Dataset Information

Detection of Postictal Generalized Electroencephalogram Suppression: Random Forest Approach.

ABSTRACT: BACKGROUND:Sudden unexpected death in epilepsy (SUDEP) is second only to stroke in neurological events resulting in years of potential life lost. Postictal generalized electroencephalogram (EEG) suppression (PGES) is a period of suppressed brain activity often occurring after generalized tonic-clonic seizure, a most significant risk factor for SUDEP. Therefore, PGES has been considered as a potential biomarker for SUDEP risk. Automatic PGES detection tools can address the limitations of labor-intensive, and sometimes inconsistent, visual analysis. A successful approach to automatic PGES detection must overcome computational challenges involved in the detection of subtle amplitude changes in EEG recordings, which may contain physiological and acquisition artifacts. OBJECTIVE:This study aimed to present a random forest approach for automatic PGES detection using multichannel human EEG recordings acquired in epilepsy monitoring units. METHODS:We used a combination of temporal, frequency, wavelet, and interchannel correlation features derived from EEG signals to train a random forest classifier. We also constructed and applied confidence-based correction rules based on PGES state changes. Motivated by practical utility, we introduced a new, time distance-based evaluation method for assessing the performance of PGES detection algorithms. RESULTS:The time distance-based evaluation showed that our approach achieved a 5-second tolerance-based positive prediction rate of 0.95 for artifact-free signals. For signals with different artifact levels, our prediction rates varied from 0.68 to 0.81. CONCLUSIONS:We introduced a feature-based, random forest approach for automatic PGES detection using multichannel EEG recordings. Our approach achieved increasingly better time distance-based performance with reduced signal artifact levels. Further study is needed for PGES detection algorithms to perform well irrespective of the levels of signal artifacts.

SUBMITTER: Li X

PROVIDER: S-EPMC7055778 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Detection of Postictal Generalized Electroencephalogram Suppression: Random Forest Approach.

Li Xiaojin X Tao Shiqiang S Jamal-Omidi Shirin S Huang Yan Y Lhatoo Samden D SD Zhang Guo-Qiang GQ Cui Licong L

JMIR medical informatics 20200214 2

<h4>Background</h4>Sudden unexpected death in epilepsy (SUDEP) is second only to stroke in neurological events resulting in years of potential life lost. Postictal generalized electroencephalogram (EEG) suppression (PGES) is a period of suppressed brain activity often occurring after generalized tonic-clonic seizure, a most significant risk factor for SUDEP. Therefore, PGES has been considered as a potential biomarker for SUDEP risk. Automatic PGES detection tools can address the limitations of ...[more]

PMID: 32130173

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Project description:It is not fully understood how seizures terminate and why some seizures are followed by a period of complete brain activity suppression, postictal generalized EEG suppression. This is clinically relevant as there is a potential association between postictal generalized EEG suppression, cardiorespiratory arrest and sudden death following a seizure. We combined human encephalographic seizure data with data of a computational model of seizures to elucidate the neuronal network dynamics underlying seizure termination and the postictal generalized EEG suppression state. A multi-unit computational neural mass model of epileptic seizure termination and postictal recovery was developed. The model provided three predictions that were validated in EEG recordings of 48 convulsive seizures from 48 subjects with refractory focal epilepsy (20 females, age range 15-61 years). The duration of ictal and postictal generalized EEG suppression periods in human EEG followed a gamma probability distribution indicative of a deterministic process (shape parameter 2.6 and 1.5, respectively) as predicted by the model. In the model and in humans, the time between two clonic bursts increased exponentially from the start of the clonic phase of the seizure. The terminal interclonic interval, calculated using the projected terminal value of the log-linear fit of the clonic frequency decrease was correlated with the presence and duration of postictal suppression. The projected terminal interclonic interval explained 41% of the variation in postictal generalized EEG suppression duration (P < 0.02). Conversely, postictal generalized EEG suppression duration explained 34% of the variation in the last interclonic interval duration. Our findings suggest that postictal generalized EEG suppression is a separate brain state and that seizure termination is a plastic and autonomous process, reflected in increased duration of interclonic intervals that determine the duration of postictal generalized EEG suppression.

Project description:Postictal generalized EEG suppression is the state of suppression of electrical activity at the end of a seizure. Prolongation of this state has been associated with increased risk of sudden unexpected death in epilepsy, making characterization of underlying electrical rhythmic activity during postictal suppression an important step in improving epilepsy treatment. Phase-amplitude coupling in EEG reflects cognitive coding within brain networks and some of those codes highlight epileptic activity; therefore, we hypothesized that there are distinct phase-amplitude coupling features in the postictal suppression state that can provide an improved estimate of this state in the context of patient risk for sudden unexpected death in epilepsy. We used both intracranial and scalp EEG data from eleven patients (six male, five female; age range 21-41 years) containing 25 seizures, to identify frequency dynamics, both in the ictal and postictal EEG suppression states. Cross-frequency coupling analysis identified that during seizures there was a gradual decrease of phase frequency in the coupling between delta (0.5-4 Hz) and gamma (30+ Hz), which was followed by an increased coupling between the phase of 0.5-1.5 Hz signal and amplitude of 30-50 Hz signal in the postictal state as compared to the pre-seizure baseline. This marker was consistent across patients. Then, using these postictal-specific features, an unsupervised state classifier-a hidden Markov model-was able to reliably classify four distinct states of seizure episodes, including a postictal suppression state. Furthermore, a connectome analysis of the postictal suppression states showed increased information flow within the network during postictal suppression states as compared to the pre-seizure baseline, suggesting enhanced network communication. When the same tools were applied to the EEG of an epilepsy patient who died unexpectedly, ictal coupling dynamics disappeared and postictal phase-amplitude coupling remained constant throughout. Overall, our findings suggest that there are active postictal networks, as defined through coupling dynamics that can be used to objectively classify the postictal suppression state; furthermore, in a case study of sudden unexpected death in epilepsy, the network does not show ictal-like phase-amplitude coupling features despite the presence of convulsive seizures, and instead demonstrates activity similar to postictal. The postictal suppression state is a period of elevated network activity as compared to the baseline activity which can provide key insights into the epileptic pathology.

Project description:BackgroundThe key roles of epistatic interactions between multiple genetic variants in the pathogenesis of complex diseases notwithstanding, the detection of such interactions remains a great challenge in genome-wide association studies. Although some existing multi-locus approaches have shown their successes in small-scale case-control data, the "combination explosion" course prohibits their applications to genome-wide analysis. It is therefore indispensable to develop new methods that are able to reduce the search space for epistatic interactions from an astronomic number of all possible combinations of genetic variants to a manageable set of candidates.ResultsWe studied case-control data from the viewpoint of binary classification. More precisely, we treated single nucleotide polymorphism (SNP) markers as categorical features and adopted the random forest to discriminate cases against controls. On the basis of the gini importance given by the random forest, we designed a sliding window sequential forward feature selection (SWSFS) algorithm to select a small set of candidate SNPs that could minimize the classification error and then statistically tested up to three-way interactions of the candidates. We compared this approach with three existing methods on three simulated disease models and showed that our approach is comparable to, sometimes more powerful than, the other methods. We applied our approach to a genome-wide case-control dataset for Age-related Macular Degeneration (AMD) and successfully identified two SNPs that were reported to be associated with this disease.ConclusionBesides existing pure statistical approaches, we demonstrated the feasibility of incorporating machine learning methods into genome-wide case-control studies. The gini importance offers yet another measure for the associations between SNPs and complex diseases, thereby complementing existing statistical measures to facilitate the identification of epistatic interactions and the understanding of epistasis in the pathogenesis of complex diseases.

Project description:Postoperative delirium is a common complication associated with increased morbidity and mortality, longer hospital stays, and greater health care expenditures. Intraoperative electroencephalogram (EEG) slowing has been associated previously with postoperative delirium, but the relationship between intraoperative EEG suppression and postoperative delirium has not been investigated.In this observational cohort study, 727 adult patients who received general anesthesia with planned intensive care unit admission were included. Duration of intraoperative EEG suppression was recorded from a frontal EEG channel (FP1 to F7). Delirium was assessed twice daily on postoperative days 1 through 5 with the Confusion Assessment Method for the intensive care unit. Thirty days after surgery, quality of life, functional independence, and cognitive ability were measured using the Veterans RAND 12-item survey, the Barthel index, and the PROMIS Applied Cognition-Abilities-Short Form 4a survey.Postoperative delirium was observed in 162 (26%) of 619 patients assessed. When we compared patients with no EEG suppression with those divided into quartiles based on duration of EEG suppression, patients with more suppression were more likely to experience delirium (?(4) = 25, P < 0.0001). This effect remained significant after we adjusted for potential confounders (odds ratio for log(EEG suppression) 1.22 [99% confidence interval, 1.06-1.40, P = 0.0002] per 1-minute increase in suppression). EEG suppression may have been associated with reduced functional independence (Spearman partial correlation coefficient -0.15, P = 0.02) but not with changes in quality of life or cognitive ability. Predictors of EEG suppression included greater end-tidal volatile anesthetic concentration and lower intraoperative opioid dose.EEG suppression is an independent risk factor for postoperative delirium. Future studies should investigate whether anesthesia titration to minimize EEG suppression decreases the incidence of postoperative delirium. This is a substudy of the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) surgical outcomes registry (NCT02032030).

Dataset Information

Detection of Postictal Generalized Electroencephalogram Suppression: Random Forest Approach.

Publications

Detection of Postictal Generalized Electroencephalogram Suppression: Random Forest Approach.

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