Christoph Baumgartner’s research while affiliated with Sigmund Freud University Vienna and other places

Objective To develop and validate a wrist‐worn accelerometer‐based, deep‐learning tunable algorithm for the automated detection of generalized or bilateral convulsive seizures (CSs) to be integrated with off‐the‐shelf smartwatches. Methods We conducted a prospective multi‐center study across eight European epilepsy monitoring units, collecting data from 384 patients undergoing video electroencephalography (vEEG) monitoring with a wrist‐worn three dimensional (3D)–accelerometer sensor. We developed an ensemble‐based convolutional neural network architecture with tunable sensitivity through quantile‐based aggregation. The model, referred to as Episave, used accelerometer amplitude as input. It was trained on data from 37 patients who had 54 CSs and evaluated on an independent dataset comprising 347 patients, including 33 who had 49 CSs. Results Cross‐validation on the training set showed that optimal performance was obtained with an aggregation quantile of 60, with a 98% sensitivity, and a false alarm rate (FAR) of 1/6 days. Using this quantile on the independent test set, the model achieved a 96% sensitivity (95% confidence interval [CI]: 90%–100%), a FAR of <1/8 days (95% CI: 1/9–1/7 days) with 1 FA/61 nights, and a median detection latency of 26 s. One of the two missed CSs could be explained by the patient's arm, which was wearing the sensor, being trapped in the bed rail. Other quantiles provided up to 100% sensitivity at the cost of a greater FAR (1/2 days) or very low FAR (1/100 days) at the cost of lower sensitivity (86%). Significance This Phase 2 clinical validation study suggests that deep learning techniques applied to single‐sensor accelerometer data can achieve high CS detection performance while enabling tunable sensitivity.

Zusammenfassung Nachdem Hans Berger 1924 die erste EEG-Ableitung am Menschen durchführte und seine Ergebnisse 1929 publizierte, dauerte es einige Jahre bis Bergers Ergebnisse in der Wissenschaftlichen Community anerkannt wurden und es schließlich zu einer breiten Anwendung des EEGs durch andere Forscher kam. Edgar Douglas Adrian und William Grey Walter führten das EEG in Großbritannien ein. In Deutschland leistete Jan Friedrich Georg Theodor Tönnies grundlegende technische Entwicklungen, wesentliche klinische und tierexperimentelle Studien wurden in Berlin von Alois Kornmüller, Max Heinrich Fischer und Hans Löwenbach durchgeführt. In den Vereinigten Staaten von Amerika waren Alexander Forbes, Samuel Howard Bartley, Lee Edward Travis und Ralph Waldo Gerard die wichtigsten Vertreter der tierexperimentellen EEG-Forschung, während Hallowell Davis, Herbert Henri Jasper, Frederic Andrews Gibbs, Donald B. Lindsley und Alfred Lee Loomis die EEG-Forschung beim Menschen vorantrieben.

Zusammenfassung Deutsches Abstract Bereits vor der ersten EEG-Aufzeichnung beim Menschen durch Hans Berger konnte die elektrische Hirnaktivität im Tierexperiment registiert werden. Richard Caton war der Erste, der spontane elektrische Hirnaktivität von der Hirnoberfläche ableitete und dies 1875 publizierte. Weitere Proponenten der tierexperimentellen EEG-Forschung vor Hans Berger waren Adolf Beck, Ernst Fleischl Edler von Marxow, Francis Gotch, Vasily Lakovlevich Danilewsky und Vladimir Práwdicz-Neminski. 1890 publizierte Beck seine Ergebnisse im Centralblatt für Physiologie und beanspruchte, das EEG entdeckt zu haben. Daraufhin entstand eine Kontroverse über die Entdeckung des EEGs, in der Fleischl, Gotch und Danilewsky feststellten, bereits vor Beck EEG-Ableitungen durchgeführt zu haben und somit die Entdeckung des EEGs für sich reklamierten. Diese Kontroverse wurde durch eine Mitteilung von Caton im Centralblatt für Physiologie beendet, in der er auf seine Publikation aus dem Jahr 1875 hinwies.

Introduction A novel focal cortex stimulation (FCS) device has recently received approval in Europe for patients with focal drug-resistant epilepsy (DRE). After 6 months of stimulation, 17 of 32 patients achieved ≥50% reduction in seizure frequency compared with their prestimulation baseline (responders). Currently, there is no established method for predicting FCS treatment response prior to implantation. Methods and analysis This is an ongoing combined retrospective-prospective non-interventional multicentre study. Clinical data of up to 100 patients treated with FCS are collected across 20 collaborating epilepsy centres in four European countries. The key outcome parameters, seizure frequency and severity, are measured along with metrics on cognition, mood and quality of life, both pre-electrode and postelectrode implantation. The data are complemented by demographics, medical history and information on antiseizure medication and FCS treatment parameters during the stimulation period. In addition to clinical data, MRI and electroencephalography registrations are used to gain insights into spatial and electrophysiological aspects of FCS. Multivariate statistical and machine learning analyses are employed to identify key predictive biomarkers associated with patient outcomes (responders vs non-responders). The primary goal is to improve counselling for DRE patients by identifying promising candidates for FCS treatment. Ethics and dissemination This study has received approval from the ethics committee of the University of Freiburg, Germany (23–1540 S1; 23–1183_1-S1-retro). The same approval is applicable for all participating centres in Germany as part of a multicentre study. Ghent University Hospital, Belgium, has received approval for participation in the retrospective arm from their local ethics committee (ONZ-2024-0168) . The final approvals for the participating Swiss and Austrian sites are still pending. The results will be made available to the public through peer-reviewed journals and conference presentations.

Introduction: Creutzfeldt-Jakob disease is a rare, neurodegenerative disorder that is incurable, always fatal, and transmissible. EEG is an integral part of the diagnostic workup with typical periodic sharp-wave complexes indicative of CJD, but early in the disease EEG is often unaltered. Accordingly, we aimed at evaluating disruption of brain network functional connectivity (FC) in regions belonging to the default mode network (DMN) as a potential early marker in CJD when EEG is considered visually normal. Methods: EEGs considered visually normal obtained from 7 CJD patients were compared to EEGs of 7 patients with subjective cognitive impairment (SCI) using Brainstorm application for Matlab. FC was calculated using the phase locking value separately for the delta-, theta-, alpha-, and beta-frequency-band. The global efficacy of the DMN was calculated as the inverse characteristic path length with brain-regions belonging to the DMN as nodes. Results: CJD vs. SCI had significantly lower global efficacy of the DMN in the gamma band. FC was decreased between bilateral orbitofrontal regions and the right parahippocampal gyrus and between bilateral orbitofrontal gyrus and the right anterior cingulate gyrus in CJD. Conclusion: Our findings provide evidence of disruption of the DMN in the gamma band and alterations of FC between specific brain regions in early CJD patients with visually normal EEGs. EEG brain network properties bear potential as a diagnostic tool for CJD early in the disease course in addition to established criteria. These findings call for further studies evaluating the diagnostic value of FC in early CJD.

Zusammenfassung In der neuen S2k-Leitlinie „Erster epileptischer Anfall und Epilepsien im Erwachsenenalter“ werden Empfehlungen zu klinisch relevanten Fragestellungen in fünf großen Themenblöcken gegeben: Management erster epileptischer Anfall, Pharmakotherapie, Epilepsiechirurgie, komplementäre und supportive Therapieverfahren und psychosoziale Aspekte. Beim Thema Management erster epileptischer Anfall werden in der Leitlinie zunächst Empfehlungen zur Unterscheidung der beiden maßgeblichen Differenzialdiagnosen, Synkope und psychogener nicht-epileptischer Anfall, gegeben. Zudem wird der Stellenwert von Zusatzuntersuchungen wie EEG, MRT und Liquor inklusive Autoantikörpern zur syndromalen und ätiologischen Zuordnung diskutiert. Weiterhin werden Empfehlungen zu neuropsychologischen und psychiatrischen Screeningtests ausgesprochen. Bei der Pharmakotherapie liegt der Schwerpunkt der Empfehlungen auf der anfallssuppressiven Monotherapie bei fokalen, genetischen generalisierten und unklassifizierten Epilepsien; Patientengruppen mit besonderen Herausforderungen wie Ältere, Frauen im gebärfähigen Alter und Menschen mit Intelligenzminderung werden hervorgehoben. Weitere Themen sind die Indikationen zur Bestimmung der Serumkonzentration von Anfallssuppressiva und die möglichen Risiken eines Herstellerwechsels. In dem Themenblock Epilepsiechirurgie werden die Indikationen zur prächirurgischen Diagnostik und zu den vielfältigen Therapieverfahren wie Resektion, Laserablation und Neurostimulation dargestellt. Einen großen Stellenwert nehmen die Empfehlungen zur postoperativen Versorgung der Patient:innen inklusive Rehabilitation und psychosozialer Beratung ein. Beim Thema komplementäre und supportive Therapieverfahren werden Empfehlungen zur Diagnostik und Therapie von die Epilepsien häufig begleitenden Angststörungen, Depressionen und Psychosen gegeben. Ein weiterer Schwerpunkt ist die Behandlung von psychogenen nicht-epileptischen Anfällen als neuropsychiatrische Differenzialdiagnose oder Begleiterkrankung von epileptischen Anfällen. Weiterhin werden Empfehlungen zum Stellenwert der ketogenen Diät sowie zu Akupunktur, Homöopathie und weiteren komplementären Behandlungsansätzen gegeben. Die Empfehlungen zu psychosozialen Aspekten umfassen alltagsrelevante Themen wie Kraftfahreignung, Ausbildung und Beruf, medizinische Rehabilitation, Sport, Transition, Selbsthilfe, Schulungen von Patient:innen und Angehörigen, Adhärenz, Aufklärung zu SUDEP (Sudden Unexpected Death in Epilepsy).

Objective This study was undertaken to develop a standardized grading system based on expert consensus for evaluating the level of confidence in the localization of the epileptogenic zone (EZ) as reported in published studies, to harmonize and facilitate systematic reviews in the field of epilepsy surgery. Methods We conducted a Delphi study involving 22 experts from 18 countries, who were asked to rate their level of confidence in the localization of the EZ for various theoretical clinical scenarios, using different scales. Information provided in these scenarios included one or several of the following data: magnetic resonance imaging (MRI) findings, invasive electroencephalography summary, and postoperative seizure outcome. Results The first explorative phase showed an overall interrater agreement of .347, pointing to large heterogeneity among experts' assessments, with only 17% of the 42 proposed scenarios associated with a substantial level of agreement. A majority showed preferences for the simpler scale and single‐item scenarios. The successive Delphi voting phases resulted in a majority consensus across experts, with more than two thirds of respondents agreeing on the rating of each of the tested single‐item scenarios. High or very high levels of confidence were ascribed to patients with either an Engel class I or class IA postoperative seizure outcome, a well‐delineated EZ according to all available invasive EEG (iEEG) data, or a well‐delineated focal epileptogenic lesion on MRI. MRI signs of hippocampal sclerosis or atrophy were associated with a moderate level of confidence, whereas a low level was ascribed to other MRI findings, a poorly delineated EZ according to iEEG data, or an Engel class II–IV postoperative seizure outcome. Significance The proposed grading system, based on an expert consensus, provides a simple framework to rate the level of confidence in the EZ reported in published studies in a structured and harmonized way, offering an opportunity to facilitate and increase the quality of systematic reviews and guidelines in the field of epilepsy surgery.