Anneleen Dereymaeker

Early development of synchrony in cortical activations in the human

Highlights • We study the early development of cortical activations synchrony index (ASI).• Cortical activations become increasingly synchronized during the last trimester.• Interhemispheric synchrony increases more than intrahemispheric synchrony.• Our EEG metric ASI can be directly translated to experimental animal studies.• ASI holds promise as an early functional biomarker of brain networks.

Interhemispheric synchrony in the neonatal EEG revisited: activation synchrony index as a promising classifier

A key feature of normal neonatal EEG at term age is interhemispheric synchrony (IHS), which refers to the temporal co-incidence of bursting across hemispheres during trace alternant EEG activity. The assessment of IHS in both clinical and scientific work relies on visual, qualitative EEG assessment without clearly quantifiable definitions. A quantitative measure, activation synchrony index (ASI), was recently shown to perform well as compared to visual assessments. The present study was set out to test whether IHS is stable enough for clinical use, and whether it could be an objective feature of EEG normality. We analyzed 31 neonatal EEG recordings that had been clinically classified as normal (n = 14) or abnormal (n = 17) using holistic, conventional visual criteria including amplitude, focal differences, qualitative synchrony, and focal abnormalities. We selected 20-min epochs of discontinuous background pattern. ASI values were computed separately for different channel pair combinations and window lengths to define them for the optimal ASI intraindividual stability. Finally, ROC curves were computed to find trade-offs related to compromised data lengths, a common challenge in neonatal EEG studies. Using the average of four consecutive 2.5-min epochs in the centro-occipital bipolar derivations gave ASI estimates that very accurately distinguished babies clinically classified as normal vs. abnormal. It was even possible to draw a cut-off limit (ASI~3.6) which correctly classified the EEGs in 97% of all cases. Finally, we showed that compromising the length of EEG segments from 20 to 5 min leads to increased variability in ASI-based classification. Our findings support the prior literature that IHS is an important feature of normal neonatal brain function. We show that ASI may provide diagnostic value even at individual level, which strongly supports its use in prospective clinical studies on neonatal EEG as well as in the feature set of upcoming EEG classifiers.

Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor

OBJECTIVE After identifying the most seizure-relevant characteristics by a previously developed heuristic classifier, a data-driven post-processor using a novel set of features is applied to improve the performance. METHODS The main characteristics of the outputs of the heuristic algorithm are extracted by five sets of features including synchronization, evolution, retention, segment, and signal features. Then, a support vector machine and a decision making layer remove the falsely detected segments. RESULTS Four datasets including 71 neonates (1023h, 3493 seizures) recorded in two different university hospitals, are used to train and test the algorithm without removing the dubious seizures. The heuristic method resulted in a false alarm rate of 3.81 per hour and good detection rate of 88% on the entire test databases. The post-processor, effectively reduces the false alarm rate by 34% while the good detection rate decreases by 2%. CONCLUSION This post-processing technique improves the performance of the heuristic algorithm. The structure of this post-processor is generic, improves our understanding of the core visually determined EEG features of neonatal seizures and is applicable for other neonatal seizure detectors. SIGNIFICANCE The post-processor significantly decreases the false alarm rate at the expense of a small reduction of the good detection rate.

Automated Respiration Detection from Neonatal Video Data

In the interest of the neonatal comfort, the need for noncontact respiration monitoring increases. Moreover, home respiration monitoring would be beneficial. Therefore, the goal is to extract the respiration rate from video data included in a polysomnography. The presented method first uses Eulerian video magnification to amplify the respiration movements. A respiration signal is obtained through the optical flow algorithm. Independent component analysis and principal component analysis are applied to improve the signal quality, with minor enhancement of the signal quality. The respiratory rate is extracted as the dominant frequency in the spectrograms obtained using the short-time Fourier transform. Respiratory rate detection is successful (94.12%) for most patients during quiet sleep stages. Real-time monitoring could possibly be achieved by lowering the spatial and temporal resolutions of the input video data. The outline for successful video-aided detection of the respiration pattern is shown, thereby paving the way for improvement of the overall assessment in the NICU and application in a home-friendly environment.

An Automated Quiet Sleep Detection Approach in Preterm Infants as a Gateway to Assess Brain Maturation

Sleep state development in preterm neonates can provide crucial information regarding functional brain maturation and give insight into neurological well being. However, visual labeling of sleep stages from EEG requires expertise and is very time consuming, prompting the need for an automated procedure. We present a robust method for automated detection of preterm sleep from EEG, over a wide postmenstrual age (PMA = gestational age + postnatal age) range, focusing first on Quiet Sleep (QS) as an initial marker for sleep assessment. Our algorithm, CLuster-based Adaptive Sleep Staging (CLASS), detects QS if it remains relatively more discontinuous than non-QS over PMA. CLASS was optimized on a training set of 34 recordings aged 27–42 weeks PMA, and performance then assessed on a distinct test set of 55 recordings of the same age range. Results were compared to visual QS labeling from two independent raters (with inter-rater agreement Kappa = 0. 93), using Sensitivity, Specificity, Detection Factor (DF = proportion of visual QS periods correctly detected by CLASS) and Misclassification Factor (MF = proportion of CLASS-detected QS periods that are misclassified). CLASS performance proved optimal across recordings at 31–38 weeks (median DF = 1.0, median MF 0–0.25, median Sensitivity 0.93–1.0, and median Specificity 0.80–0.91 across this age range), with minimal misclassifications at 35–36 weeks (median MF = 0). To illustrate the potential of CLASS in facilitating clinical research, normal maturational trends over PMA were derived from CLASS-estimated QS periods, visual QS estimates, and nonstate specific periods (containing QS and non-QS) in the EEG recording. CLASS QS trends agreed with those from visual QS, with both showing stronger correlations than nonstate specific trends. This highlights the benefit of automated QS detection for exploring brain maturation.

Clinical presentation and spectrum of neuroimaging findings in newborn infants with incontinentia pigmenti

To report on the neurological presentation and neuroimaging findings in newborn infants with incontinentia pigmenti.

Review of sleep-EEG in preterm and term neonates

Neonatal sleep is a crucial state that involves endogenous driven brain activity, important for neuronal survival and guidance of brain networks. Sequential EEG-sleep analysis in preterm infants provides insights into functional brain integrity and can document deviations of the biologically pre-programmed process of sleep ontogenesis during the neonatal period. Visual assessment of neonatal sleep-EEG, with integration of both cerebral and non-cerebral measures to better define neonatal state, is still considered the gold standard. Electrographic patterns evolve over time and are gradually time locked with behavioural characteristics which allow classification of quiet sleep and active sleep periods during the last 10weeks of gestation. Near term age, the neonate expresses a short ultradian sleep cycle, with two distinct active and quiet sleep, as well as brief periods of transitional or indeterminate sleep. Qualitative assessment of neonatal sleep is however challenged by biological and environmental variables that influence the expression of EEG-sleep patterns and sleep organization. Developing normative EEG-sleep data with the aid of automated analytic methods, can further improve our understanding of extra-uterine brain development and state organization under stressful or pathological conditions. Based on those developmental biomarkers of normal and abnormal brain function, research can be conducted to support and optimise sleep in the NICU, with the ultimate goal to improve therapeutic interventions and neurodevelopmental outcome.

Monitoring Effective Connectivity in the Preterm Brain: A Graph Approach to Study Maturation

In recent years, functional connectivity in the developmental science received increasing attention. Although it has been reported that the anatomical connectivity in the preterm brain develops dramatically during the last months of pregnancy, little is known about how functional and effective connectivity change with maturation. The present study investigated how effective connectivity in premature infants evolves. To assess it, we use EEG measurements and graph-theory methodologies. We recorded data from 25 preterm babies, who underwent long-EEG monitoring at least twice during their stay in the NICU. The recordings took place from 27 weeks postmenstrual age (PMA) until 42 weeks PMA. Results showed that the EEG-connectivity, assessed using graph-theory indices, moved from a small-world network to a random one, since the clustering coefficient increases and the path length decreases. This shift can be due to the development of the thalamocortical connections and long-range cortical connections. Based on the network indices, we developed different age-prediction models. The best result showed that it is possible to predict the age of the infant with a root mean-squared error ( ) equal to 2.11 weeks. These results are similar to the ones reported in the literature for age prediction in preterm babies.

Complexity Analysis of Neonatal EEG Using Multiscale Entropy: Applications in Brain Maturation and Sleep Stage Classification

Automated analysis of the electroencephalographic (EEG) data for the brain monitoring of preterm infants has gained attention in the last decades. In this study, we analyze the complexity of neonatal EEG, quantified using multiscale entropy. The aim of the current work is to investigate how EEG complexity evolves during electrocortical maturation and whether complexity features can be used to classify sleep stages. First , we developed a regression model that estimates the postmenstrual age (PMA) using a combination of complexity features. Then, these features are used to build a sleep stage classifier. The analysis is performed on a database consisting of 97 EEG recordings from 26 prematurely born infants, recorded between 27 and 42 weeks PMA. The results of the regression analysis revealed a significant positive correlation between the EEG complexity and the infant’s age. Moreover, the PMA of the neonate could be estimated with a root mean squared error of 1.88 weeks. The sleep stage classifier was able to discriminate quiet sleep from nonquiet sleep with an area under the curve (AUC) of 90%. These results suggest that the complexity of the brain dynamics is a highly useful index for brain maturation quantification and neonatal sleep stage classification.

Corrigendum to "Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor" [Clin Neurophysiol 127 (2016) 3014-3024].

The authors regret that some text regarding Fig. 3 inadvertently appeared on p. 3018 in the paragraph after equation (3). The text should have read: To illustrate the difference of MPC between an artifact and an actual seizure, Fig. 4 plots a falsely detected ECG artifact (a, MPC: 0:21) and a truly detected rhythmic seizure (b, MPC: 0:04). In the current work, the MPC of EEG segment and the polygraphic signals ECG, EMG, EOG, and Resp. are measured and used as four synchronization features (Ansari et al., 2015). The authors would like to apologise for any inconvenience caused.