Identifying stereotypic evolving micro-scale seizures (SEMS) in the hypoxic-ischemic EEG of the pre-term fetal sheep...

Perinatal hypoxic-ischemic encephalopathy (HIE) around the time of birth due to lack of oxygen can lead to debilitating neurological conditions such as epilepsy and cerebral palsy. Experimental data have shown that brain injury evolves over time, but during the first 6-8 hours after HIE the brain has recovered oxidative metabolism in a latent phase, and brain injury is reversible. Treatments such as therapeutic cerebral hypothermia (brain cooling) are effective when started during the latent phase, and continued for several days. Effectiveness of hypothermia is lost if started after the latent phase. Post occlusion monitoring of particular micro-scale transients in the hypoxic-ischemic (HI) Electroencephalogram (EEG), from an asphyxiated fetal sheep model in utero, could provide precursory evidence to identify potential biomarkers of injury when brain damage is still treatable. In our studies, we have reported how it is possible to automatically detect HI EEG transients in the form of spikes and sharp waves during the latent phase of the HI EEG of the preterm fetal sheep. This paper describes how to identify stereotypic evolving micro-scale seizures (SEMS) which have a relatively abrupt onset and termination in a frequency range of 1.8-3Hz (Delta waves) superimposed on a suppressed EEG amplitude background post occlusion. This research demonstrates how a Wavelet Type-II Fuzzy Logic System (WT-Type-II-FLS) can be used to automatically identify subtle abnormal SEMS that occur during the latent phase with a preliminary average validation overall performance of 78.71%±6.63 over the 390 minutes of the latent phase, post insult, using in utero pre-term hypoxic fetal sheep models.