Detection of generalized tonic-clonic seizures from ear-EEG based on EMG analysis

Seizure. 2018 Jul:59:54-59. doi: 10.1016/j.seizure.2018.05.001. Epub 2018 May 4.

Abstract

Purpose: Sudden unexpected death in epilepsy (SUDEP) is associated with generalized tonic-clonic seizures (GTCS) with most deaths occurring during sleep. Seizure detection devices have been suggested as a SUDEP prevention strategy. EMG-based GTCS detection can take advantage of the GTCS characteristic of sustained high-amplitude, high-frequency activity in the time-domain.

Method: We present a GTCS-detection method based on median-filtered variance estimates on surface EMG measurements and describe its performance in a small exploratory proof-of-concept setting involving a group of 15 patients with 3 GTCS recorded with ear-EEG and another group of 6 patients with 11 GTCS recorded with scalp-EEG.

Results: GTCS intervals were detected within 4.2-12.9 s of onset with 100% sensitivity (CI 29.2-100%) without false positives in 820.7 h of ear-EEG. The same detection method worked for the 11 GTCS from scalp EEG data with 100% sensitivity (CI 71.5-100%) and no false positives.

Conclusions: Ear-EEG contains enough GTCS-specific EMG activity for GTCS detection to be feasible. Ear-EEG could be considered for nocturnal GTCS monitoring as a supplement to SUDEP preventive interventions.

Keywords: Ear-EEG; Epilepsy; GTCS; Neurophysiological monitoring; SUDEP prevention; Seizure detection.

MeSH terms

  • Algorithms
  • Ear
  • Electroencephalography / instrumentation*
  • Electroencephalography / methods
  • Electromyography* / methods
  • False Positive Reactions
  • Humans
  • Neurophysiological Monitoring* / instrumentation
  • Neurophysiological Monitoring* / methods
  • Pattern Recognition, Automated / methods
  • Proof of Concept Study
  • Scalp
  • Seizures / diagnosis*
  • Seizures / physiopathology
  • Sensitivity and Specificity
  • Signal Processing, Computer-Assisted