Precise preoperative evaluation of drug-resistant epilepsy (DRE) requires accurate analysis of invasive stereoelectroencephalography (SEEG). With the tremendous breakthrough of Artificial intelligence (AI), previous studies can help clinical experts to identify pathological activities automatically. However, they still face limitations when applied in real-world clinical DRE scenarios, such as sample imbalance, cross-subject domain shift, and poor interpretability. Our objective is to propose a model that can address the above problems and realizes high-sensitivity SEEG pathological activity detection based on two real clinical datasets. Our proposed innovative and effective SEEG-Net introduces a multiscale convolutional neural network (MSCNN) to increase the receptive field of the model, and to learn SEEG multiple frequency domain features, local and global features. Moreover, we designed a novel focal domain generalization loss (FDG-loss) function to enhance the target sample weight and to learn domain consistency features. Furthermore, to enhance the interpretability and flexibility of SEEG-Net, we explain SEEG-Net from multiple perspectives, such as significantly different features, interpretable models, and model learning process interpretation by Grad-CAM++. The performance of our proposed method is verified on a public benchmark multicenter SEEG dataset and a private clinical SEEG dataset for a robust comparison. The experimental results demonstrate that the SEEG-Net model achieves the highest sensitivity and is state-of-the-art on cross-subject (for different patients) evaluation, and well deal with the known problems. Besides, we provide an SEEG processing and database construction flow, by maintaining consistency with the real-world clinical scenarios. According to the results, SEEG-Net is constructed to increase the sensitivity of SEEG pathological activity detection. Simultaneously, we settled certain problems about AI assistance in clinical DRE, built a bridge between AI algorithm application and clinical practice.

Surgical intervention or the control of drug-refractory epilepsy requires accurate analysis of invasive inspection intracranial EEG (iEEG) data. A multi-branch deep learning fusion model is proposed to identify epileptogenic signals from the epileptogenic area of the brain. The classical approach extracts multi-domain signal wave features to construct a time-series feature sequence and then abstracts it through the bi-directional long short-term memory attention machine (Bi-LSTM-AM) classifier. The deep learning approach uses raw time-series signals to build a one-dimensional convolutional neural network (1D-CNN) to achieve end-to-end deep feature extraction and signal detection. These two branches are integrated to obtain deep fusion features and results. Resampling is employed to split the imbalanced epileptogenic and non-epileptogenic samples into balanced subsets for clinical validation. The model is validated over two publicly available benchmark iEEG databases to verify its effectiveness on a private, large-scale, clinical stereo EEG database. The model achieves high sensitivity (97.78%), accuracy (97.60%), and specificity (97.42%) on the Bern–Barcelona database, surpassing the performance of existing state-of-the-art techniques. It is then demonstrated on a clinical dataset with an average intra-subject accuracy of 92.53% and cross-subject accuracy of 88.03%. The results suggest that the proposed method is a valuable and extremely robust approach to help researchers and clinicians develop an automated method to identify the source of iEEG signals.

Successful surgery on drug-resistant epilepsy patients (DRE) needs precise localization of the seizure onset zone (SOZ). Previous studies analyzing this issue still face limitations, such as inadequate analysis of features, low sensitivity and limited generality. Our study proposed an innovative and effective SOZ localization method based on multiple epileptogenic biomarkers (spike and HFOs), and analysis of single-contact (MEBM-SC) to address the above problems. We extracted contacts epileptic features from signal distributions and signal energy based on machine learning and end-to-end deep learning. Among them, a normalized pathological ripple rate was designed to reduce the disturbance of physiological ripple and enhance the performance of SOZ localization. Then, a feature selection algorithm based on Shapley value and hypothetical testing (ShapHT+) was used to limit interference from irrelevant features. Moreover, an attention mechanism and a focal loss algorithm were used on the classifier to learn significant features and overcome the unbalance of SOZ/nSOZ contacts. Finally, we provided an SOZ prediction and visualization on magnetic resonance imaging (MRI). Ten patients with DRE were selected to verify our method. The experiment performed cross-validation and revealed that MEBM-SC obtains higher sensitivity. Additionally, the spike has better sensitivity while HFOs have better specificity, and the combination of these biomarkers can achieve the best performance. The study confirmed that MEBM-SC can increase the sensitivity and accuracy of SOZ localization and help clinicians to perform a precise and reliable preoperative evaluation based on interictal SEEG.