Unsupervised Learning of Spatiotemporal Interictal Discharges in Focal Epilepsy

BACKGROUND Interictal epileptiform discharges are an important biomarker for localization of focal epilepsy, especially in patients who undergo chronic intracranial monitoring. Manual detection of these pathophysiological events is cumbersome, but is still superior to current rule-based approaches in most automated algorithms. OBJECTIVE To develop an unsupervised machine-learning algorithm for the improved, automated detection and localization of interictal epileptiform discharges based on spatiotemporal pattern recognition. METHODS We decomposed 24 h of intracranial electroencephalography signals into basis functions and activation vectors using non-negative matrix factorization (NNMF). Thresholding the activation vector and the basis function of interest detected interictal epileptiform discharges in time and space (specific electrodes), respectively. We used convolutive NNMF, a refined algorithm, to add a temporal dimension to basis functions. RESULTS The receiver operating characteristics for NNMF-based detection are close to the gold standard of human visual-based detection and superior to currently available alternative automated approaches (93% sensitivity and 97% specificity). The algorithm successfully identified thousands of interictal epileptiform discharges across a full day of neurophysiological recording and accurately summarized their localization into a single map. Adding a temporal window allowed for visualization of the archetypal propagation network of these epileptiform discharges. CONCLUSION Unsupervised learning offers a powerful approach towards automated identification of recurrent pathological neurophysiological signals, which may have important implications for precise, quantitative, and individualized evaluation of focal epilepsy.