Vladimir Matic

Automated artifact removal as preprocessing refines neonatal seizure detection

OBJECTIVE The description and evaluation of algorithms using Independent Component Analysis (ICA) for automatic removal of ECG, pulsation and respiration artifacts in neonatal EEG before automated seizure detection. METHODS The developed algorithms decompose the EEG using ICA into its underlying sources. The artifact source was identified using the simultaneously recorded polygraphy signals after preprocessing. The EEG was reconstructed without the corrupting source, leading to a clean EEG. The impact of the artifact removal was measured by comparing the performance of a previously developed seizure detector before and after the artifact removal in 13 selected patients (9 having artifact-contaminated and 4 having artifact-free EEGs). RESULTS A significant decrease in false alarms (p=0.01) was found while the Good Detection Rate (GDR) for seizures was not altered (p=0.50). CONCLUSIONS The techniques reduced the number of false positive detections without lowering sensitivity and are beneficial in long term EEG seizure monitoring in the presence of disturbing biological artifacts. SIGNIFICANCE The proposed algorithms improve neonatal seizure monitoring.

Multi-structural Signal Recovery for Biomedical Compressive Sensing

Compressive sensing has shown significant promise in biomedical fields. It reconstructs a signal from sub-Nyquist random linear measurements. Classical methods only exploit the sparsity in one domain. A lot of biomedical signals have additional structures, such as multi-sparsity in different domains, piecewise smoothness, low rank, etc. We propose a framework to exploit all the available structure information. A new convex programming problem is generated with multiple convex structure-inducing constraints and the linear measurement fitting constraint. With additional a priori information for solving the underdetermined system, the signal recovery performance can be improved. In numerical experiments, we compare the proposed method with classical methods. Both simulated data and real-life biomedical data are used. Results show that the newly proposed method achieves better reconstruction accuracy performance in term of both L1 and L2 errors.

Line length as a robust method to detect high-activity events: Automated burst detection in premature EEG recordings

OBJECTIVE EEG is a valuable tool for evaluation of brain maturation in preterm babies. Preterm EEG constitutes of high voltage burst activities and more suppressed episodes, called interburst intervals (IBIs). Evolution of background characteristics provides information on brain maturation and helps in prediction of neurological outcome. The aim is to develop a method for automated burst detection. METHODS Thirteen polysomnography recordings were used, collected at preterm postmenstrual age of 31.4 (26.1-34.4)weeks. We developed a burst detection algorithm based on the feature line length and compared it with manual scorings of clinical experts and other published methods. RESULTS The line length-based algorithm is robust (84.27% accuracy, 84.00% sensitivity, 85.70% specificity). It is not critically dependent on the number of measurement channels, because two channels still provide 82% accuracy. Furthermore, it approximates well clinically relevant features, such as median IBI duration 5.45 (4.00-7.11)s, maximum IBI duration 14.02 (8.73-18.80)s and burst percentage 48.89 (35.45-60.12)%, with a median deviation of respectively 0.65s, 1.96s and 6.55%. CONCLUSION Automated assessment of long-term preterm EEG is possible and its use will optimize EEG interpretation in the NICU. SIGNIFICANCE This study takes a first step towards fully automatic analysis of the preterm brain.

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.

Objective differentiation of neonatal EEG background grades using detrended fluctuation analysis

A quantitative and objective assessment of background electroencephalograph (EEG) in sick neonates remains an everyday clinical challenge. We studied whether long range temporal correlations quantified by detrended fluctuation analysis (DFA) could be used in the neonatal EEG to distinguish different grades of abnormality in the background EEG activity. Long-term EEG records of 34 neonates were collected after perinatal asphyxia, and their background was scored in 1 h epochs (8 h in each neonate) as mild, moderate or severe. We applied DFA on 15 min long, non-overlapping EEG epochs (n = 1088) filtered from 3 to 8 Hz. Our formal feasibility study suggested that DFA exponent can be reliably assessed in only part of the EEG epochs, and in only relatively short time scales (10–60 s), while it becomes ambiguous if longer time scales are considered. This prompted further exploration whether paradigm used for quantifying multifractal DFA (MF-DFA) could be applied in a more efficient way, and whether metrics from MF-DFA paradigm could yield useful benchmark with existing clinical EEG gradings. Comparison of MF-DFA metrics showed a significant difference between three visually assessed background EEG grades. MF-DFA parameters were also significantly correlated to interburst intervals quantified with our previously developed automated detector. Finally, we piloted a monitoring application of MF-DFA metrics and showed their evolution during patient recovery from asphyxia. Our exploratory study showed that neonatal EEG can be quantified using multifractal metrics, which might offer a suitable parameter to quantify the grade of EEG background, or to monitor changes in brain state that take place during long-term brain monitoring.

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.

Automated EEG inter-burst interval detection in neonates with mild to moderate postasphyxial encephalopathy

EEG inter-burst interval (IBI) and its evolution is a robust parameter for grading hypoxic encephalopathy and prognostication in newborns with perinatal asphyxia. We present a reliable algorithm for the automatic detection of IBIs. This automated approach is based on adaptive segmentation of EEG, classification of segments and use of temporal profiles to describe the global distribution of EEG activity. A pediatric neurologist has blindly scored data from 8 newborns with perinatal postasphyxial encephalopathy varying from mild to severe. 15 minutes of EEG have been scored per patient, thus totaling 2 hours of EEG that was used for validation. The algorithm shows good detection accuracy and provides insight into challenging cases that are difficult to detect.

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.

Heart Rate Variability in Newborns with Hypoxic Brain Injury

In neonatal intensive care units, there is a need for continuous monitoring of sick newborns with perinatal hypoxic ischemic brain injury (HIE). We assessed the utility of heart rate variability (HRV) in newborns with acute HIE undergoing simultaneous continuous EEG (cEEG) and ECG monitoring. HIE was classified using clinical criteria as well as visual grading of cEEG. Newborns were divided into two groups depending on the severity of the hypoxic injury and outcome. Various HRV parameters were compared between these groups, and significantly decreased HRV was found in neonates with severe HIE. As HRV is affected by many factors, it is difficult to attribute this difference solely to HIE. However, this study suggests that further investigation of HRV as a monitoring tool for acute neonatal hypoxic injury is warranted.