Multimodal wearable EEG, EMG and accelerometry measurements improve the accuracy of tonic-clonic seizure detection.

Objective. This paper aims to investigate the possibility of detecting tonic-clonic seizures (TCSs) with behind-the-ear, two-channel wearable electroencephalography (EEG), and to evaluate its added value to non-EEG modalities in TCS detection.Methods. We included 27 participants with a total of 44 TCSs from the European multicenter study SeizeIT2. The wearable Sensor Dot (Byteflies) was used to measure behind-the-ear EEG, electromyography (EMG), electrocardiography, accelerometry (ACC) and gyroscope. We evaluated automatic unimodal detection of TCSs, using sensitivity, precision, false positive rate (FPR) and F1-score. Subsequently, we fused the different modalities and again assessed performance. Algorithm-labeled segments were then provided to two experts, who annotated true positive TCSs, and discarded false positives.Results. Wearable EEG outperformed the other single modalities with a sensitivity of 100% and a FPR of 10.3/24 h. The combination of wearable EEG and EMG proved most clinically useful, delivering a sensitivity of 97.7%, an FPR of 0.4/24 h, a precision of 43%, and an F1-score of 59.7%. The highest overall performance was achieved through the fusion of wearable EEG, EMG, and ACC, yielding a sensitivity of 90.9%, an FPR of 0.1/24 h, a precision of 75.5%, and an F1-score of 82.5%.Conclusions. In TCS detection with a wearable device, combining EEG with EMG, ACC or both resulted in a remarkable reduction of FPR, while retaining a high sensitivity.Significance. Adding wearable EEG could further improve TCS detection, relative to extracerebral-based systems.

Learning Robust Representations of Tonic-Clonic Seizures With Cyclic Transformer.

Tonic-clonic seizures (TCSs) pose a significant risk for sudden unexpected death in epilepsy (SUDEP). Previous research has highlighted the potential of multimodal wearable seizure detection systems in accurately detecting TCSs through continuous monitoring, enabling timely alarms and potentially preventing SUDEP. However, such multimodal systems carry a higher risk of sensor malfunction. In this paper, we propose a cyclic transformer approach to address these challenges. The cyclic transformer learns a robust representation by performing circular modal translations between the source and target modalities. It leverages back-translation as regularization technique to enhance the discriminative power of the learned representation. Notably, the proposed cyclic transformer is trained on paired multimodal data but requires only a single source modality during deployment. This characteristic ensures the robustness of the cyclic transformer to perturbations or missing information in the target modality. Experimental results demonstrate that the proposed cyclic transformer achieves competitive performance compared with existing multimodal systems. While both approaches were trained using EEG and EMG data, the cyclic transformer exclusively employs EEG data for testing, diverging from the state-of-the-art's utilization of both EEG and EMG data during test. This showcases the effectiveness of the cyclic transformer in multimodal TCSs detection, offering a promising approach for enhancing the accuracy and robustness of seizure detection systems while mitigating the risks associated with sensor malfunction.

CoRe-Sleep: A Multimodal Fusion Framework for Time Series Robust to Imperfect Modalities.

Sleep abnormalities can have severe health consequences. Automated sleep staging, i.e. labelling the sequence of sleep stages from the patient's physiological recordings, could simplify the diagnostic process. Previous work on automated sleep staging has achieved great results, mainly relying on the EEG signal. However, often multiple sources of information are available beyond EEG. This can be particularly beneficial when the EEG recordings are noisy or even missing completely. In this paper, we propose CoRe-Sleep, a Coordinated Representation multimodal fusion network that is particularly focused on improving the robustness of signal analysis on imperfect data. We demonstrate how appropriately handling multimodal information can be the key to achieving such robustness. CoRe-Sleep tolerates noisy or missing modalities segments, allowing training on incomplete data. Additionally, it shows state-of-the-art performance when testing on both multimodal and unimodal data using a single model on SHHS-1, the largest publicly available study that includes sleep stage labels. The results indicate that training the model on multimodal data does positively influence performance when tested on unimodal data. This work aims at bridging the gap between automated analysis tools and their clinical utility.

Detecting Epileptic Seizures Using Hand-Crafted and Automatically Constructed EEG Features.

Epileptic seizure detection aims to replace unreliable seizure diaries by a model that automatically detects seizures based on electroencephalography (EEG) sensors. However, developing such a model is difficult and time consuming as it requires manually searching for relevant features from complex EEG data. Domain experts may have a partial understanding of the EEG characteristics that indicate seizures, but this knowledge is often not sufficient to exhaustively enumerate all relevant features. To address this challenge, we investigate how automated feature construction may complement hand-crafted features for epileptic seizure detection. By means of an empirical comparison on a real-world seizure detection dataset, we evaluate the ability of automated feature construction to come up with new relevant features. We show that combining hand-crafted and automated features results in more accurate models compared to using hand-crafted features alone. Our findings suggest that future studies on developing EEG-based seizure detection models may benefit from features constructed using a combination of hand-crafted and automated feature engineering.

Home recording of 3-Hz spike-wave discharges in adults with absence epilepsy using the wearable Sensor Dot.

OBJECTIVE: Home monitoring of 3-Hz spike-wave discharges (SWDs) in patients with refractory absence epilepsy could improve clinical care by replacing the inaccurate seizure diary with objective counts. We investigated the use and performance of the Sensor Dot (Byteflies) wearable in persons with absence epilepsy in their home environment. METHODS: Thirteen participants (median age = 22 years, 11 female) were enrolled at the university hospitals of Leuven and Freiburg. At home, participants had to attach the Sensor Dot and behind-the-ear electrodes to record two-channel electroencephalogram (EEG), accelerometry, and gyroscope data. Ground truth annotations were created during a visual review of the full Sensor Dot recording. Generalized SWDs were annotated if they were 3 Hz and at least 3 s on EEG. Potential 3-Hz SWDs were flagged by an automated seizure detection algorithm, (1) using only EEG and (2) with an additional postprocessing step using accelerometer and gyroscope to discard motion artifacts. Afterward, two readers (W.V.P. and L.S.) reviewed algorithm-labeled segments and annotated true positive detections. Sensitivity, precision, and F1 score were calculated. Patients had to keep a seizure diary and complete questionnaires about their experiences. RESULTS: Total recording time was 394 h 42 min. Overall, 234 SWDs were captured in 11 of 13 participants. Review of the unimodal algorithm-labeled recordings resulted in a mean sensitivity of .84, precision of .93, and F1 score of .89. Visual review of the multimodal algorithm-labeled segments resulted in a similar F1 score and shorter review time due to fewer false positive labels. Participants reported that the device was comfortable and that they would be willing to wear it on demand of their neurologist, for a maximum of 1 week or with intermediate breaks. SIGNIFICANCE: The Sensor Dot improved seizure documentation at home, relative to patient self-reporting. Additional benefits were the short review time and the patients' device acceptance due to user-friendliness and comfortability.

The Power of ECG in Semi-Automated Seizure Detection in Addition to Two-Channel behind-the-Ear EEG.

Long-term home monitoring of people living with epilepsy cannot be achieved using the standard full-scalp electroencephalography (EEG) coupled with video. Wearable seizure detection devices, such as behind-the-ear EEG (bte-EEG), offer an unobtrusive method for ambulatory follow-up of this population. Combining bte-EEG with electrocardiography (ECG) can enhance automated seizure detection performance. However, such frameworks produce high false alarm rates, making visual review necessary. This study aimed to evaluate a semi-automated multimodal wearable seizure detection framework using bte-EEG and ECG. Using the SeizeIT1 dataset of 42 patients with focal epilepsy, an automated multimodal seizure detection algorithm was used to produce seizure alarms. Two reviewers evaluated the algorithm's detections twice: (1) using only bte-EEG data and (2) using bte-EEG, ECG, and heart rate signals. The readers achieved a mean sensitivity of 59.1% in the bte-EEG visual experiment, with a false detection rate of 6.5 false detections per day. Adding ECG resulted in a higher mean sensitivity (62.2%) and a largely reduced false detection rate (mean of 2.4 false detections per day), as well as an increased inter-rater agreement. The multimodal framework allows for efficient review time, making it beneficial for both clinicians and patients.

Automatic annotation correction for wearable EEG based epileptic seizure detection.

Objective. Video-electroencephalography (vEEG), which defines the ground truth for the detection of epileptic seizures, is inadequate for long-term home monitoring. Thanks to advantages in comfort and unobtrusiveness, wearable EEG devices have been suggested as a solution for home monitoring. However, one of the challenges in data-driven automated seizure detection with wearable EEG data is to have reliable seizure annotations. Seizure annotations on the gold-standard 25-channel vEEG recordings may not be optimal to delineate seizure activity on the concomitantly recorded wearable EEG, due to artifacts or absence of ictal activity on the limited set of electrodes of the wearable EEG. This paper aims to develop an automatic approach to correct for imperfect annotations of seizure activity on wearable EEG, which can be used to train seizure detection algorithms.Approach. This paper first investigates the effectiveness of correcting the seizure annotations for the training set with a visual annotation correction. Then a novel approach has been proposed to automatically remove non-seizure data from wearable EEG in epochs annotated as seizures in gold-standard video-EEG recordings. The performance of the automatic annotation correction approach was evaluated by comparing the seizure detection models trained with (a) original vEEG seizure annotations, (b) visually corrected seizure annotations, and (c) automatically corrected seizure annotations.Main results. The automated seizure detection approach trained with automatically corrected seizure annotations was more sensitive and had fewer false-positive detections compared to the approach trained with visually corrected seizure annotations, and the approach trained with the original seizure annotations from gold-standard vEEG.Significance. The wearable EEG seizure detection approach performs better when trained with automatic seizure annotation correction.

Early soft and flexible fusion of electroencephalography and functional magnetic resonance imaging via double coupled matrix tensor factorization for multisubject group analysis.

Data fusion refers to the joint analysis of multiple datasets that provide different (e.g., complementary) views of the same task. In general, it can extract more information than separate analyses can. Jointly analyzing electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) measurements has been proved to be highly beneficial to the study of the brain function, mainly because these neuroimaging modalities have complementary spatiotemporal resolution: EEG offers good temporal resolution while fMRI is better in its spatial resolution. The EEG-fMRI fusion methods that have been reported so far ignore the underlying multiway nature of the data in at least one of the modalities and/or rely on very strong assumptions concerning the relation of the respective datasets. For example, in multisubject analysis, it is commonly assumed that the hemodynamic response function is a priori known for all subjects and/or the coupling across corresponding modes is assumed to be exact (hard). In this article, these two limitations are overcome by adopting tensor models for both modalities and by following soft and flexible coupling approaches to implement the multimodal fusion. The obtained results are compared against those of parallel independent component analysis and hard coupling alternatives, with both synthetic and real data (epilepsy and visual oddball paradigm). Our results demonstrate the clear advantage of using soft and flexible coupled tensor decompositions in scenarios that do not conform with the hard coupling assumption.

Enhanced design matrix for task-related fMRI data analysis.

In this paper, we introduce a novel methodology for the analysis of task-related fMRI data. In particular, we propose an alternative way for constructing the design matrix, based on the newly suggested Information-Assisted Dictionary Learning (IADL) method. This technique offers an enhanced potential, within the conventional GLM framework, (a) to efficiently cope with uncertainties in the modeling of the hemodynamic response function, (b) to accommodate unmodeled brain-induced sources, beyond the task-related ones, as well as potential interfering scanner-induced artifacts, uncorrected head-motion residuals and other unmodeled physiological signals, and (c) to integrate external knowledge regarding the natural sparsity of the brain activity that is associated with both the experimental design and brain atlases. The capabilities of the proposed methodology are evaluated via a realistic synthetic fMRI-like dataset, and demonstrated using a test case of a challenging fMRI study, which verifies that the proposed approach produces substantially more consistent results compared to the standard design matrix method. A toolbox extension for SPM is also provided, to facilitate the use and reproducibility of the proposed methodology.

Accurate detection of typical absence seizures in adults and children using a two-channel electroencephalographic wearable behind the ears.

OBJECTIVE: Patients with absence epilepsy sensitivity <10% of their absences. The clinical gold standard to assess absence epilepsy is a 24-h electroencephalographic (EEG) recording, which is expensive, obtrusive, and time-consuming to review. We aimed to (1) investigate the performance of an unobtrusive, two-channel behind-the-ear EEG-based wearable, the Sensor Dot (SD), to detect typical absences in adults and children; and (2) develop a sensitive patient-specific absence seizure detection algorithm to reduce the review time of the recordings. METHODS: We recruited 12 patients (median age = 21 years, range = 8-50; seven female) who were admitted to the epilepsy monitoring units of University Hospitals Leuven for a 24-h 25-channel video-EEG recording to assess their refractory typical absences. Four additional behind-the-ear electrodes were attached for concomitant recording with the SD. Typical absences were defined as 3-Hz spike-and-wave discharges on EEG, lasting 3 s or longer. Seizures on SD were blindly annotated on the full recording and on the algorithm-labeled file and consequently compared to 25-channel EEG annotations. Patients or caregivers were asked to keep a seizure diary. Performance of the SD and seizure diary were measured using the F1 score. RESULTS: We concomitantly recorded 284 absences on video-EEG and SD. Our absence detection algorithm had a sensitivity of .983 and false positives per hour rate of .9138. Blind reading of full SD data resulted in sensitivity of .81, precision of .89, and F1 score of .73, whereas review of the algorithm-labeled files resulted in scores of .83, .89, and .87, respectively. Patient self-reporting gave sensitivity of .08, precision of 1.00, and F1 score of .15. SIGNIFICANCE: Using the wearable SD, epileptologists were able to reliably detect typical absence seizures. Our automated absence detection algorithm reduced the review time of a 24-h recording from 1-2 h to around 5-10 min.

The power of ECG in multimodal patient-specific seizure monitoring: Added value to an EEG-based detector using limited channels.

OBJECTIVE: Wearable seizure detection devices could provide more reliable seizure documentation outside the hospital compared to seizure self-reporting by patients, which is the current standard. Previously, during the SeizeIT1 project, we studied seizure detection based on behind-the-ear electroencephalography (EEG). However, the obtained sensitivities were too low for practical use, because not all seizures are associated with typical ictal EEG patterns. Therefore, in this paper, we aim to develop a multimodal automated seizure detection algorithm integrating behind-the-ear EEG and electrocardiography (ECG) for detecting focal seizures. In this framework, we quantified the added value of ECG to behind-the-ear EEG. METHODS: This study analyzed three multicenter databases consisting of 135 patients having focal epilepsy and a total of 896 seizures. A patient-specific multimodal automated seizure detection algorithm was developed using behind-the-ear/temporal EEG and single-lead ECG. The EEG and ECG data were processed separately using machine learning methods. A late integration approach was applied for fusing those predictions. RESULTS: The multimodal algorithm outperformed the EEG-based algorithm in two of three databases, with an increase of 11% and 8% in sensitivity for the same false alarm rate. SIGNIFICANCE: ECG can be of added value to an EEG-based seizure detection algorithm using only behind-the-ear/temporal lobe electrodes for patients with focal epilepsy.

Classification with a Deferral Option and Low-Trust Filtering for Automated Seizure Detection.

Wearable technology will become available and allow prolonged electroencephalography (EEG) monitoring in the home environment of patients with epilepsy. Neurologists analyse the EEG visually and annotate all seizures, which patients often under-report. Visual analysis of a 24-h EEG recording typically takes one to two hours. Reliable automated seizure detection algorithms will be crucial to reduce this analysis. We investigated such algorithms on a dataset of behind-the-ear EEG measurements. Our first aim was to develop a methodology where part of the data is deferred to a human expert, who performs perfectly, with the goal of obtaining an (almost) perfect detection sensitivity (DS). Prediction confidences are determined by temperature scaling of the classification model outputs and trust scores. A DS of approximately 90% (99%) can be achieved when deferring around 10% (40%) of the data. Perfect DS can be achieved when deferring 50% of the data. Our second contribution demonstrates that a common modelling strategy, where predictions from several short EEG segments are combined to obtain a final prediction, can be improved by filtering out untrustworthy segments with low trust scores. The false detection rate shows a relative decrease between 21% and 43%, and the DS shows a small increase or decrease.

Emojis influence autobiographical memory retrieval from reading words: An fMRI-based study.

Advances in computer and communications technology have deeply affected the way we communicate. Social media have emerged as a major means of human communication. However, a major limitation in such media is the lack of non-verbal stimuli, which sometimes hinders the understanding of the message, and in particular the associated emotional content. In an effort to compensate for this, people started to use emoticons, which are combinations of keyboard characters that resemble facial expressions, and more recently their evolution: emojis, namely, small colorful images that resemble faces, actions and daily life objects. This paper presents evidence of the effect of emojis on memory retrieval through a functional Magnetic Resonance Imaging (fMRI) study. A total number of fifteen healthy volunteers were recruited for the experiment, during which successive stimuli were presented, containing words with intense emotional content combined with emojis, either with congruent or incongruent emotional content. Volunteers were asked to recall a memory related to the stimulus. The study of the reaction times showed that emotional incongruity among word+emoji combinations led to longer reaction times in memory retrieval compared to congruent combinations. General Linear Model (GLM) and Blind Source Separation (BSS) methods have been tested in assessing the influence of the emojis on the process of memory retrieval. The analysis of the fMRI data showed that emotional incongruity among word+emoji combinations activated the Broca's area (BA44 and BA45) in both hemispheres, the Supplementary Motor Area (SMA) and the inferior prefrontal cortex (BA47), compared to congruent combinations. Furthermore, compared to pseudowords, word+emoji combinations activated the left Broca's area (BA44 and BA45), the amygdala, the right temporal pole (BA48) and several frontal regions including the SMA and the inferior prefrontal cortex.

Blind fMRI source unmixing via higher-order tensor decompositions.

BACKGROUND: The growing interest in neuroimaging technologies generates a massive amount of biomedical data of high dimensionality. Tensor-based analysis of brain imaging data has been recognized as an effective analysis that exploits its inherent multi-way nature. In particular, the advantages of tensorial over matrix-based methods have previously been demonstrated in the context of functional magnetic resonance imaging (fMRI) source localization. However, such methods can also become ineffective in realistic challenging scenarios, involving, e.g., strong noise and/or significant overlap among the activated regions. Moreover, they commonly rely on the assumption of an underlying multilinear model generating the data. NEW METHOD: This paper aims at investigating the possible gains from exploiting the 4-dimensional nature of the brain images, through a higher-order tensorization of the fMRI signal, and the use of less restrictive generative models. In this context, the higher-order block term decomposition (BTD) and the PARAFAC2 tensor models are considered for the first time in fMRI blind source separation. A novel PARAFAC2-like extension of BTD (BTD2) is also proposed, aiming at combining the effectiveness of BTD in handling strong instances of noise and the potential of PARAFAC2 to cope with datasets that do not follow the strict multilinear assumption. COMPARISON WITH EXISTING METHODS: The methods were tested using both synthetic and real data and compared with state of the art methods. CONCLUSIONS: The simulation results demonstrate the effectiveness of BTD and BTD2 for challenging scenarios (presence of noise, spatial overlap among activation regions and inter-subject variability in the haemodynamic response function (HRF)).