Manual Interpretation of EEGs: - PowerPoint Presentation

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Manual Interpretation of EEGs:A Machine Learning Perspective

Christian Ward, Dr. Iyad Obeid and Dr. Joseph PiconeNeural Engineering Data ConsortiumCollege of EngineeringTemple UniversityPhiladelphia, Pennsylvania, USA

AbstractThe goal of this presentation is to

describe, from a machine learning perspective, how an electroencephalogram (EEG) is manually interpreted. This presentation is not meant to be a comprehensive tutorial on diagnosing illnesses from EEG data. Instead, it attempts to document what physicians look for in the signals, and to describe these in terms that can be translated into signal processing and machine learning code.An extracranial EEG measures brain function indirectly through electrodes placed in an array on the scalp. Events of interest to physicians originate as nerve impulses deep in the brain. By the time these signals reach the scalp they are heavily filtered and spatially dispersed. Interpreting the underlying pathology or determining the diagnosis is an art because (1) the transduced signals at the scalp are very noisy due to their relatively low voltage (microvolts) and (2) the artifacts in the waveform that correlate with a pathology are context dependent (knowledge of the surrounding behavior is important).In this presentation, we review what diseases are diagnosed using EEGs, what artifacts are used to identify these diseases, and what properties of the signal correlate with these artifacts. Both time domain (e.g., waveform shapes) and frequency domain behavior (e.g., fundamental frequency) play an important role in identifying these artifacts.

A technician administers a 30−minute recording session.

An EEG specialist (neurologist) interprets the EEG.

An EEG report is generated with the diagnosis.

Patient is billed once the report is coded and signed off.

Manual Interpretation of EEGs

329 positions are defined as potential electrode locations:

24 to 36 channels are commonly used; 64 and 128-channel EEGs are used in research10/20 configuration (black): yields 19 channels plus several reference channels (typically the ears and forehead)10/10 configuration (gray): typically doubles the number of channelsDifferential voltages are typically measured between a sensor and an ear (e.g., F3-T9)

Common reference points include the ears (T9 and T10), the nose (e.g., ???) and the heart/respiratory system (e.g., EKG1 and EKG2)

Signal Transduction

Epilepsy

: a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions.Stroke: a sudden disabling attack or loss of consciousness caused by an interruption in the flow of blood to the brain.Posterior Reversible Encephalopathy Syndrome (PRES): characterized

by headache

, confusion, seizures and visual loss. It may occur due to a number of causes, predominantly malignant hypertension, eclampsia and some medical treatments.

Middle Cerebral Artery (MCA) I

nfarct:

obstruction of one

of the three major paired arteries that supply blood to the cerebrum

.

Other uses

of EEGs include

diagnosis of Alzheimer's disease, certain psychoses, and sleep disorders (narcolepsy).

The EEG may also be used to determine the overall electrical activity of the

brain, which is used to

evaluate trauma, drug intoxication, or

brain damage.

The

EEG may also be used to monitor blood flow in the brain during surgical procedures

.

The EEG

cannot be used to measure

intelligence



Common Diseases Diagnosed With An EEG

Background:

models all other artifactsnot included in the above categories.Though there are some variations in these signals for infants whose brains are not fully developed, the basic composition of these signals is relatively age and subject invariant.

Spike and Wave:

… describe… … .. .. .. . . . . . . . …………………. . . . . . .

GPED

Triphasic

:

… describe …. . . . . . . . ... . . . … . . . . . . . . . . . . . . .

PLED:

… describe …. . . . . . . .. . . . . . . . . . . . . … . . . . . . . . . . . .

Eye Blink:

… describe why …… . . . . . . . . . . . . . . . . ….. . . . . . . . . .

Most Significant Primitives

Other Primitives

NameAcronymDefinitionElectrographic Seizure

N/A

Rhythmic

discharge or spike and wave pattern with definite evolution in frequency, location or morphology lasting at least 10 sec

Periodic

Epileptiform

discharges

PED

Repetitive

sharp waves, spikes, or sharply contoured waves at regular or nearly regular intervals and without clear evolution in frequency or location

Perioidic

Lateralized

Epileptiform

discharges

PLED

Consistently lateralized

PED

Generalized

PED

GPED

Bilateral

and synchronous PED with no consistent lateralization

Bilateral

PLED

BiPLED

PLED occurring bilaterally, but independently and

sychronously

Triphasic

Waves

N/A

Generalized periodic

sharp waves or sharply contoured delta waves with

triphasic

morphology, at 1-3 Hz, with/without anterior-posterior or posterior-anterior lag

Frontal Intermittent Rhythmic Delta Activity

FIRDA

Moderate- to high-voltage

monorhythmic

and sinusoidal 1-3 Hz activity seen bilaterally, maximal in anterior leads, no evolution

Classification of Diseases

NamePrimary Marker(s)Secondary Marker(s)Epilepsy

Stroke

PRES

MCA

Infarct

Summary and Future Work

Summary:Deep…For…NEDC…Future Work:Three…Two…

Brief

Bibliography of Relevant Documentation[1] Tatum, W., Husain, A., Benbadis, S., & Kaplan, P. (2007). Handbook of EEG Interpretation. (Kirsch, Ed.) (p. 276). New York City, New York, USA: Demos Medical Publishing.[2] Wulsin, D. F., Gupta, J. R., Mani, R., Blanco, J. A., & Litt, B. (2011). Modeling electroencephalography waveforms with semi-supervised deep belief nets: fast classification and anomaly measurement. Journal of Neural Engineering, 8(3), 36015.[3] Jurcak, V., Tsuzuki, D., & Dan, I. (2007). 10/20, 10/10, and 10/5 systems revisited: Their validity as relative head-surface-based positioning systems. NeuroImage, 34(4), 1600–1611.[4] Claassen

, J., Mayer, S. A., Kowalski, R. G., Emerson, R. G., & Hirsch, L. J. (2004). Detection of electrographic seizures with continuous EEG monitoring in critically ill patients.

Neurology, 62(10), 1743–1748.