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These algorithms may also help alert caregivers of impending seizures at home. 8 , 9 EEG‐based seizure detection and prediction algorithms proposed by studies over the past 5 years have largely relied on publicly available EEG‐based datasets.
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IMPACT data were added in regression by the insert model, which forces the entry of all variables. In addition, the scores were added in a second block to evaluate its increment in the standard model. To systematize and stratify TBI patients based on CT imaging characteristics, several classification systems have been proposed; the most popular used in practice are Marshall CT classification and Rotterdam and Helsinki CT scores. The lower limits of detection, the lower limits of quantification, and the calibration ranges for the blood-based biomarkers are shown in Supplementary Table 1. One patient had an S100B level below the lower limit of detection range, and therefore, the concentration of 1 pg/ml was applied, permitting statistical analysis.
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The current results suggest that outcome prediction ability of the HCTS could be significantly enhanced with rapid point-of-care measurement of plasma levels of IL-10 and Aβ40. This may allow the identification of initially neurologically stable patients who, however, are developing severe secondary brain injury that significantly impairs their recovery. To better illuminate the predictive power of biomarkers in patients with CT-positive findings, we also investigated their abilities in distinguishing between patients with complete and incomplete recovery. The best-performing biomarkers were the same as in discrimination of patients with favorable and unfavorable outcomes, but the predictive performance of the HCTS was low. The HCTS was designed to predict functional outcome according to the GOS (13).
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We investigated the advantages and limitations of the characteristics of the EEG datasets. Based on our study, we identified 17 characteristics that make the EEG datasets unique from each other. The generalized model only learns features and biomarkers present in the current group of patients but might fail to highlight or capture important unique characteristics of certain patients outside the group. However, using larger datasets or multiple datasets for a certain study introduces potential complexity if there are differences in the number of channels or structural properties. To further elucidate the outcome prediction performance of the biomarkers, we also studied patients with CT-negative TBIs (comparison study cohort).
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The results presented here suggest that protein biomarkers IL-10 and Aβ40 provide incremental value in outcome prediction when used in combination with the HCTS. In line with this finding, it has been previously reported that most of the clinical studies have not identified a correlation between blood IL-10 levels and GCS scores (33). We have recently reported IL-10 thresholds of 0.38 and 0.44 pg/ml depending on other markers included in the panels for predicting unfavorable outcomes. Correspondingly, when the HCTS is included in the panels, IL-10 thresholds need to be lower to capture patients with low IL-10 levels, low GCS scores, and unfavorable outcomes. The Electroencephalogram (EEG) plays an important role in detecting and localizing seizures, as well as in the diagnosis of epilepsy. 1
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However, we do not consider this a major limitation, since EEG signals are the main focus and the scalp datasets normally follow the international 10–20 system or the Nomenclature 10–10 system. The CHB‐MIT Scalp EEG dataset consists of long‐term and short‐term continuous data in segments depending on the patients. However, the dataset has a 10 seconds gap between the continuous segments due to the limitations of the recording device and some longer gaps in certain patients. TUSZ contains multiple pruned short‐term continuous segments from multiple sessions across all patients. Pruning refers to cases where segments that are of interest from the same recording section are cut and joined together. The Neurovista ictal dataset, made available via Epilepsyecosystem.org, does not fall into any category, since it only consists of multiple recordings of seizure events for patients.
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Artifacts such as muscle or eye movement were removed from the continuous recording by visual inspection to form the final dataset from the University of Bonn. 24 In addition to removing artifacts, the EEG segments chosen in the final dataset had to satisfy the criterion of at least weak stationarity. 24
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