Multimodal Detection of Early Partial Seizure Onsets

描述（由申请人提供）：闭环治疗（神经刺激、冷却和药物治疗）作为几种抗癫痫药物治疗失败且不适合手术的患者的癫痫发作治疗的替代方法重新受到关注。反应性闭环治疗旨在癫痫发作后数秒内进行干预，以终止癫痫活动或防止演变为致残性癫痫发作。闭环治疗面临的挑战是需要非常早期的检测，同时仍然保持特异性，因此治疗可以足够早地进行，并且仍然保持安全。设计更具体的检测方法的一个局限性是，部分癫痫发作的特征不像原发性全身性癫痫发作的特征那样清楚地建立。虽然部分性癫痫发作对于同一患者可能有些刻板印象，但总体部分性癫痫发作通常更微妙，发展更缓慢，最重要的是，更不均匀。考虑到发作模式的这种可变性，可以使用多模态方法来实现更自适应的检测范例的设计，该方法将评估部分性癫痫发作时颅内EEG特性的变化，包括通常观察到的频率内容的变化以及复杂性和熵的变化。然后，发作变化的特征可以是同一患者的所有癫痫发作中发生的刻板发作成分和癫痫发作之间可变的变异发作成分。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的变异成分的方法的组合可以提高部分癫痫发作发作的早期检测的可靠性。改进的早期癫痫发作检测不仅有利于闭环治疗的应用，而且可以用于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.