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Comparison of fractal dimension estimation algorithms for epileptic seizure

Comparison of fractal dimension estimation algorithms for epileptic seizure

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Comparison of fractal dimension estimation algorithms for epileptic seizure onset detection

This article has been downloaded from IOPscience. Please scroll down to see the full text article.

2010 J. Neural Eng. 7 046007

(http://iopscience.iop.org/1741-2552/7/4/046007)

View the table of contents for this issue, or go to the journal homepage for more

Download details:

IP Address: 147.102.20.112

The article was downloaded on 25/10/2010 at 12:08

IOP PUBLISHING

doi:10.1088/1741-2560/7/4/046007

estimation algorithms for epileptic seizure

onset detection

G E Polychronaki1 , P Y Ktonas2 , S Gatzonis2,3 , A Siatouni2,3 ,

P A Asvestas4 , H Tsekou2,3 , D Sakas2,3 and K S Nikita1

1

School of Electrical and Computer Engineering, National Technical University of Athens, 9, Heroon

Polytechniou Str., Zografou, Athens 157 80, Greece

2

Greek Center for Neurosurgical Research Prof. Petros Kokkalis, 3, Ploutarxou Str., Athens 106 75,

Greece

3

Epilepsy Surgery Unit, Department of Neurosurgery, University of Athens, Evangelismos Hospital,

45-47, Ipsilantou Str., Athens 106 76, Greece

4

Department of Medical Instruments Technology, Faculty of Technological Applications, Technological

Educational Institute of Athens, Ag. Spyridonos Str., Egaleo, Athens 122 10, Greece

E-mail: gpoly@biosim.ntua.gr, knikita@cc.ece.ntua.gr and Periklis.Ktonas@mail.uh.edu

Accepted for publication 26 May 2010

Published 23 June 2010

Online at stacks.iop.org/JNE/7/046007

Abstract

Fractal dimension (FD) is a natural measure of the irregularity of a curve. In this study the

performances of three waveform FD estimation algorithms (i.e. Katzs, Higuchis and the

k-nearest neighbour (k-NN) algorithm) were compared in terms of their ability to detect the

onset of epileptic seizures in scalp electroencephalogram (EEG). The selection of parameters

involved in FD estimation, evaluation of the accuracy of the different algorithms and

assessment of their robustness in the presence of noise were performed based on synthetic

signals of known FD. When applied to scalp EEG data, Katzs and Higuchis algorithms were

found to be incapable of producing consistent changes of a single type (either a drop or an

increase) during seizures. On the other hand, the k-NN algorithm produced a drop, starting

close to the seizure onset, in most seizures of all patients. The k-NN algorithm outperformed

both Katzs and Higuchis algorithms in terms of robustness in the presence of noise and

seizure onset detection ability. The seizure detection methodology, based on the k-NN

algorithm, yielded in the training data set a sensitivity of 100% with 10.10 s mean detection

delay and a false positive rate of 0.27 h1 , while the corresponding values in the testing data

set were 100%, 8.82 s and 0.42 h1 , respectively. The above detection results compare

favourably to those of other seizure onset detection methodologies applied to scalp EEG in the

literature. The methodology described, based on the k-NN algorithm, appears to be promising

for the detection of the onset of epileptic seizures based on scalp EEG.

(Some figures in this article are in colour only in the electronic version)

demands. Surgical resection is nowadays evolving into a

broadly applied strategy for confronting some types of focal

epilepsies (Tellez-Zenteno et al 2005). Long-term video/EEG

monitoring during pre-surgical evaluation for epilepsy

surgery produces huge numbers of continuous multiple-day

1. Introduction

Epilepsy belongs amongst the most common neurological

diseases, second only to strokes (Annegers 1997). Although

computer detection of epileptic seizures is a relatively old

field of research (Gotman 1982), its significance becomes

1741-2560/10/046007+18$30.00

G E Polychronaki et al

recordings, which need to be reviewed for the existence

of seizures. Similar needs arise from ambulatory EEG

monitoring (Waterhouse 2003). For that reason, various

automated seizure detection techniques have been developed

which aim to detect the presence of a seizure using both scalp

(Sazonov et al 2009, Schad et al 2008, van Putten et al 2005,

Wilson et al 2004, Liu et al 2002, McSharry et al 2002,

Schindler et al 2001, Gabor 1998, Gabor et al 1996, Gotman

1990, 1982) and intracranial EEG (Schad et al 2008, Bhavaraju

et al 2006, Gardner et al 2006, Meng et al 2004, Khan and

Gotman 2003, Schindler et al 2001, Harding 1993, Murro et al

1991).

Exhaustive pre-surgical evaluation should commonly

provide information about the localization of an epileptic

focus, which could be ascertained by the interaction of medical

staff with the patient during the first few seconds of the

evolving seizure. This leads to the more challenging task

of online seizure onset detection, with moreover as few false

detections (false positives (FP)) as possible. Systems capable

of defining seizures onsets with high sensitivity and low FP

rates could also be utilized for automatic seizure termination,

e.g. via electrical stimulation (Morrell 2006) or drug delivery

(Eder et al 1997). The patient-specific algorithm of Qu and

Gotman (1997) for the detection of seizure onset in long-term

scalp EEG monitoring was the first attempt at introducing such

a seizure warning system. Other important works in the field

of seizure onset detection include Meier et al (2008), Saab

and Gotman (2005) and Shoeb et al (2004) which have been

developed using scalp EEG, while intracranial EEG has been

used in Haas et al (2007), Grewal and Gotman (2005), Osorio

et al (2002, 1998).

The term fractal can be used to characterize objects

in space or fluctuations in time which show a form of selfsimilarity. A fractal is an object made of parts similar to

the whole and has the property that more fine structure is

revealed as the object is magnified (Klonowski 2000). The

fractal dimension (FD) is a measure of how complicated a

self-similar object is, taking greater values for increasing

complexity. Strict self-similarity is a property that only

artificially generated mathematical objects are characterized

by; the Sierpinski triangle is such an example (Kaplan and

Glass 1995). Natural objects show statistical self-similarity

(Klonowski 2000). In the statistical sense, an object is selfsimilar if its parts, on average, are similar to the whole (Kaplan

and Glass 1995), but there exist no exact replicas of particular

parts. In statistical self-similarity, a measure of complexity for

a given magnification will have the same statistical moments

as at any other magnification, although the details will not be

identical (Arle and Simon 1990).

In time series analysis, FD can be used to quantify the

irregularity or complexity of a waveform (Katz and George

1985). In this study, we compared different FD estimation

algorithms using scalp EEG data in order to assess their

usefulness in automatically detecting the onset of epileptic

seizures of patients with refractory mesial temporal lobe

(MTL) epilepsy. MTL epilepsy is the most common form

of human epilepsy and is typically medically refractory

are described by electroencephalographers as low to medium

voltage, irregular and arrhythmic, while during the ictal period

(seizure) the EEG activity changes to have more organized,

rhythmic and self-sustained characteristics (Sackellares et al

2000). Therefore, intuitively, it seems that the FD is an

appropriate measure for the characterization of changes in such

EEG dynamics, as it could be expected to drop in value during

seizures as compared to interictal periods. In the current study,

the selection of scalp over intracranial EEG was motivated by

the fact that seizure detection using this type of EEG recordings

would be more practical in real life and, moreover, it would be

suitable for types of epilepsy that do not warrant intracranial

electrode implantation (Le Van Quyen et al 2001). It has to

be pointed out, however, that scalp EEG is subject to many

different types of artefacts (e.g. eye blinks, muscle activity,

etc) which make the detection of seizures onsets with a low

FP rate a challenging task.

The applicability of fractal analysis to EEG time series has

been examined in various studies (Andrzejak et al 2006, 2001,

Li et al 2005, Liu et al 2005, Klonowski 2002, Esteller et al

2001b, Accardo et al 1997, Bullmore et al 1994, Cabukovski

et al 1993, Arle and Simon 1990, and references therein)

using different FD estimators including, but not limited to,

algorithms by Petrosian (1995), Maragos and Sun (1993), Katz

(1988), Higuchi (1988), Richardson in Voss (1988), Pickover

and Khorasani (1986), Grassberger and Procaccia (1983). For

a review of applications of fractal time series analysis in

physiological research, not limited to EEG analysis, see Eke

et al (2002).

In the current study, two of the most widely used FD

methods in the literature, i.e. the algorithms proposed by Katz

(1988) and Higuchi (1988), are compared to the algorithm

introduced by our group (Asvestas et al 1999), called the

k-nearest neighbour (k-NN) algorithm. The former two

algorithms, or variations thereof, have been broadly applied

in various studies (Gomez et al 2009, Acharya et al 2005,

Berryman et al 2005, Accardo et al 1997, Esteller et al 2001b,

Bullmore et al 1994). In contrast, to the best of our knowledge,

this is the first time that the k-NN algorithm has been applied

in a time series analysis sense.

Few works in the literature have utilized FD methods

particularly for the study of epileptic seizures (Esteller

et al 2001b, 1999, Accardo et al 1997, Bullmore et al

1994, 1992). The main objective of those works was to

examine whether FD could provide a sensitive criterion for

discriminating the seizure from the non-seizure state by

observing whether distinct changes in the FD would arise

during seizures. Nevertheless, none of those studies used

long-term EEG data to assess the ability of different FD

algorithms to be not only sensitive but also specific in detecting

changes during seizures. In all studies, the results using

only short EEG segments containing seizures were reported

and no interictal data were analysed to provide a further

understanding of how FD values would change during the

different physiological states (e.g. sleep, chewing, etc) that

would normally exist during an inpatient or ambulatory setting.

Analysis of long interictal EEG records would be necessary

2

G E Polychronaki et al

Patient

Sex

Age (years)

Seizure type

Outcome

No of seizures

1

2

3

4

f

m

f

m

36

62

32

38

CP

CP

CP, sGTC

CP

I

I

13

162.5

16.9

68.94

4

5

7

21

78.48

52.47

58.85

72.34

Sum training

Mean training

261.34

65.34 69.62

37

I

Ib

I

Ib

101

67

62.91

60.89

Sum testing

Mean testing

291.8

72.95 18.87

18

Sum overall

Mean overall

553.14

69.14 47.39

55

5

6

7

8

f

m

f

f

33

25

30

32

CP

CP, sGTC

CP

CP, sGTC

3

8

4

3

65.53 11.96

31.57

55.15

54.14

71.7

53.18 16.40

59.36 14.84

m, male; f, female. Seizure types: complex partial (CP), secondarily generalized tonicclonic (sGTC). Values presented are mean

standard deviation. The outcome is according to Engels classification.

could be far more distinct as compared to those during other

physiological states and that, therefore, FD measures could be

utilized effectively for the purpose of seizure detection.

The main objective of the current work was to perform

a comparison of the three FD methods in terms of their

ability to detect the onset of epileptic seizures and at the

same time produce an acceptable number of FPs, using longterm, multichannel, continuous scalp EEG data, including

artefacts. In order to ensure an optimal EEG analysis using

the algorithms and to facilitate the interpretation of the results,

all three algorithms were first applied on synthetic signals

of known FD. This is related to the second objective of the

current work, which was, based on the synthetic signals, the

selection of appropriate values for the parameters involved

in FD estimation algorithms (i.e. in Higuchis and the k-NN

algorithms) and the comparison of the different algorithms

based on the assessment of their estimation accuracy and

robustness in the presence of noise.

In section 2, the EEG data set used in the current

study is presented and an outline of the FD estimation

algorithms utilized is provided. Moreover, the seizure

detection methodology developed based on FD is described.

This is followed in section 3 by the evaluation of the FD

algorithms and the selection of the parameters involved in

FD calculations, using synthetic signals of known FD. The

application of the FD algorithms to scalp EEG data and a

comparison of the different algorithms seizure onset detection

ability are presented in section 4. Discussion of the results and

suggestions for further work follow in section 5.

University of Athens, Evangelismos Hospital, during longterm video/EEG for pre-surgical evaluation. For the data

acquisition, a Beehive Millennium Digital Recording System

with Grass Telefactor Twin Recording and Analysis Software

was used. The low- and high-pass filters of the amplifiers

allowed EEG frequencies between 0.1 and 70 Hz to be

recorded. Data were acquired at a sampling rate of 400 Hz,

with 12 bits A/D resolution. The data set comprised 553.14 h

of EEG recording and included 55 seizures in total. Table 1

summarizes patients characteristics as well as details about the

EEG recordings. Making the rough assumption that between

11.30 p.m. and 7.30 a.m. the patient was asleep, 183.5 h were

sleep recordings, originating from seven of eight patients in the

data set. No exclusion of records with artefacts, such as those

introduced by movement of the patient or transient electrode

failure, was undertaken. Twenty-five gold disk electrodes were

placed according to the 1020 international system in addition

to six temporal electrodes. Two of these were sphenoidal,

and the rest consisted of T1, T2 (placed according to the

international extended 1020 system) and 27, 28, which were

placed at mastoid hilus. A referential electrode montage was

used both for the recording and the analysis, with the reference

electrode being placed between Cz and Pz.

In order to design and develop the automatic seizure

detection methodology, the EEG records were divided into

a training and a testing data set. After sorting the patients in

the chronological order of admission for long-term video/EEG

monitoring, we selected the first four patients as our training

data set (261.34 h, 37 seizures) and the remaining four as the

testing data set (291.8 h, 18 seizures). Seizure onset times

were marked by a single expert as the time points at which the

first EEG changes occurred which led to a clear EEG seizure

discharge. Seizure offset times were also marked.

2.1. EEG data description

suffering from refractory epilepsy with mesial temporal

sclerosis were used.

All the data were collected in

Higuchis and the k-NN FD estimation algorithms, do not

3

G E Polychronaki et al

This is a great advantage when a detailed temporal evolution

of the signal is of interest, as in our case where we wished

to detect the presence of seizures as closely to their onset as

possible. Such time-domain approaches (as opposed to the

phase-space approaches which actually calculate FD in phase

space) require a significantly lower number of points in order to

provide an estimate of the FD (Bullmore et al 1992, Accardo

et al 1997, Esteller et al 2001b). This has the additional

advantage that stationarity of EEG segments analysed can be

more easily assumed for shorter time windows. Moreover, the

techniques are faster in terms of required computational time

(Esteller et al 2001b) and, therefore, could be better candidates

for a possible online implementation.

The k-NN algorithm was considered an appropriate

candidate for scalp EEG analysis for epileptic seizure detection

for two reasons: first, the aforementioned low demands in

input data points, and second, the fact that in image analysis,

where it was originally applied, it proved to be superior

in terms of accuracy, dynamic range and computational

time (Asvestas et al 1999) as compared to other traditional

FD estimation methods (e.g. box-counting dimension and

correlation algorithm).

FD estimation is also based on curve length measurement.

The algorithm estimates the mean length of the curve, by

using a segment of k samples as a unit of measure. In practice,

Higuchis method is a modification of an older similar FD

estimation approach proposed by Burlaga and Klein (1986).

In more detail, Higuchis FD estimation technique consists of

the following steps.

Step 1. Let us define the values of a finite set of time series

observations, which are taken in a regular interval as

y1 , y2 , y3 , . . . , yi , . . . , yN = y(1), y(2), y(3), . . . ,

y(i), . . . , y(N ), where i = 1, 2, . . . , N (N: number of points

in the time series). In our case, y would be the successive

EEG values. For a range of k values ranging from 1 to kmax ,

construct k new times series yk m defined as follows:

yk m : y(m), y(m + k), y(m + 2k), . . . , y(m + ik), . . . ,

N m

k , where m = 1, 2, . . . , k.

y m + int

k

Step 2. Calculate the length Lm (k) of each curve yk m as follows:

Nm

int( k )

|y(m + i k) y(m + (i 1) k)|

Lm (k) =

i=1

collections of points p

i = (xi , yi ) with xi < xi+1 , i = 1, 2, . . . ,

N (N: number of points), and they are special cases of planar

curves (moving only forward in the x direction). Katz (1988)

based his method of FD estimation on the measurement of the

length of such curves. He incorporated Mandelbrots original

contribution (Mandelbrot 1982), in combination with a unit of

measure or yardstick definition, in order to take into account

that, to calculate FD, space must be discretized. According to

Mandelbrot (1982), the FD of a planar curve is given by

FD = log(L)/log(d),

N 1

Nm

k 1 .

k

k

1

The term (N 1) int Nm

serves as a normalization

k

k

factor for the curve length of yk m . For an illustrative example

of Lm (k) calculation, the interested reader may refer to Accardo

et al (1997).

int

L(k), as the average value

over k sets of Lm (k), for m = 1,

2, . . . , k, as L(k) = k1 km=1 Lm (k). Repeat the calculation

for k ranging from 1 to kmax .

(1)

For waveforms, the total length L is the sum of the distances

between successive points

d = max

pi p

1 .

dimension FD. In that case, the plot of ln(L(k)) against

ln(k) should fall on a straight line with slope equal to FD.

Therefore, FD can be calculated by means of a least-squares

linear best-fitting procedure.

One important point that Higuchi did not extensively

elaborate on in his original work (Higuchi 1988) is the selection

of kmax . In this study, we attempted to provide a means for

selecting an optimum kmax , as illustrated in section 3.2.1.

of the average step a of the waveform (which is the average

distance between successive points) viewed as a yardstick.

Using a, (1) becomes

log(L/a)

FD =

.

(2)

log(d/a)

Defining n as the number of steps in the curve (1 less than

the number of points N), n = L/a. Substituting n in (2), FD

according to Katzs approach is expressed as

log(n)

FD =

log(n) + log(d/L)

and Higuchis algorithms, which are based on measurements

of the length of the waveform under investigation, the k-NN

algorithm belongs to a class of algorithms, called fixed-mass,

according to which FD estimation is based on the sizes of cubes

which are scaled appropriately as to contain the same number

of points (fixed-mass) (Asvestas et al 1999, and references

therein). The average distance, rk , of a point from its

kth nearest neighbour can be expressed as a function of k

as (Grassberger 1985)

rk = G(k, )(k/N ) /D( ) ,

(3)

L=

N

pi+1 p

i ,

i=1

extent) d can be considered to be the farthest distance between

the starting point and any other point of the waveform:

i

G E Polychronaki et al

dimension of order q, N is the number of points and G(k, ) is

a function of k and , which is near unity for large k. For q =

0, the FD is obtained, that is FD = D0 , which means that FD

is the fixed point of the function D( ), namely FD = D(FD)

(for more details see Asvestas et al (1999)).

The FD of a waveform is estimated iteratively, using (3),

for k = kmin , . . . , kmax (k integer), as follows (Asvestas et al

1999).

Table 2. EEG channels for which the results are presented for each

FD algorithm. Td denotes the value of the threshold which was used

in order to select those channels. Patients 14 are the training and

58 the testing data set.

G(k, ) is set to unity for every k (G(k, ) was set to unity in

Asvestas et al (1999) and we follow the same assumption in the

current study). Since the FD of waveforms lies theoretically

between 1 and 2 (Klonowski 2000), it would be better to choose

0 in this range, i.e. 0 = 1.5.

Step 2. For every point p

i = (xi , yi ), i = 1, 2, . . . , N,

we calculate the Euclidian distances rki from its k-nearest

neighbours, k = kmin , . . . , kmax .

Patient

Katzs

algorithm

Td = 1.89

Higuchis

algorithm

Td = 1.39

k-NN

algorithm

Td = 1.27

1

2

3

4

5

6

7

8

T1

F8

T1

T4

F7

T2

F7

T6

T3

T2

T5

28

F7

28

T5

T2

T3

T2

T3

T4

T3

T2

T1

28

data window. Five FD time profiles were generated using a

standard set of five EEG traces for each patient, depending on

the lateralization of the seizure origin (EEG channels T1, T3,

T5, F7, 27 were used for left temporal epilepsy, and T2, T4, T6,

F8, 28 for right temporal epilepsy). The procedure described

above was repeated using all three different FD algorithms.

The results presented for each FD algorithm and each

patient are the ones produced by the EEG channels which

achieved the earliest seizure detections. Those channels were

selected on the basis of a threshold Td. A different value for

Td was defined for each FD algorithm based on the recordings

of the training data set as follows: we used the seizures of

the channels associated with the maximum FD drops during

seizures and Td was computed as the average of the median

FD values during those seizures (all seizures of all patients

in the training data set were used for the averaging). Td

was then applied to every patient in the training data set

in order to detect seizures and define associated detection

delays (DD) (the exact procedure for calculation of DDs is

explained in the next paragraph). The channel selected for each

patient in the training data set was the one which detected the

largest number of seizures and at the same time produced the

minimum average DD calculated using all detected seizures of

the patient. The channels in the testing data set were similarly

selected, based on application of Td on the first two seizures of

each patient. Channels selected and used for analysis as well

as the Td value for each FD method are depicted in table 2.

In order to detect seizure onset in the selected channels,

a generic threshold Tg (different for each FD algorithm)

was applied to the FD time profiles of both the training

and the testing data set (the procedure for Tg selection will

be explained in the next paragraph). In order to produce

alarms related to automatically detected seizures, a two-step

procedure was followed. In the first step, a parameter w

was defined as the number of FD values (i.e. number of 2 s

windows) that should have remained under the threshold in

order for a detection mark to be produced and placed at

the end of the last 2 s window. This parameter w, which

has been used in a similar manner in the seizure detection

literature (Osorio et al 1998), was incorporated in order to

eliminate possible detections due to short bursts of EEG

applied:

j 1

,

j = D(j ),

(4)

D(j ) =

sj 1

where

sj 1 is the slope of the best-fitting line at the points

N

1 j 1

rk j 1 =

r .

N i=1 ki

D( )

j

j 1

1

2 [D(j ) + j 1 ]

drops below a certain value or a maximum number of iterations

is reached. FD is calculated as D( j ) for the last j before the

above criterion is met.

Similarly to Higuchis algorithm, the k-NN algorithm

is also parametric: kmin and kmax need to be defined. In

section 3.2.2 we propose a method of selecting an optimum

pair of kmin and kmax .

2.3. Description of the seizure detection methodology based

on FD

The first step of our approach included band-pass filtering of

the EEG data between 3 and 30 Hz. The reason for this was

threefold: (a) seizure activity during seizure onset lies more

often between 3 and 29 Hz (Gotman 1982); (b) occurrences

of 03 Hz activity can be frequent in non-ictal sleep EEG

(Saab and Gotman 2005) and (c) this filtering removed highamplitude slow post-ictal EEG activity, which in our analysis

of the training data proved to be the cause of a great number

of FPs (which were eliminated after filtering). A zero-phase

Butterworth filter of order 4 was utilized. After filtering, a

sliding-window approach was employed for the production

of FD time profiles: 2 s length windows (corresponding to

800 points) with no overlap were used. This led to the

production of FD time profiles (time series), individual points

5

G E Polychronaki et al

(a)

(b)

Figure 1. Demonstration of the automatic seizure detection methodology using the k-NN algorithm. (a) FD time profile for 1.5 h of

recording of patient 4, including one seizure starting at about 3370 s (the start and the end of the seizure are denoted by solid vertical lines).

Note the clear drop of the k-NN FD time profile during the seizure, as compared to interictal activity. (b) Detail of (a), zoomed around the

seizure (again the start and the end of the seizure are denoted by solid vertical lines, while the seizure start is aligned with t = 0). A star

indicates the FD value which is estimated based on the EEG values of the 2 s data window which starts at the point in time that the star lies.

The solid horizontal line denotes the threshold. Dotted vertical lines depict the times that a detection mark is produced, before the

grouping of detection marks is performed. The first of them, which in the figure is dotted in bold, is the alarm. Note that the alarm is

produced only after 2 FD points are found to be below the threshold.

electroencephalographers employ for visual inspection of EEG

data records: according to their assessment, whether some

epileptiform activity is actually a seizure or an interictal

discharge critically depends on the duration of this activity. In

the present study, we used w = 2 which ensured a reduction in

FPs without significantly affecting the DDs. During seizures,

multiple successive 4 s windows (defined by w = 2) produced

detection marks, since many successive FD values were

smaller than the threshold Tg. Therefore, in the second step

towards producing alarms related to automatically detected

seizures, detection marks separated by less than 40 s were

grouped in a single alarm (the same approach as in Saab

and Gotman (2005)). This alarm was located at the same

position in time as the first detection mark of the group, i.e.

at the end of the first 4 s window with corresponding FD values

below the threshold Tg. The value of 40 s was selected based

on the fact that seizures in the examined data set (table 1)

had durations that mostly exceeded 40 s. This grouping

identified detection marks that should be attributable to the

same event (the user should be notified about one seizure with

only one alarm). Alarms were then categorized as true

positives if they appeared during the seizures duration or as

FPs otherwise. In the case of a true positive detection, DD was

defined as the time elapsed between the beginning of a seizure,

as found by the EEG specialist, and the position in time of the

alarm. The FP rate was calculated for each patient as the total

number of FPs generated divided by the total duration of the

recording after excluding the seizures duration. The FP rate

provided a measure of specificity: the lower the FP rate, the

higher the achieved specificity. An example of the automatic

detection procedure for a seizure is illustrated in figure 1.

In the detection framework described so far, the selection

of threshold Tg for each FD method is of crucial importance.

Since both the FP rate and DD are of interest, ideally a

threshold should provide 100% success in the detection of

a more realistic scenario, some FPs can be allowed, and the

threshold can be defined based on a maximum allowed number

of FPs per hour. In the recent seizure detection literature

using scalp EEG, FP rates in the range 0.02 h1 (Qu and

Gotman 1997) to 0.86 h1 (Saab and Gotman 2005) have been

reported, with corresponding sensitivities/DD of 100%/9.35 s

and 77.9%/9.8 s. In the current work, 0.3 h1 was set as

the maximum FP rate allowed, following Saab and Gotman

(2005). To that end, Tg was defined for each FD method as

the maximum threshold whose application produced a mean

FP rate <0.3 h1 in the training data set (the mean FP rate was

calculated using the channels selected based on the threshold

Td, as explained earlier in this section). The value of Tg for

each FD method is provided in section 4 and in the caption of

figure 13.

3.1. Purpose of study with synthetic signals and signal

generation

In this section, Katzs, Higuchis and the k-NN FD estimation

algorithms were applied to synthetic signals of known FD. The

purpose of this application was twofold: in the first step, the

definition of an objective and systematic way for determining

the parameters of each of the parametric algorithms studied,

i.e. Higuchis and the k-NN algorithms, was pursued; in the

second step, using the selected parameter values, the different

algorithms were assessed in terms of accuracy and noise

sensitivity.

For the synthetic signal generation, a deterministic

Weierstrass cosine function (Tricot 1995), sampled at N

equidistant points, was used:

M

iH cos(2 i x),

0 < H < 1,

(5)

WH (x) =

i=0

G E Polychronaki et al

(a)

(b)

Figure 2. Weierstrass cosine function for two different theoretical FD values (FDth = 1.2 (a) and FDth = 1.5 (b)).

Esteller et al (2001b), and x [0,1]. N = 800 was used.

The above-defined function is Weierstrasss example of a

continuous function that is nowhere differentiable and has a

known theoretical FD (Falconer 2003). More specifically,

parameter H, and this parameter alone, is connected to

the theoretical FD (FDth) of the Weierstrass waveform by

FDth = 2 H. Using (5), Weierstrass sequences, each having a

different theoretical FD value (i.e. 1.1, 1.2, 1.3, . . . , 1.9), were

generated. In figure 2, two of those sequences are depicted.

In the current study, N = 800 was used both for the synthetic

signals and the EEG data analysis. This data window length

was selected as an acceptable compromise between including

an adequate number of points for accurate FD estimation and

being relatively short in time, as to enable us to reasonably

assume that the EEG signal is stationary during that data

window.

values. MSE takes minimum values for kmax equal to 9, 25 and 50.

kmax values, a mean square error (MSE) was estimated

according to (6)

n

(FDei FDthi )2

,

(6)

MSE = i=1

n

where FDth is the theoretical FD value for the synthetic signals,

FDe is the estimated one and n is the number of Weierstrass

sequences (of different theoretical FD values) used for the

MSE estimation. Figure 3 shows the MSE against kmax . Values

of kmax lower than 5 led to a clearly poor FD estimation which

resulted in very high MSEs (one order of magnitude higher, up

to 0.085, not displayed in the figure). According to figure 3,

there are three troughs of lower MSE values, and for increasing

kmax values past 50 the FD estimations only get worse. The

lowest MSE values for each trough correspond to the following

values of kmax : 9, 25 and 50. All these values were considered

as candidates for FD estimation using Higuchis algorithm

when applied to the EEG data, as they correspond to similar

MSE values. Therefore, all three of them were tested and the

results are presented in section 4.2.

3.2.1. Higuchis algorithm. Even though Higuchi did not

elaborate extensively on the selection of kmax in his original

work (Higuchi 1988), it seems that this parameter has a

decisive role for the FD estimation when utilizing his method,

as illustrated in the current work. A few studies in the past have

attempted to address the issue of kmax selection: the authors

in Accardo et al (1997) selected kmax = 6 as the optimum

kmax value in the range kmax = 310. Other studies have

suggested that the selection of the kmax range should probably

be subjected to further consideration if a large N is to be

used. In his paper Higuchi selected in illustrative examples

much greater values of kmax , i.e. kmax = 211 , for N = 217 .

In another study (Paramanathan and Uthayakumar 2008), the

authors provided an algorithmic estimation of kmax , inspired by

a divider method for FD estimation. In their approach, kmax of

Higuchis method was recalculated for every FD estimation.

In that study too, the authors suggested increasing kmax for

increasing N.

In the current study, a wide range of kmax values was

considered, i.e. 280 (recall N = 800 is used). Using each

of those values, the FDs using Higuchis algorithm were

calculated for different Weierstrass sequences. In order to

for Higuchis algorithm, based on the MSE of estimations,

7

G E Polychronaki et al

Calculate of DF:

Best: FD Higushi.

possible (kmin , kmax ) combinations of values examined. For (kmin ,

kmax ) = (1, 173) the minimum MSE = 6.5 104 is achieved.

(FDe) plotted against the corresponding theoretical FD values

(FDth), using all three FD estimation algorithms.

was applied for estimating (kmin , kmax ) for the k-NN algorithm.

Again, a wide range of possible (kmin , kmax ) values was tested,

i.e. kmin was assigned values in the range 15 and kmax in

the range 100250. The MSE was calculated for all possible

(kmin , kmax ) combinations (and it only increased for values of

(kmin , kmax ) outside the range presented here). The results are

presented in figure 4. In the case of (kmin , kmax ) selection for the

k-NN-based estimation, the problem of multiple troughs with

similar MSEs, such as in figure 3, did not appear. In contrast,

there existed a single minimum towards which all MSE values

converged, which was achieved for the combination (kmin ,

kmax ) = (1, 173). Therefore, this pair of values was selected

as the optimal and was used for all the calculations in the rest

of this work, both with synthetic signals and with scalp EEG.

FD and SNR were estimated, and the mean value and standard

deviation of the estimates were calculated. Again, for the

estimation of FDs using Higuchis algorithm, kmax = 50 was

used, while for k-NN, (kmin , kmax ) = (1, 173) were used.

The results for all different noise levels and FD algorithms

are presented in figures 6(a)(c). In figure 6(d), the MSEs

of all algorithms plotted against decreasing noise power are

shown (MSEs estimated as described in section 3.2). The

results presented in figure 6 are discussed in section 3.5.

The calculations of figure 6(b) (Higuchis algorithm) were

repeated for kmax = 9 and kmax = 25. The analysis revealed

that, for increasing kmax values, the accuracy of estimation

achieved improved, as the estimated points tended to better

approach the diagonal. This result provided a first indication

that selection of kmax = 50 might be more appropriate for the

calculations with EEG data. More about this selection follows

in section 4.2.

different algorithms

In order to assess the accuracy of the three algorithms

under examination, Weierstrass functions were generated as

described in section 3.1. For the estimation of FDs using

Higuchis algorithm, kmax = 50 was used, while for the

k-NN algorithm, (kmin , kmax ) = (1, 173) were used. Figure 5

shows the estimated FD values, calculated using each of

the algorithms and plotted against the corresponding known

theoretical FD values of the synthetic signals. The results

presented in figure 5 are discussed in section 3.5.

analysis

The most desirable characteristic of an FD estimation

algorithm is its ability to clearly discriminate among signals

of different complexities. For instance, in the framework

described in this section, we would ideally expect an algorithm

to provide FD estimates that fall onto a straight line of slope

equal to one and going through the axes origin (indicated in

figure 5 by a bold line). It can be deduced from figure 5 that

Katzs algorithm yielded the worst estimation as compared

to Higuchis and the k-NN algorithms since it overestimated

the FD values for the whole range of theoretical FD values

examined. Higuchis algorithm provided the most accurate

estimations for the whole range of theoretical FD values.

On the other hand, the k-NN algorithm provided satisfactory

estimations for almost the whole range of theoretical FD

values, slightly overestimating the lower and higher FDs and

underestimating the middle ones. All algorithms demonstrated

a wide dynamic range, in contrast to other FD estimation

algorithms, such as Petrosians algorithms (Esteller et al

The EEG is frequently contaminated by electrophysiological

potentials generated by muscle activity (Vergult et al 2007).

Muscle artefacts, due to their broad frequency spectrum

(Goncharova et al 2003), may be considered as white noise

(De Clercq et al 2006). In the current study, we assessed the

reliability and robustness of each FD algorithm in the presence

of noise, using Weierstrass signals with added white Gaussian

noise of different signal-to-noise ratios (SNRs). Eleven noise

levels were used, i.e. 3010 dB with step 2 dB. For each

noise level, 100 Weierstrass sequences of the same theoretical

FD with additive noise were produced. Using each algorithm,

8

Better results.

G E Polychronaki et al

additive white

Gaussian noise

mas ruido

(a)

(c)

(b)

(d)

Figure 6. Mean FD estimates using Katzs (a), Higuchis (b) and the k-NN (c) algorithms using 100 Weierstrass cosine functions with

additive white Gaussian noise of increasing power (FD estimations were averaged for 100 Weierstrass cosine functions for each theoretical

FD value and each noise level). Error bars indicate the standard deviation of the FD estimates. (d) MSE estimates plotted against SNR for

all different algorithms.

signals of different complexities.

The results presented in figure 6 reveal that, not

surprisingly, the accuracy of estimation for all FD algorithms

decreases with increasing noise power. For all FD algorithms,

their estimates move towards higher values. This is in

agreement with results presented in Accardo et al (1997),

where noise was directly added to EEG signals. This

effect is more prominent for the lower FD values. That is

reasonable since noise addition to signals with higher FD

values, which are already complicated enough, would not

be expected to have a decisive impact on their estimated

complexity. Katzs and Higuchis algorithms failed to provide

monotonically increasing estimates in the range 1.11.6 and

1.11.5, respectively, for SNR = 20 and 10 (figures 6(a) and

(b)). The k-NN algorithm, on the other hand, maintained its

ability to discriminate among different FD values, even for the

lower theoretical FD values and for SNR levels down to 10 dB

(figure 6(c)). Additionally, figure 6(d) reveals that the smaller

MSEs for all SNR levels are achieved by the k-NN algorithm

which seems to be the most robust and reliable in the presence

of noise.

4.1. Katzs algorithm

FD time profiles using Katzs algorithm were produced as

described in section 2.3. Indicative results derived from the

recordings of two patients from the training and two patients

from the testing data set are depicted in figure 7. The values

of the FD time profiles away from the seizures have a mean

value of around 1.92.2, which appear to be limiting values

for the FD of an EEG signal. This is in agreement with the

overestimations of the true FD values of the synthetic signals

using Katzs algorithm (see section 3.3, figure 5). In the

case of patient 1 (figure 7(a)), no important changes during the

seizures were observed. During the first two seizures of patient

4 (figure 7(b)), a slight drop was evident, but the existence of

this drop was not consistent for all the seizures of that patient.

In the case of patient 7 (figure 7(c)), a slight rise of FD was

recorded around the seizures (but not strictly localized to the

seizure duration), while a similar situation was observed when

patient 8 was examined (figure 7(d)). Similar FD profiles were

produced from the analysis of the other four patients.

9

G E Polychronaki et al

(a)

(b)

(c)

(d)

Figure 7. FD time profiles using Katzs algorithm for patients 1 (a) and 4 (b) from the training data set and patients 7 (c) and 8 (d) from the

testing data set. Solid vertical lines indicate the start and end of seizures (seizure starts are aligned with t = 0), while dashed vertical lines

indicate the times of alarms. Solid horizontal lines indicate the generic threshold for Katzs algorithm Tg = 1.48.

dimension D and, in that case, the plot of ln(L(k)) against

ln(k) should fall on a straight line with a slope equal to D.

When analysing real data (e.g. EEG), it is possible that the

points (ln(k), ln(L(k))) might not fall on a straight line for the

whole range of k values. In that case, kmax must be selected

appropriately in order for the estimated slope to optimally

approximate the slope of the linear part of the ln(L(k)) versus

ln(k) plot. An example is provided in figure 8, where ln(L(k))

is plotted against ln(k), as estimated using 2 s of EEG data from

patient 1. In figure 8(b), the least-squares fits for kmax = 9, 25,

50 are presented. The straight line that best approximates the

linear part of the ln(L(k)) versus ln(k) curve for a broad range

of k values is the one corresponding to kmax = 50. Similar plots

were acquired when using different EEG segments from the

same patient and also from different patients.

FD time profiles using Higuchis algorithm were produced

as described in section 2.3. Figures 9(a)(c) depict 2000 s of

Higuchis FD time profiles obtained from the first recording

of patient 1 (containing a seizure) and estimated using kmax =

9 (figure 9(a)), 25 (figure 9(b)) and 50 (figure 9(c)). It can be

observed that as kmax increases, the estimated FD values also

increase. This can be explained by figure 8, where, for the same

detection methodology described in section 2.3 produced the

results presented in figure 13. Using the generic threshold

value Tg = 1.48, no seizures were detected for either the

training or the testing data set, resulting in a 0% sensitivity.

Nevertheless, the FP rates produced were, in four patient cases,

close to or above 0.3 h1 . From both visual analysis (figure 7)

and numerical results (figure 13), it becomes clear that Katzs

algorithm did not produce FD changes which were pronounced

enough to enable seizure detection.

4.2. Higuchis algorithm

As already discussed, based on synthetic signal analysis, the

performance of Higuchis algorithm depends on the selection

of the parameter kmax . In section 3.2.1, it was illustrated that

there are three troughs in the plot of MSE versus kmax (figure 3).

The MSE minimum values appeared at kmax = 9, 25, 50, and it

was mentioned that those three values could all be considered

as candidates for FD estimation using Higuchis algorithm

when applied to the EEG data. According to Higuchis

algorithm, the FD of a curve is estimated by means of a leastsquares linear best-fitting procedure. In section 2.2.2, it was

10

G E Polychronaki et al

(a)

(b)

Figure 8. (a) 2 s of EEG from patient 1. (b) Least-squares best fit lines calculated from the (ln(k), ln(L(k))) points as estimated using the

EEG data segment presented in (a), using different values of kmax . Those lines lead to estimates of the FD (with Higuchis algorithm) which

are equal to slope (slope is defined in the legend), for each value of kmax .

(a)

(d)

(b)

(e)

(c)

(f)

Figure 9. 2000 s of FD time profiles estimated using Higuchis algorithm, taken from the first recording of patient 1 (containing a seizure),

and estimated using kmax = 9 (a), 25 (b), 50 (c). Part of FD time profiles depicted in (a)(c), zoomed around the seizure, using kmax = 9 (d),

25 (e), 50 (f) (beginning and end of seizure is indicated by vertical lines).

using Higuchis algorithm with kmax = 50, from the recordings

of two patients from the training and two patients from the

testing data set (same as in figure 7). In this case, the values

of the FD time profiles away from the seizures had a mean

value of around 1.31.7. In the case of patient 1, there was a

short drop in the Higuchi FD profile at the beginning of each

seizure (figure 10(a)), but during the rest of the seizure the

FD values ranged at similar levels as in the interictal periods.

Similar profiles, displaying a short drop at the beginning of

a seizure, were produced for some seizures of patient 6. In

contrast, the FD values derived from the EEG data of patient

4 (figure 10(b)) exhibited a drop during most of the duration

of the seizures, for all seizures. Drops were also recorded

during most of the duration of the seizures of patient 2 and

during the second half of the seizure duration of patients 3

and 7 (figure 10(c), upper two subplots). However, for some

leads to greater slopes and, therefore, higher FD estimates.

As can be seen in figures 9(a)(c), selection of kmax = 50

provided FD values closer to the ones estimated using the

k-NN algorithm (as will be shown in figure 11). Moreover,

when zooming into the seizure part displayed in figures 9(d)

(f), it is clear that during the seizure, the value kmax = 50

(figure 9(f)) is the one which achieves better discrimination

of the beginning of the seizure (bigger drop in the FD values

during the beginning of the seizure as compared to the time

interval immediately preceding the seizure) amongst kmax =

9, 25, 50. The same was observed for other seizures from

the same patient and from different patients. Moreover, recall

from section 3.4 that analysis of synthetic signals with added

noise revealed that the most robust estimates were generated

for kmax = 50. Based on these observations, the value kmax =

50 was selected for the analysis of the EEG data.

11

G E Polychronaki et al

(a)

(b)

(c)

(d)

Figure 10. FD time profiles produced using Higuchis algorithm for patients 1 (a) and 4 (b) from the training data set and patients 7 (c) and

8 (d) from the testing data set. Solid vertical lines indicate the start and end of seizures (seizure starts are aligned with t = 0), while dashed

vertical lines indicate the times of alarms. Solid horizontal lines indicate the generic threshold for Higuchis algorithm Tg = 1.29.

because, in that case, the FD time profiles away from the

seizures had a mean value of around 1.3 (figure 10(d)), i.e.

a value very close to Higuchis generic threshold Tg = 1.29.

Similarly, the use of a generic threshold for seizure detection

in Saab and Gotman (2005) resulted in some patients having

higher FP rates than others. In order to remedy that, the authors

proposed a threshold-tuning mechanism. A similar approach

could be applied to our seizure detection methodology and will

be discussed in section 5.3.

for the seizures of patients 5 and 8 (figure 10(d)), either an

increase or no particular change in FD values was observed. It

is interesting to note that this increase was not specific to the

seizure and also appeared in other parts of the recording as well

(as an example, see the rise of FD after the seizure in the last

seizure data displayed for patient 8 in figure 10(d)). This could

be attributed to higher frequency components present during

those recording parts, as discussed in section 5.2. Similarly

to Katzs algorithm, Higuchis algorithm failed to produce

consistent changes of a single character (either a drop or an

increase) that could provide a systematic and specific criterion

indicative of a seizure. In addition, in some seizure cases,

the drops or increases were of short duration in comparison to

the seizure duration and, therefore, did not provide a distinct

characteristic of the dynamics of the whole seizure.

Using Higuchis algorithm, application of the seizure

detection methodology described in section 2.3 produced the

results presented in figure 13. Using the generic threshold

value Tg = 1.29, 24 of 37 seizures were detected in the training

and 1 of 18 seizures in the testing data set. The FP rates were

for six patients well below 0.3 h1 , while for one patient

(patient 3) the FP rate approached 1. However, for patient 8,

k-NN FD time profiles were produced as described in section

2.3. Figure 11 illustrates indicative FD time profiles, derived

using the k-NN algorithm with (kmin , kmax ) = (1, 173). The

recordings of two patients from the training and two patients

from the testing data set are depicted (same patients as in

figures 7 and 10). In almost all cases, the FD values during

the seizures were of clearly different mean amplitude in

comparison to what happened away from the seizures where

the mean FD value for all patients was above 1.4. This clear

distinction of the ictal period that the k-NN algorithm achieves

12

G E Polychronaki et al

(a)

(b)

(c)

(d)

Figure 11. FD time profiles produced using the k-NN algorithm for patients 1 (a) and 4 (b) from the training data set and patients 7 (c) and

8 (d) from the testing data set. Solid vertical lines indicate the start and end of seizures (seizure starts are aligned with t = 0), while dashed

vertical lines indicate the times of alarms. Solid horizontal lines indicate the generic threshold for the k-NN algorithm Tg = 1.27.

for seizure detection.

As can be seen in figure 11, the k-NN FD for some data

windows took values greater than 2 (when, theoretically, the

FD of a curve can only have values between 1 and 2). These

overestimations occurred in cases where the EEG in the time

window under investigation included some values that were

outliers when regarding the amplitude distribution of the rest

of the EEG data points in the window (those were mostly

due to artefacts, e.g. chewing activity). An example of an

EEG segment causing overestimations in the k-NN FD time

profile is illustrated in figure 12. It is worth noting that those

overestimations did not affect the result of the seizure detection

methodology, as production of alarms was associated with

FD points being below the threshold.

Using the k-NN algorithm, application of the seizure

detection methodology described in section 2.3 produced the

results presented in figure 13. Using the generic threshold

value Tg = 1.27, all seizures were detected both for the training

and the testing data set, resulting in 100% sensitivity. Of all

seizure detections, 89.09% were achieved within the first third

of the corresponding seizure duration. Only 6 of 55 seizures

were detected late, 5 of which were of patient 3 and 1 of

for the training and the testing data set.

5. Discussion

5.1. General comments on the contribution of the current

work

In epileptogenesis, according to most of the theories

commonly accepted today, neuronal synchronization is

considered to be decisive (Mormann et al 2000 and references

therein). In epileptic EEG, seizures are usually characterized

by rhythmic patterns (Meier et al 2008). This fact points to the

possible usefulness of fractal analysis in the context of seizure

detection. Synchronized, rhythmic activity during the seizures

is expected to lead to a reduction in complexity, as compared to

the more disorganized interictal activity. This reduction can,

in principle, be quantified utilizing nonlinear measures such

as the FD, which is expected to show a drop in values during

the seizure period, in comparison to the interictal period.

As presented in the introduction, the idea of analysing

EEG recordings using FD methods for epileptic seizure

detection has been examined in a few past studies (Esteller et al

13

G E Polychronaki et al

(a)

(b)

Figure 12. (a) EEG data segment of patient 1 contaminated with muscle artefact due to chewing. (b) Overestimations (FD k-NN>2) in the

k-NN FD time profile. A star indicates the FD value which is estimated based on the EEG values of the 2 s data window which starts at the

point in time that the star lies. Dashed vertical lines in (a) mark the time window which produced the first overestimated FD value indicated

by a dashed vertical line in (b). A second overestimated value follows in the next window.

(a)

(b)

(c)

Figure 13. Performance of the seizure detection methodology using Katzs, Higuchis and the k-NN FD estimation algorithms.

(a) Sensitivity achieved for each FD algorithm using the generic threshold values Tg = 1.48 (Katzs algorithm), 1.29 (Higuchis algorithm)

and 1.27 (k-NN algorithm). In the bars, the number of detected seizures over the total number of seizures for each patient is depicted. (b)

Mean values and standard deviations of DDs for the patients in the training and testing data sets. (c) FP rates for the patients in the training

and testing data sets. Mean values for sensitivity, DD and FP rate for both the training and the testing data set are presented at the right end

of each bar chart.

high sensitivity and specificity, accompanied by low DDs. To

this end, three waveform FD estimation algorithms were used.

In order to pursue the goal of seizure onset detection,

a careful and extensive evaluation of the algorithms utilized

using synthetic data of known FD was found to be necessary.

This evaluation was the second objective of the current study,

and it was twofold. On the one hand, parameters involved

in the calculation of Higuchis and the k-NN algorithms were

therein). Nevertheless, to the best of our knowledge, no

extensive study has been published to date on an FD estimation

algorithm for seizure onset detection applied on multi-day

scalp or intracranial EEG, including all different physiological

states that could exist in a long-term EEG monitoring setting

(e.g. eating, sleeping, etc) as well as several possible artefacts.

The main objective of this study was to examine and compare

the ability of different FD estimation algorithms to detect the

14

G E Polychronaki et al

algorithms failed to produce consistent changes of a single

type (either a drop or an increase) that could provide a

systematic and specific criterion indicative of seizures. It is

worth noting that Katzs algorithm, in general, produced less

distinct changes in FD time profiles as compared to Higuchis

algorithm. In quite a few cases, no clear change would be

observed using Katzs algorithm. This probably explains the

failure of Katzs algorithm to detect any seizures both in the

training and the testing data set.

The FD time profiles produced based on both Katzs

and Higuchis methods, though, seemed to follow a similar

underlying trend: during seizures where Higuchis FD time

profile would show a drop (or increase), something similar

(but less pronounced) would happen for Katzs FD time profile

(figures 7 and 10). This could be attributed to the common

approach behind FD estimation used in both algorithms, which

is estimation of the length of a curve. The superiority of

Higuchis algorithm might be related to a more accurate curve

length estimation or to its superior robustness in the presence

of noise.

On the other hand, the k-NN algorithm exhibited a FD

drop which was evident during most seizures of all patients

and was also specific to the seizures. This could be attributed to

the different underlying approach that the k-NN algorithm uses

for FD estimation, which is a fixed-mass approach, instead of

a curvelength estimation approach. The fixed-mass approach

for estimation might also be the reason that, when using

synthetic signals contaminated with noise, the k-NN algorithm

proved to be superior in terms of robustness of estimation, as

illustrated in section 3.4 (figure 6).

Why would the FD time profiles using Katzs and

Higuchis algorithms show in some seizure cases an increase

instead of a drop? Investigation of the frequency content of the

EEG signal during those seizures revealed that this increase

might be associated with the presence of higher frequency

components in the EEG (above the alpha EEG rhythm range),

which were not present during seizures for which a drop was

observed. This observation is in agreement with a previous

study using a line-length metric for seizure detection (Esteller

et al 2001a), according to which the line-length metric grew

as the data sequence frequency or magnitude increased. Such

higher frequency components also appeared in our EEG data

set away from seizures, for instance due to artefacts or muscle

activity.

the synthetic data. To the best of our knowledge, such an

approach for selecting the parameters for both algorithms has

not been presented in the literature before. The results of the

current study, however, emphasize the importance of these

parameters selection. On the other hand, the accuracy of the

algorithms and their robustness in the presence of noise was

assessed. A similar comparison between Katzs and Higuchis

algorithms, based on synthetic data, has been attempted in the

past (Esteller et al 2001b), but the current work is enhanced

with the inclusion of the k-NN algorithm in the comparison,

which was found to be the most robust in the presence of noise.

The results of the current work indicate that fractal

analysis can indeed be useful for epileptic seizure onset

detection with high sensitivity and specificity, but only when

using the k-NN algorithm. Katzs and Higuchis algorithms

failed to produce systematic and specific changes in FD time

profiles and showed non-satisfactory numerical results. The

reason that seizure onset detection was feasible in the current

study using a simple threshold (Tg) on the k-NN FD time

profiles is twofold. On the one hand, the k-NN FD values

started dropping immediately after the seizure onset in most

seizures. On the other hand, the separation between the k-NN

FD values corresponding to seizures and those corresponding

to non-seizure periods was big enough and allowed us to use

a simple threshold to distinguish between the two, without the

production of an unacceptable number of FPs.

Utilizing the k-NN algorithm as a time series analysis

methodology in the current work brought out its potential

usefulness for other time series analysis applications. Its high

discriminatory power, illustrated in the context of consistently

identifying the dynamics of the seizure state, indicates that it

can be applied to other signals besides the EEG (e.g. financial

time series) in order to provide a characterization of possibly

different states of the system generating the signal.

5.2. Comparison of FD algorithms based on scalp EEG

analysis

The main purpose of our work was to compare the suitability

of different FD methods for detecting seizures of MTL origin.

In that vein we provided evidence supporting the superiority

of the k-NN method, application of which resulted in 100%

sensitivity accompanied by relatively low DD times and

relatively low FP rates. On the other hand, Katzs method

produced relatively low mean FP rates in both the testing

and the training data sets, but failed to detect any seizures.

Higuchis method did not detect all the seizures in the training

data set and detected only one seizure in the testing, and at

the same time produced a higher mean FP rate and DD as

compared to the results of the k-NN method in both the training

and the testing data set. The success of the k-NN method could

be attributed to its ability to produce lower FD values during the

seizures even in the presence of higher frequency activity, in

contrast to Katzs and Higuchis methods. Therefore, the k-NN

method is expected to be successful in detecting seizures with

high-frequency content, such as those of neocortical origin

(Worrell et al 2004).

Due to the very different nature of scalp and intracranial EEG,

we could only compare the results of the present study to those

of seizure onset detection studies based on scalp EEG (Meier

et al 2008, Saab and Gotman 2005, Shoeb et al 2004, Qu and

Gotman 1997). The system of Saab and Gotman (2005) aimed

at detecting the onset of epileptic seizures in scalp EEG, based

on wavelet decomposition and Bayesian probabilities. Using

a threshold-tuning mechanism, they reported in their testing

data set (360 h of scalp EEG, which included 69 seizures

in 16 patients suffering from various epilepsy types) 76%

15

G E Polychronaki et al

The results without tuning were 77.9%, 0.86 h1 and 9.8 s,

respectively. Our methodology based on the k-NN algorithm,

applied to our testing data set, seems to compare favourably

in terms of sensitivity (100%), FP rate (0.42 h1 ) and (mean)

DD (8.82 s). However, a direct comparison might not be

appropriate since, on the one hand, we only included seizures

of MTL origin in our study, and, on the other hand, we did not

use any techniques for automatic artefact rejection.

Saab and Gotman (2005), in addition to filtering the

data between 3 and 30 Hz, applied various artefact rejection

techniques prior to automatic detection production, to confront

common sources of FP for their system, such as alpha EEG

activity, EMG and electrode failure of different kinds. In

our work, no artefact rejection techniques were applied, other

than filtering the data between 3 and 30 Hz and making

use of the parameter w. The most common sources of

FPs using our methodology were artefacts mainly caused

by chewing, movement of the reference electrode or other

electrode artefacts, and bursts of rhythmic EEG activity. In a

few cases, sleep rhythmic EEG activity and activity of epileptic

origin caused some FPs. The latter, nevertheless, were not

actual epileptic seizures. Therefore, they were categorized

as FPs. Inclusion of some artefact rejection techniques might

improve the performance of the seizure detection methodology

of the current study.

In a recent study (Meier et al 2008), the authors attention

was focused on detecting different seizure morphologies,

rather than just seizures originating from different epilepsy

types. Using 91 seizures, representing the most common

ictal morphologies, from 57 patients, they reported FP rates

<0.5 h1 (for specific ictal morphologies even <0.25 h1 ),

with average sensitivity >96% and very short DDs, of about

1.6 2.8 s. Nevertheless, they defined the seizure onset as the

beginning of the first observable seizure pattern in the EEG

rather than the time point at which the first EEG changes

occur which lead to a clear seizure discharge as defined in the

current study. Thus, direct comparisons in terms of DDs may

not be appropriate.

The authors in Qu and Gotman (1997) designed a system

based on a seizure template for each patient and achieved a

seizure onset detection rate of 100%, with an average delay

of 9.35 s after onset, accompanied by an FP rate of 0.02 h1

(method evaluated in 12 patients with a total of 47 seizures). In

their system, at least one seizure, as well as a broad variety of

the patients background EEG patterns had to be available for

tuning the method on each patient separately before actually

applying the method. In Shoeb et al (2004), the authors

utilized wavelet decomposition and support vector machines to

detect 131 out of 139 studied seizures of different types (94%

sensitivity) within 8.0 3.2 s of seizure onset. In 60 h of EEG,

15 false detections were declared (FP rate of 0.25 h1 ). Those

results were fairly satisfactory, but their system required 24

seizures to be a priori available for each patient, in addition to

non-seizure EEG segments separating the seizure occurrences

for each patient.

The proposed seizure detection methodology does not

require a priori information about the morphology of the

records of a patient. After an initial calculation of a generic

threshold Tg from the training data, the same threshold can

be applied to any patient and the value of this threshold is

the only information needed for producing alarms using one

EEG channel. Nevertheless, the selection of the appropriate

EEG channel to be used, as described in section 2.3, requires

the recording of at least one seizure. Note though that this

does not affect the way the FD time profiles are generated.

It only affects the post-processing of the FD time profiles for

alarms.

Saab and Gotman (2005) described a seizure detection

methodology which was also based on the application of a

generic threshold. Application of their methodology to scalp

EEG revealed that some patients had higher false detection

rates than others. In order to improve performance for those

patients in a clinical setting, the authors described the idea

of properly tuning the threshold in order not to exceed a

predefined FP rate (see above for their results). This tuning

could be applied to our seizure detection methodology. The

reasoning behind the applicability of a tuning mechanism is

the following: first, different seizures, even if they all originate

from MTL, can exhibit a wide range of morphologies. If the

seizures of a patient are characterized by high rhythmicity,

the corresponding FD values can be significantly lower as

compared to the interictal FD values and could, therefore,

be detected using relatively low threshold values. However,

seizures of not enough rhythmic content could be missed.

Secondly, during the interictal period, there may exist different

rhythmic EEG patterns related or unrelated to epilepsy, which

can lead, for some patients, to interictal FD values closer to

the generic threshold, thus causing a high number of FPs. The

tuning mechanism can provide a means for correcting for

the different characteristics of each patient.

It should be pointed out that direct comparison between

different seizure onset detection algorithms would be

appropriate only if the algorithms were to be applied on the

same data set. Differences in the length of data and type

of epilepsies under investigation, the variability of seizure

patterns, the presence of different uncontrollable technical

artefacts in the EEG, and even different recording settings

during data acquisition could make a direct comparison

unfeasible.

5.4. Future work

For future work towards automatic seizure onset detection,

application of our method to EEG data from more patients and

of more epilepsy types is needed. Appropriate modification

of the k-NN FD estimation methodology as to include

information from multiple channels would address the issue of

initialization which requires the selection of a single electrode

channel for the analysis to be performed. Utilization of

multiple channels would also facilitate the inclusion of some

artefact removal techniques. Additionally, analysing the EEG

data using different frequency bands could prove useful for

some types of seizure morphologies. Finally, since the k-NN

FD estimation algorithm, using a simple thresholding

16

G E Polychronaki et al

its inclusion as a feature in more sophisticated seizure detection

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The work of GEP was supported by the Hellenic State

Scholarships Foundation.

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