Multimodal Detection of Early Partial Seizure Onsets

描述（由申请人提供）：对闭环疗法（神经刺激、冷却和药物治疗）重新产生兴趣，作为几种抗癫痫药物无效且不适合手术治疗的患者的癫痫治疗的替代方法。反应性闭环治疗是在癫痫发作后几秒钟内进行干预，以终止癫痫发作活动或防止演变为致残癫痫发作。闭环疗法面临的挑战是需要非常早的发现，同时仍然保持特异性，因此治疗可以尽早实施，并且仍然保持安全。设计更具体的检测方法的一个限制是部分癫痫发作的特征不像原发性全身性癫痫发作那样明确。虽然部分性发作的发作在某种程度上可能是同一患者的典型症状，但整体部分性发作的发作通常更微妙，发展更缓慢，最重要的是，更具有异质性。考虑到这种发作模式的可变性，可以使用多模态方法来设计更具适应性的检测范式，该方法将评估部分癫痫发作时颅内脑电图特性的变化，包括通常观察到的频率内容变化，以及复杂性和熵的变化。然后，可以通过在同一患者的所有癫痫发作中发生的典型癫痫发作成分和在每次癫痫发作中变化的变异癫痫发作成分来表征癫痫发作的变化。基于模式识别的评估刻板成分的方法和基于新颖性检测的评估癫痫发作变体成分的方法的组合可以提高部分癫痫发作早期检测的可靠性。提高癫痫的早期检测不仅有利于闭环治疗的应用，而且可以为患者提供可靠的早期预警系统。

DESCRIPTION (provided by applicant): There is renewed interest for closed-loop therapy (neurostimulation, cooling, and medication) as an alternative method of seizure treatment for patients who have failed several antiepileptic drugs and are not surgery candidates. Responsive closed-loop therapy is designed to intervene within seconds after seizure onset to terminate seizure activity or prevent evolution to a disabling seizure. The challenge to closed-loop therapy is the requirement of very early detection while still retaining specificity, so the therapy can be administered early enough and still remains safe. One limitation of designing more specific detection methods is that partial seizure onset features are not as clearly established as those of primary generalized seizures. Although onsets of partial seizures can be somewhat stereotypical for the same patient, overall partial seizure onsets are typically more subtle, more slowly evolving and above all, more heterogeneous. Taking into account this variability of onset patterns, the design of a more adaptive paradigm of detection may be achieved using a multimodal approach which will assess the changes of intracranial EEG properties at the onset of partial seizures including commonly observed changes in frequency content but also changes in complexity and entropy. The ictal changes can be then characterized by the stereotypical ictal components occurring for all seizures in the same patient and the variant ictal components that are variable from seizure to seizure. Combinations of pattern recognition based methods to assess the stereotypical components and novelty detection based methods to assess the variant components of a seizure can improve the reliability of the early detection of partial seizure onsets. Improved early seizure detection can benefit not only the application of closed loop therapy, but also could be used for a reliable early warning system for patients.