEG could be used more widely than current MEG systems, and may become an affordable alternative to scalp EEG, with the potential benefits of increased spatial accuracy, reduced sensitivity to volume conduction/field spread, and increased sensitivity to deep sources. Wearable MEG thus provides an unprecedented opportunity for epilepsy, and given its patient-friendliness, we envisage that it will not only be used for presurgical evaluation of epilepsy patients, but also for diagnosis after a first seizure.

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“…Refs. 86 , 87 ) would ease the objective comparison of the performance of both MEG systems, yet this was beyond the scope of the current manuscript.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive measurements of ictal and interictal epileptiform activity using optically pumped magnetometers

Hillebrand

Holmes

Sijsma

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Use of more sophisticated algorithms for the identification of interictal abnormalities (e.g. da Silva Lourenço et al (2021); Kural et al (2022)) would ease the objective comparison of the performance of both MEG systems, yet this was beyond the scope of the current manuscript.…”

Section: Limitations On Identification Of Iedsmentioning

confidence: 97%

Improved non-invasive detection of ictal and interictal epileptiform activity using Optically Pumped Magnetometers

Hillebrand

Holmes

Sijsma

et al. 2022

Preprint

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Magneto- and Electroencephalography (MEG/EEG) are important techniques for the diagnosis and pre-surgical evaluation of epilepsy. Yet, in current cryogen-based MEG systems the sensors are offset from the scalp, which limits the signal-to-noise ratio (SNR) and thereby the sensitivity to activity from deep structures such as the hippocampus. This effect is amplified in children, for whom adult-sized fixed-helmet systems are typically too big. Moreover, ictal recordings with fixed-helmet systems are problematic because of limited movement tolerance. Optically Pumped Magnetometers (OPMs) can be placed directly on the scalp, thereby improving SNR and consequently the sensitivity to, and localisation accuracy of, epileptiform activity. In addition, recording during seizures becomes feasible with these wearable sensors. We aimed to demonstrate these advantages of OPMs in a clinical population. Three adults with known weak sources of interictal epileptiform discharges (IEDs), along with three children with focal epilepsy and one adult with frequent seizures underwent MEG recordings using a 12-channel OPM-system and a 306-channel cryogen-based whole-head system. Performance of the two systems was compared in terms of IED-rate and SNR. In one patient the OPMs detected IEDs that were not found with the SQUID-system. In one patient the spike yield was higher for the OPM data (9.00 versus 6.76), with negligible difference in SNR compared to the SQUID data (3.85 versus 3.93; U = -2.86, d = -0.14). This was also the case for a patient with a spike yield that was comparable to that for the SQUID data (after accounting for unilateral coverage with the OPMs; SNR 4.47 versus 4.57; U = -3.81, d = -0.14). For one patient the spike yield (11.03 versus 24.50) and SNR (4.39 versus 4.05; U = 9.53, d = -0.36) were both lower for the OPMs. In two patients no IEDs were found with either system. Importantly, the wearability of OPMs enabled the recording of seizure activity in a patient with hyperkinetic movements during the seizure. The observed ictal onset and semiology were in agreement with previous video- and stereo-EEG recordings. Overall, OPM data were very much comparable to those obtained with a cryogenic system: OPMs outperformed SQUIDs for two of the four patients with IEDs, with either a higher spike yield, or an ability to detect IEDs that were not observable in the SQUID data. For three patients the SNRs of IEDs were (slightly) lower in the OPM data than in the SQUID data, but with negligible effect sizes for two of these patients. The relatively cheap technology, in combination with reduced running and maintenance costs, means that OPM-based MEG could be used more widely than current MEG systems, and may become an affordable alternative to scalp EEG, with the potential benefits of increased spatial accuracy, reduced sensitivity to volume conduction/field spread, and increased sensitivity to deep sources. Wearable MEG thus provides an unprecedented opportunity for epilepsy, and given its patient-friendliness, we envisage that it will not only be used for presurgical evaluation of epilepsy patients, but also for diagnosis after a first seizure.

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“…These queries may be used "in the loop" or "out of the loop". With the former, clinicians may need to modify treatment options based on data that the BCI reads; e.g., confirming that Hull has correctly detected seizures and responded appropriately [37,38]. The latter refers to interactive queries used by technicians to debug system operations, by clinicians to glean the individual's medical history, and by researchers to better understand brain function.…”

Section: Introductionmentioning

confidence: 99%

A Multi-Site Accelerator-Rich Processing Fabric for Scalable Brain-Computer Interfacing

Sriram¹,

Pothukuchi²,

Michał³

et al. 2023

Preprint

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Hull 1 is an accelerator-rich distributed implantable brain-computer interface (BCI) that reads biological neurons at data rates that are 2-3 orders of magnitude higher than the prior art, while supporting many neuroscientific applications. Prior approaches have restricted brain interfacing to tens of megabits per second in order to meet two constraints necessary for effective operation and safe long-term implantation-power dissipation under tens of milliwatts and response latencies in the tens of milliseconds. Hull also adheres to these constraints, but is able to interface with the brain at much higher data rates, thereby enabling, for the first time, BCI-driven research on and clinical treatment of brain-wide behaviors and diseases that require reading and stimulating many brain locations. Central to Hull's power efficiency is its realization as a distributed system of BCI nodes with accelerator-rich compute. Hull balances modular system layering with aggressive cross-layer hardware-software co-design to integrate compute, networking, and storage. The result is a lesson in designing networked distributed systems with hardware accelerators from the ground up.

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Accurate identification of EEG recordings with interictal epileptiform discharges using a hybrid approach: Artificial intelligence supervised by human experts

Cited by 37 publications

References 46 publications

Non-invasive measurements of ictal and interictal epileptiform activity using optically pumped magnetometers

Non-invasive measurements of ictal and interictal epileptiform activity using optically pumped magnetometers

Improved non-invasive detection of ictal and interictal epileptiform activity using Optically Pumped Magnetometers

A Multi-Site Accelerator-Rich Processing Fabric for Scalable Brain-Computer Interfacing

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