U.S. patent number 3,863,625 [Application Number 05/412,496] was granted by the patent office on 1975-02-04 for epileptic seizure warning system.
This patent grant is currently assigned to The United States of America as represented by the Secretary Department. Invention is credited to Carl C. Kesler, Jr., William B. Martin, Vladimir A. Ordon, Sam S. Viglione.
United States Patent |
3,863,625 |
Viglione , et al. |
February 4, 1975 |
Epileptic seizure warning system
Abstract
Epileptic seizure warning system based on pattern recognition
principles is embodied in a small self-contained device which can
be carried in a pocket of a person subject to grand mal seizures,
to monitor the person's condition and provide sufficient advance
warning of any imminent seizure so that the person can take
preventive medication or lie down to prevent or minimize any
harmful seizure effects. Scalp electrode connections provide a
suitable (brain wave) electrical signal to the device which
preprocesses the signal to transform it into a predetermined
format, reiteratively processes the transformed signal and extracts
or detects essential features from the processed signal and decides
from the detected features the condition of the person and, when a
predetermined number of preseizure decisions is exceeded within a
given period indicating an imminent seizure, produces both audio
and visual warning signals. The warning signals can comprise an
audible beeping and a flashing light. Only the initiated audible
signal can be suppressed and, as long as the warning condition
persists, the light continues to flash.
Inventors: |
Viglione; Sam S. (Anaheim,
CA), Ordon; Vladimir A. (Long Beach, CA), Martin; William
B. (Newport Beach, CA), Kesler, Jr.; Carl C. (Fountain
Valley, CA) |
Assignee: |
The United States of America as
represented by the Secretary Department (Washington,
DC)
|
Family
ID: |
23633246 |
Appl.
No.: |
05/412,496 |
Filed: |
November 2, 1973 |
Current U.S.
Class: |
600/545 |
Current CPC
Class: |
A61B
5/369 (20210101); A61B 5/4094 (20130101); A61B
5/316 (20210101); A61B 5/0002 (20130101); A61B
5/7405 (20130101) |
Current International
Class: |
A61B
5/04 (20060101); A61B 5/0476 (20060101); A61b
005/04 () |
Field of
Search: |
;128/2.6A,2.6R,2.1B,2.1R
;340/279 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Sciarretta et al., Medical & Biological Engineering, Vol. 8,
No. 5, September, 1970, pp. 517-519..
|
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Jeu; D. N. Jason; Walter J. Royer;
Donald L.
Claims
We claim:
1. A warning activation system comprising:
means for providing an electrical signal characteristic of the
condition of a component part of a subject;
means for preprocessing said electrical signal to transform it into
a predetermined format;
means for processing said transformed signal to measure energy
characteristics thereof;
means for detecting predetermined features indicative of a
relatively early abnormal condition of said component part of said
subject, when predisposed to occurrence of an impending and
disturbing event, from said measured energy characteristics of said
transformed signal;
means for deciding from said detected features the condition of
said component part of said subject and providing an output of a
predetermined category for said abnormal condition thereof;
means for controlling said processing means to process said
transformed signal reiteratively over successive sampling epochs
thereof whereby decisions on the condition of said component part
of said subject can be made for said epochs by said decision means;
and
means responsive to the output of said decision means for providing
an activation signal in advance of the occurrence of said event
when said decision means output is of said predetermined category
for at least a predetermined number of said epochs within an
immediately preceding predetermined period.
2. The invention as defined in claim 1 wherein said preprocessing
means includes a bank of bandpass filters having different
predetermined passbands to provide a plurality of signal components
having resepctive predetermined bandwidths, and said processing
means includes a corresponding plurality of means for measuring
respective energy characteristics of said signal components, said
plurality of measuring means being controlled by said controlling
means, said detecting means detects predetermined features from
said measured energy characteristics of said signal components and
said decision means decides from said detected features the
condition of said component part of said subject.
3. The invention as defined in claim 1 wherein said processing
means includes rectifying, integrating and normalization means to
measure said energy characteristics of said transformed signal.
4. The invention as defined in claim 1 wherein said activation
signal providing means includes shift register means of a
predetermined stage capacity corresponding numerically to said
epochs within said predetermined period, for receiving and storing
said decision means output over said successive sampling epochs
therein and producing said activation signal when said decision
means output is of said predetermined category for at least said
predetermined number of said epochs within said predetermined
period.
5. The invention as defined in claim 2 wherein said plurality of
measuring means each includes rectifying, integrating and
normalization means to measure said energy characteristics of said
transformed signal, and said activation signal providing means
includes shift register means of a predetermined stage capacity
corresponding numerically to said epochs within said predetermined
period, for receiving and storing said decision means output over
said successive sampling epochs therein and producing said
activation signal when said decision means output is of said
predetermined category for at least said predetermined number of
said epochs within said predetermined period.
6. An epileptic seizure warning system comprising:
means for providing an electrical signal characteristic of the
brain activity of a subject;
means for preprocessing said electrical signal to transform it into
a predetermined format;
means for processing said transformed signal to measure energy
characteristics thereof;
means for detecting predetermined features indicative of a
relatively early preseizure condition of said subject, when
predisposed to an impending seizure, from said measured energy
characteristics of said transformed signal;
means for deciding from said detected features the condition of
said subject and providing an output of a predetermined category
for said preseizure condition thereof;
means for controlling said processing means to process said
transformed signal reiteratively over successive sampling epochs
thereof whereby decisions on the condition of said subject can be
made for said epochs by said decision means; and
means responsive to the output of said decision means for providing
a preseizure warning signal in advance of the occurrence of said
seizure when said decision means output is of said predetermined
category for at least a predetermined number of said epochs within
an immediately preceding predetermined period.
7. The invention as defined in claim 6 wherein said warning signal
includes a visual signal, and said warning signal providing means
further includes means for providing a simultaneous audio signal
when said decision means output is of said predetermined category
for at least said predetermined number of said epochs within said
predetermined period.
8. The invention as defined in claim 7 wherein said warning signal
providing means further includes means for electively suppressing
said audio signal after said visual and audio signals are
initiated, and means for maintaining said visual signal for a
predetermined duration after said decision means output is no
longer of said predetermined category for at least said
predetermined number of said epochs within said predetermined
period.
9.
A warning activation system comprising:
means for providing an electrical signal characteristic of the
condition of a component part of a subject;
pattern recognition means for analyzing and classifying said
characteristic signal and providing an output of a predetermined
category for a relatively early abnormal condition of said
component part of said subject when predisposed to occurrence of an
impending and disturbing event;
means for controlling said recognition means to analyze and
classify said characteristic signal reiteratively over successive
sampling epochs thereof whereby classifications on the condition of
said component part of said subject can be made for said epochs by
said recognition means; and
means responsive to the output of said recognition means for
providing an activation signal in advance of the occurrence of said
event when said recognition means output is of said predetermined
category for at least a predetermined number of said epochs within
an immediately preceding predetermined period.
10. The invention as defined in claim 9 wherein said activation
signal providing means includes shift register means of a
predetermined stage capacity corresponding numerically to said
epochs within said predetermined period, for receiving and storing
said recognition means output over said successive sampling epochs
therein and producing said activation signal when said recognition
means output is of said predetermined category for at least said
predetermined number of said epochs within said predetermined
period.
11. A method of providing an activating control signal, which
comprises the steps of:
sensing an electrical signal characteristic of the condition of a
component part of a subject;
analyzing and classifying said characteristic signal by pattern
recognition means and providing an output therefrom of a
predetermined category for a relatively early abnormal condition of
said component part of said subject when predisposed to occurrence
of an impending and disturbing event;
controlling said recognition means to analyze and classify said
characteristic signal reiteratively over successive sampling epochs
thereof whereby classifications on the condition of said component
part of said subject can be made for said epochs by said
recognition means; and
producing an activation signal for energizing control means in
advance of the occurrence of said event when said recognition means
output is of said predetermined category for at least a
predetermined number of said epochs within an immediately preceding
predetermined period.
12. The invention as defined in claim 11 wherein said activation
signal is produced by receiving and storing said recognition means
output over said successive sampling epochs in shift register means
of a predetermined stage capacity corresponding numerically to said
epochs within said predetermined period, and generating said
activation signal when said recognition means output is of said
predetermined category for at least said predetermined number of
said epochs within said predetermined period.
Description
The invention described herein was made in the course of, or under,
a contract with the United States Department of Health, Education,
and Welfare.
BACKGROUND OF THE INVENTION
Our present invention pertains generally to the field of warning
systems. More particularly, the invention relates to an epileptic
seizure warning system.
Epilepsy has been defined as a tendency in a person to recurrent
attacks involving changes in the state of consciousness, motor
activity or sensory phenomena, associated with indications of
abnormal overactivity of at least some part of the brain at the
time of an attack. Epilepsy is a medical term covering a wide
variety of episodic disturbances, and any recurrent seizure pattern
might be properly termed epilepsy.
Grand mal seizures or convulsions are the most common form of
epilepsy and may occur at any age. About 90 percent of patients are
subject to this form of seizures, either alone (60 percent) or in
combination with other forms (30 percent). Petit mal epilepsy is
characterized by a brief and sudden loss of consciousness,
occurring predominantly in children and usually disappears after
adolescence. This form of seizures occurs in about 25 percent of
patients, either alone (4 percent) or in combination with other
forms (21 percent). The psychomotor form of epilepsy is
characterized by a clouding of consciousness for one or two minutes
and may develop at any age. Psychomotor seizures occur in
approximately 18 percent of patients, either alone (6 percent) or
in combination with other forms (12 percent). The petit mal,
psychomotor and other forms of epilepsy are relatively mild and
less disruptive than the convulsive form. Overall, about 70 percent
of patients have only one form of seizures and the remaining 30
percent have two or more forms.
Epileptics who are ambulatory, able to work, but still vulnerable
to convulsive seizures can be greatly aided by a device which
reliably predicts the occurrence of an imminent seizure at least
several minutes in advance. The epileptic would then have
sufficient time to administer preventive medication and allow it to
take effect. Alternatively, the epilieptic could lie down or
otherwise have enough time to adjust to a safe situation against
the forthcoming seizure. The importance of a device which can
predict with good reliability an immiment seizure derives from the
fact that, in the United States alone, approximately three million
persons have epilepsy and about 75,000 new cases appear
annually.
Pattern recognition technology has been applied to, for example,
sleep state classification. In this case, the electroencephalograph
recording or electroencephalogram (EEG) was utilized for
categorizing sleep periods of selected subjects. The EEG signal
successively assumes several well-defined patterns throughout the
course of a normal night's sleep. The procedure followed for
processing this EEG data, the recognition technique used for
pattern classification, and the results are discussed by S. S.
Viglione on "Applications of Pattern Recognition Technology" in
Chapter 4 of "Adaptive, Learning and Pattern Recognition Systems"
edited by J. M. Mendel and K. S. Fu, and published by Academic
Press, New York, 1970.
Of course, it is well-known that the EEG has long served as a
clinical aid for the diagnosis of mental disorders and brain
defects, and has been quite useful in the study of epilepsy. The
hypothesis was thus formulated that definable preseizure activity
may be noted from EEG data, and pattern recognition techniques can
be used for detecting and classifying such activity. Certain
experimental procedures and equipment have been established and
tested to assure reliable acquisition of EEG and other correlated
data from physically active epileptic subjects. Pattern recognition
studies of the EEG data using a known iterative design technique
have demonstrated that hypotheses may be easily formed by automatic
methods on the characteristics of preseizure patterns in individual
subjects. The results support the hypothesis that preseizure
activity can be localized. The acquisition of data and pattern
recognition studies are discussed by S. S. Viglione, V. A. Ordon
and Frank Risch in a paper entitled "A Methodology for Detecting
ongoing Changes in the EEG Prior to Clinical Seizures" presented at
the 21st Western Institute on Epilepsy on Feb. 27 and 28, 1970.
SUMMARY OF THE INVENTION
Subsequent further experiments and studies produced new and useful
developments in methodology and techniques, based upon pattern
recognition procedures, which led to the invention and realization
of an autonomous epileptic seizure warning system capable of
predicting and forewarning an epileptic subject of an impending
attack. Briefly, and in general terms, our invention is embodied in
a small battery-supplied device which can be carried in a shirt
pocket of a person subject to grand mal and other forms of
epileptic seizures. The device monitors the person's condition and
can provide sufficient advance warning of any imminent seizure so
that the person can take preventive medication or lie down to
prevent or minimize any harmful seizure effects.
The warning device broadly comprises suitable scalp electrode means
for sensing an electrical EEG (brain wave) signal, a preamplifier
for amplifying the EEG signal, means for preprocessing the
amplified signal to transform it into a format of a plurality of
frequency bands including input data therein, means for processing
the input data to rectify, integrate and normalize (and
additionally square where required) such input data, means for
detecting certain predetermined features or properties from the
processed input data, means for classifying or deciding from the
detected features the condition of the person, and warning means
responsive to the output of the decision means for providing both
audio and visual warning signals when the person is subject to an
imminent seizure. The amplified EEG signal is reiteratively sampled
to determine the person's condition and, when a predetermined
number of preseizure decisions is exceeded within a given
immediately preceding period, the warning means is activated to
produce the audio and visual warning signals. The warning device
further comprises means for inhibiting the audio signal after it is
initiated.
BRIEF DESCRIPTION OF THE DRAWINGS
Our invention will be more fully understood and other advantages
and features thereof will become apparent from the description
given below of an exemplary embodiment of the invention. The
description is to be taken in conjunction with the accompanying
drawings, in which:
FIG. 1 is a block diagram of an epileptic seizure warning system
according to this invention;
FIG. 2 is a block diagram illustrating effective decision structure
for an epileptic subject RA and which can be used in a warning
system similar to that shown generally in FIG. 1;
FIG. 3 is a block diagram of effective decision structure for
another epileptic subject BJ and which can be used in a warning
system simplified from that shown generally in FIG. 1;
FIG. 4 is a block diagram of warning logic means which can be used
in the warning system generally shown in FIG. 1;
FIG. 5 is a circuit diagram showing the scalp electrode connections
and preamplification means which can be used in an epileptic
seizure warning system for the subject BJ;
FIG. 6 is a circuit diagram of the preprocessing and processing
means including filters, rectifiers, integrators and scaling
amplifiers for the warning system of the subject BJ;
FIG. 7 is a circuit diagram showing the typical supply and
stabilizing connections normally used in all of the operational
amplifiers;
FIG. 8 is a circuit diagram showing the decision structure which
can be used in the warning system for the subject BJ;
FIG. 9 is a graph showing plots of output voltage versus frequency
for the filters used in the warning system of the subject BJ;
FIG. 10 is a circuit diagram of a voltage regulation circuit for
providing a stable voltage reference used in voltage-sensitive
portions of the warning system for the sujbect BJ;
FIG. 11 is a circuit diagram of a squaring circuit which can be
used in the warning system shown in FIG. 1, to provide the square
of the value of a normalized filter output;
FIG. 12 is a circuit diagram of an illustrative summing circuit
which implements both negative and positive input weights, and can
be used with suitable input modifications as the summing amplifiers
in the decision structures of FIGS. 2 and 3;
FIG. 13 is a circuit diagram of the timing and control means
broadly indicated in the warning system of FIG. 1; and
FIG. 14 is a circuit diagram of the warning logic means shown in
block diagram form in FIG. 4.
DESCRIPTION OF THE PRESENT EMBODIMENT
In the following description and accompanying drawings of an
illustrative embodiment of our invention, some specific values and
types of components are disclosed. It is to be understood, of
course, that such values and types of components are given as
examples only and are not intended to limit the scope of this
invention in any manner.
As originally conceived, the epileptic seizure warning system for
use by individuals suffering primarily from grand mal epilepsy
might have been configured in two different ways. The first method
would have employed a subjectmounted EEG amplification and
telemetry system remotely coupled to a telemetry receiver and a
small digital data processor. The advantages of this technique
included the use of existing, proven telemetry, and standard
computer techniques, the ability to perform accurate frequency
analysis through the use of the Fourier transform, and the ability
to add fairly complex logical operations to the outputs of the
pattern recognition systems. However, this remote processor concept
implied that the subject would have to remain within range of the
telemetry receiver or a telephone tie-line.
The second alternative employed a set of analog signal processors
(filters, etc.) which operated on the EEG to produce approximations
to the frequency parameters and decision logic used by the digital
simulations of the warning systems. This approach was expected to
be less accurate than the digital design and would limit the types
of logical operations that could be performed on the output
decisions. However, the subject would be allowed free range of
movements and would not be tied to a central receiving or
processing station. The processor would be completely
self-contained, including battery power supply and audible alarm,
so continuous monitoring by trained personnel would not be
required. This alternative was selected and the following material
describes a self-contained subject-mounted warning system.
FIG. 1 is a block diagram of the self-contained epileptic seizure
warning system 30 implemented according to our invention. The EEG
preamplification means 32 builds up the low level EEG signal
obtained from scalp electrodes (not shown in this Figure) suitably
attached to a subject. The amplified EEG signal is fed through a
bank of bandpass filters 34. The center frequencies indicated by
the filters 34 are given only as illustrative and typical examples.
The output of each filter 34 is rectified and integrated over, for
example, successive 15-second epochs to yield a voltage for each
epoch proportional to the energy in each frequency band. Each
filter output is normalized by subtracting the mean and dividing by
the standard deviation of the EEG signal obtained over a 30-minute
time interval of normal EEG. This information has been previously
obtained and is implemented as fixed resistive values in the
scaling amplifier circuits shown in FIG. 6. Rectification,
integration and normalization are accomplished by means 36. Where
the decision structure 38 selected uses both the normalized
spectral values and the squares of the normalized values, each
normalized spectral output is passed through a squaring circuit 40
as indicated in FIG. 1. The decision structure 38 is preferably of
the well known error correction type.
The output of the decision structure 38 is applied to warning logic
means 42 which provides both audio and visual warning signals
whenever the person being monitored is subject to an imminent
seizure. Timing and control means 44 produces reiterative
integration in the means 36 for the successive 15-second epochs
and, when a predetermined number of preseizure decisions for the
epochs from the decision structure 38 to the warning logic means 42
is exceeded within an immediately preceding period of, for example,
5 minutes, warning devices of the warning logic means are activated
to provide the audio and visual warning signals. The warning logic
means 42 includes shift register means for counting the number of
preseizure decisions from the decision structure 38. The timing and
control means 44 includes clocking means for properly clocking in
the decisions from the decision structure 38 into the shift
register means and, for system checkout purposes only, clearing
means for clearing and resetting the entire warning system. The
warning logic means 42 further includes means for inhibiting the
audio warning signal after it is initiated but not the visual
warning signal.
FIGS. 2 and 3 are block diagrams of exemplary decision structures
46 and 48 for epileptic subjects RA and BJ, respectively. These
decision structures 46 and 48 are depicted as multiple and single
layer threshold logic systems. The examples shown contain three
threshold logic units 50, 52 and 54 in the first logic layer for
subject RA (FIG. 2) and one unit 56 for subject BJ (FIG. 3). In
general, there may be any number of first-layer logic units. Each
threshold logic unit (TLU) has a linear input and for subject RA,
also a squared input, from each bandpass filter. Each first-layer
logic unit computes a weighted sum of all its inputs and compares
the sum with its predetermined threshold .theta.. If the sum is
greater than the threshold, the unit is "on" (output = 1);
otherwise, the unit is "off" (output = 0). Similarly, the
second-layer threshold logic unit 58, where required as in FIG. 2,
calculates a weighted sum of the outputs of the first-layer units
50, 52 and 54 to determine if the observed 15-second epoch were
baseline (output = 0) or preseizure (output = 1). These decision
devices 46 and 48 can be implemented using integrated circuit
summing amplifiers 60 in conjunction with Schmitt triggers 62.
Generally, in achieving the decision structures 46 and 48, recorded
EEG analog data obtained by use of a biotelemetry system and
including baseline (normal) and preseizure periods of an epileptic
subject are digitized and a large number of samples of 15-seconds
epochs are gathered therefrom. A preseizure period is chosen to be
the 10 minutes immediately prior to a seizure. A Fourier analysis
is performed on all of the samples and, for example, 13 frequency
bands are normally found desirable and practical to cover the
frequency range of interest (such as 0 to 26 Hz.) A bank of 13
analog filters (each having an output voltage versus frequency
characteristic similar to the plots 142 and 144 of FIG. 9) is then
digitally simulated in a general purpose computer, with processing
normalization of filter outputs and squaring of the normalized
outputs. Ideally, the filter characteristic could be rectangular
but this is impractical to achieve. The simulated filters provide
13 linear and 13 squared outputs (coefficients or numbers) for each
sample.
Digital (computer) simulation of a decision structure is also made
wherein such structure includes first and second layers of
interconnected threshold logic units and selected (by estimation)
to begin with two baseline channels and two preseizure channels.
The logic units have arbitrarily chosen input weights. Training and
test patterns are randomly selected from the processed 15-second
baseline and preseizure data. A test pattern can be, for example,
every fifth processed sample. Baseline data do not include any EEG
data recorded approximately 1 hour prior to the EEG signs of grand
mal seizure or data from 30 minutes following the start of a
seizure. The test (or system evaluation) set of data consists of
the data from other recorded seizures and the balance of the
baseline recordings.
Computer runs are made with the numerous training patterns which
are used for adjustment of the weights of the threshold logic
units. The 26 coefficients or numbers of each training pattern are
provided as inputs to the simulated decision structure and the
weights are adjusted according to well known error correction
procedure. For each possible output of the threshold logic units of
the decision structure, if the decision is incorrect (or correct)
for the particular input pattern, each input coefficient or number
is multiplied by a small predetermined constant (c) and adding (or
subtracting) the product to the corresponding channel input weight
(or from the other associated channel input weight). The value +1,
multiplied by the small constant, is also added to (or subtracted
from) the related threshold weight. See, for example, pages 69
through 74 of "Learning Machines" by Nils J. Nilsson, McGraw-Hill
Book Company, New York, 1965. Every so often during the design
process, the system is tested on the separate group of test
patterns. These tests involve no weight changes but the best design
point for a particular error correction run set is determined by
the percentage correct on the test group. Thus, the final decision
structures were based upon good performance on an independent set
of test patterns as well as the set of training patterns.
On successive training pattern runs, inputs (filters) are deleted
based upon low weight values. The lowest weighted groups are
progressively dropped until no more can be deleted without
degradation of the required performance. Under this process, the
final adequate decision structure 46 (FIG. 2) for subject RA was
reduced to two baseline and one preseizure channels each requiring
five linear and five squared input signals. On the other hand, the
final adequate decision structure 48 (FIG. 3) for the subject BJ
was reduced to a single channel wherein the second layer TLU became
unnecessary and was omitted for further simplification of the
structure. The first layer threshold logic units 50, 52 and 54 in
the decision structure 46 can be considered to be feature
extractors or detectors, and the second layer response unit 58 can
be considered to be a decision element or classifier. In the
decision structure 48, the input weights and summing amplifier 60
can be considered to be the feature detector, and the threshold
.theta..sub.5 and Schmitt trigger 62 can be considered to be the
decision element.
For the RA decision structure 46 in FIG. 2, all of the input
signals X.sub.1 through X.sub.5 and X.sub.1.sup.2 through
X.sub.5.sup.2 are applied to each of the three first-layer summing
amplifiers 60 through respective weights W.sub.1 through W.sub.10,
W.sub.11 through W.sub.20 and W.sub.21 through W.sub.30. The
thresholds .theta..sub.1 through .theta..sub.4 are established by
respective weights W.sub.31 through W.sub.34. The output signals of
the three Schmitt triggers 62 are applied to the second-layer
summing amplifier 60 through respective weights W.sub.35 through
W.sub.37. For the BJ decision structure 48 in FIG. 3, only the
input signals X.sub.1 ' and X.sub.2 ' are required and are applied
through respective weights W.sub.38 and W.sub.39 to the summing
amplifier 60 having a threshold .theta..sub.5 established by the
weight W.sub.40. The weights are, for example, as follows.
______________________________________ W.sub.1 = -24.7 W.sub.21 =
+15.1 W.sub.2 = -37.5 W.sub.22 = +10.8 W.sub.3 = -18.3 W.sub.23 =
+17.3 W.sub.4 = +68.6 W.sub.24 = -51.2 W.sub.5 = +27.6 W.sub.25 =
-32.7 W.sub.6 = -20.8 W.sub.26 = - 2.45 W.sub.7 = +30.6 W.sub.27 =
-22.4 W.sub.8 = + 5.79 W.sub.28 = -19.4 W.sub.9 = -109.8 W.sub.29 =
+70.2 W.sub.10 = -55.6 W.sub.30 = +19.2 W.sub.11 = -16.8 W.sub.31 =
+36.8 W.sub.12 = -22.9 W.sub.32 = + 3.53 W.sub.13 = + 6.66 W.sub.33
= - 4.51 W.sub.14 = +77.4 W.sub.34 = - 4.96 W.sub.15 = +70.0
W.sub.35 = + 6.09 W.sub.16 = - 7.87 W.sub.36 = + 3.54 W.sub.17 =
+52.5 W.sub.37 = - 1.69 W.sub.18 = +30.0 W.sub.38 = +27.241
W.sub.19 = -152.2 W.sub.39 = -91.228 W.sub.20 = -48.3 W.sub.40 =
+95.884 ______________________________________
FIG. 4 is a block diagram of the warning logic means 42 showing the
configuration of audible and visible alarm circuitry portion of the
warning system 30 (FIG. 1). The stream of successive 15-second
decisions output from the decision structure 38 is stored in a
20-bit shift register 64. A summing amplifier 66 is connected to
the 20 parallel outputs of the shift register 64 and serves to
count the number of preseizure decisions occuring in the preceding
five minutes.
A voltage regulator 68 is provided in connection with the summing
amplifier 66 to compensate for battery supply voltage variations.
The output of the summing amplifier 66 is applied to a threshold
comparator 70 which governs the activation of pacer 72 that
energizes the audio and visual alarms 74 and 76. The output of the
comparator 70 also conditions the flip-flop 78 so that the audio
alarm 74 can be energized. A pushbutton switch 80 can be operated
to inhibit the audio alarm 74 after it is energized by resetting
the flip-flop 78. When the output of comparator 70 changes from a
preseizure conditin, timer 82 operates to deactivate the pacer 72
after, for example, 5.5 minutes.
A circuit was also needed to provide signals for timing the
15-second analysis intervel, resetting the filter integrators, and
clocking the decision outputs into the warning system shift
register (see the timing and control block diagram, FIG. 13). The
15-second timing is provided by an integrator and Schmitt trigger.
The required pulses are produced by a digital storage register and
logic gates connected in a "one-shot" configuration. Additional
circuitry provides capability for pushbutton resetting of the
system, including clearing of the warning logic memory.
In deriving the basic configuration of the system, some of the more
significant criteria were low power consumption, number of
components, accuracy of analog operations, and insensitivity to
battery supply voltage variations.
FIG. 5 is a circuit diagram showing the scalp electrode connections
84, 86 and 88 for EEG acquisition and the preamplification means 32
which can be used in the epileptic seizure warning system for the
subject BJ. Central and occipital placement of electrodes 84 and 88
can be used with a C.sub.z reference (behind the ear) electrode 86.
A commercially available EEG preamplifier 90 (BioCom Model 121 IC)
was obtained for the system. This unit 90 consumes more power than
desired and does not provide as high common mode rejection ratio
(CMRR) as certain other preamplifiers, but it produces satisfactory
EEG traces.
Gain amplifiers 92 and 94 are connected to the output of the
preamplifier 90. The amplifier 92 includes a low pass filter 96.
The output of the amplifier 94 is connected by a normally closed
switch 98 to the bandpass filters shown in FIG. 6. A jack socket
100 is mechanically coupled to the switch 98. When the jack of a
tape recorder (not shown) is plugged into the socket 100, the
switch 98 is automatically opened to disconnect the
preamplification means 32.
FIG. 6 is a circuit diagram of the signal preprocessing and
processing means 102 and 104 of the seizure warning system for the
subject BJ. The preprocessing means 102 includes filters 106 and
108 which can be operational amplifiers having bridged-T filter
feedback networks 110 and 112. The processing means 104 includes
rectifiers 114 and 116, integrators 118 and 120, and scaling
amplifiers 122 and 124 for the two frequency bands involved in this
warning system.
The rectifiers 114 and 116 can be operational amplifier circuits
including diodes CR1 and CR2 which apply respective rectified
signals to the integrators 118 and 120. The integrating capacitors
126 and 128 are respectively discharged by the field effect
transistors Q5 and Q6 when a dump signal is provided on their gates
at the end of each 15-second epoch. The scaling amplifiers 122 and
124 normalize the integrated signals from the integrators 118 and
120. The -V reference bias and its scaling resistor pairs 130 and
132 serve to subtract a predetermined mean of the energy in each
frequency component and, since gain is the reciprocal of division,
the gain of the operational amplifiers 122 and 124 is suitably
selected to divide the mean by the standard deviation of that
component for normalization.
In order to test for differences more easily between epochs or
periods temporally associated with seizures, a long period referred
to as a "baseline" period is chosen from each subject's EEG which
(1) did not precede or follow a seizure by less than several hours,
(2) did not contain a seizure, (3) was recorded under similar
physical conditions as the seizure (although for the overnight
records, several stages of sleep may be included), and (4) was
relatively free of artifacts. The mean and standard deviation of
the energy in each frequency component of the spectrum can be
estimated using the energies in the numerous epochs of these long
records. Normalization highlights shifts from baseline averages for
a subject.
FIG. 7 is a circuit diagram showing the supply and stabilizing
connections of virtually all of the operational amplifiers used in
the seizure warning system for the subject BJ. The only exception
is in the low frequency oscillator amplifier in FIG. 14, where the
pin 8 is connected through a one megohm resistor to the output of
the timer threshold comparator. All of the operational amplifiers
are, for example, of the type FU5B7776393.
FIG. 8 is a circuit diagram showing the decision structure 48 which
can be used in the seizure warning system for the subject BJ. A
single threshold logic unit with only two inputs, one positive and
one negative, is utilized. The summing amplifier 60 (FIG. 3) is
embodied in an operational amplifier 134, and the Schmitt trigger
62 (threshold unit or classifier) can be constructed from two NAND
gates 136 and 138. The diode CR3 protects the input to the Schmitt
trigger 62 which has an inverter 140 output. The weights W.sub.38,
W.sub.39 and W.sub.40 of FIG. 3 have been converted into
appropriate resistances by suitable application of the pertinent
scaling factors.
FIG. 9 is a graph showing plots 142 and 144 of the output voltage
characteristics for the bandpass filters 106 and 108 (FIG. 6)
centered at 9.6 and 25.9 Hz. Each of the filters 106 and 108
utilizes a single operational amplifier with a nulling circuit in
the feedback path as previously described. This filter provided the
desired sharp peak in the center of the band and dropped off
sharply outside of the passband. Only one active device and a
relatively small number of components are required. The circuit
also produced a substantial voltage gain, reducing the requirements
imposed on the EEG preamplifier 32 (FIG. 5).
To determine the energy within their passbands, the outputs of the
filters 106 and 108 are subjected to suitable rectification and
integration. By using a half-wave rectifier requiring only one
amplifier for each filter to keep the parts count down, an
approximate energy determination is made. The half-wave rectifier
functioned satisfactorily; however, full-wave rectification of the
filter outputs is preferred to determine the energy within the
passbands more accurately. The full-wave rectifier designs can, of
course, employ two operational amplifiers.
The integrators 118 and 120 are of substantially conventional
design; however, considerable time was required to obtain
satisfactory accuracy. It was found that the critical element was
selection of a capacitor with the lowest possible dissipation
factor. Capacitors fabricated with polycarbonate or polystyrene
dielectrics were found to be suitable but very bulky. No smaller
capacitors were found that would give satisfactory performance as
the integrating component. Each integrator includes a circuit that
resets the initial conditions every 15 seconds by dumping the
charge on the integrator capacitor through a field effect
transistor (FET). The integrator also requires very careful
balancing of the amplifier input bias currents to obtain accurate
integation.
FIG. 10 is a circuit diagram of a voltage regulation circuit 146
which provides a stable voltage reference for the integrators 118
and 120 (FIG. 6). The stable voltage reference is required since
the integrator balance control (potentiometers 148 and 150 in FIG.
6) is sensitive to changes in battery supply voltage. This voltage
reference is also used in other voltage-sensitive portions of the
system (timing circuit, decision threshold logic units, and warning
logic circuit). The operational amplifier 152 measures the voltage
drop across transistor Q7. Since the voltage drop across transistor
Q7 is stable, then the output of the amplifier 152 will be
stable.
Scaling and normalization of each of the integrator outputs is
accomplished by adjusting the gain and bias of the operational
amplifiers 122 and 124 (FIG. 6) to reflect values of mean and
standard deviation previously calculated by the computer for
baseline data for each filter as previously described.
The digital simulation of the seizure warning system for subject RA
required, in addition to the normalized filter output, the square
of that value for each filter. Historically, analog operations
involving addition and subtraction have been relatively easily
accomplished using operational amplifiers. Multiplication
(including squaring) and division have been much more difficult and
have involved cumbersome or inaccurate equipment such as
synchrodriven potentiometers, Hall effect devices (interaction
between a current and a magnetic field in a semiconductor), diode
function generators, and log-antilog devices. Recently, integrated
circuits which are small and accurate have been developed to
perform multiplication base upon the principle of variable
transconductance.
FIG. 11 is a circuit diagram of a squaring circuit 154 including
one of these devices, the Motorola MC 1594 which maintained an
accuracy of 1/2 percent of full scale over its full range of
operation. In addition, the new circuit was found to be much more
accurate at low input levels, required fewer external components to
trim the operating conditions, and proved to be less prone to
oscillation. The circuit 154 did require special attention to
prevent oscillation. Input leads were twisted and lead lengths were
kept as short as possible. Decoupling capacitors were used on the
power supplies and input leads. Potentiometers 156 and 158 can be
adjusted to balance the circuitry to obtain a true square output,
and variable resistor 160 can be used to adjust the gain of the
operational amplifier 162.
The primary disadvantage of the squaring circuit is power
consumption. Each circuit draws 250 milliwatts. Thus, the five
squaring circuits 40 (FIG. 1) required for the RA system draw more
power (1.25 watts) than the entire remainder of the seizure warning
system (0.3 watt), which is composed mainly of micropower
amplifiers and low-power digital logic. The relatively large
battery pack needed for the RA system is required primarily to
supply power to these five devices for a 10-hour period. The BJ
system does not use squared inputs; consequently, power
requirements for BJ are greatly reduced.
It may be noted that in implementing the decision structure 46
(FIG. 2) of subject RA, the only major problem encountered was in
obtaining sufficient accuracy with teninput summing amplifiers to
approximate the simulated decision threshold logic units. The goal
established was 1/2 percent of full-scale accuracy for all
combinations of inputs. It was impossible to test all possible
inputs, but tests were conducted using many combinations of 1 volt
and 0 bolt inputs, as well as varying voltage levels for individual
inputs. During these tests, input weighting resistors were
selected, replaced, or trimmed to achieve the desired accuracy for
almost all combinations tried.
FIG. 12 is a circuit diagram of an illustrative summing circuit 164
with four inputs and which implements both negative and positive
input weights. The equation for the output voltage as a function of
the input voltages is indicated below the summing circuit. This
summing circuit 164, with more or less inputs, can be used as the
summing amplifiers 60 in the decision structure 46 of FIG. 2. The
threshold voltage input is critical and can be supplied by the
voltage regulation circuit 146 (FIG. 10) described earlier.
The summing amplifier 60 of the response unit 58 in FIG. 2
presented a much easier design problem than the summing amplifiers
60 of the units 50, 52 and 54. Inasmuch as the three inputs are
limited to values of 1 or 0, there are only eight possible input
combinations, each of which may be checked for the proper output
decision. An output level of 1 (4 volts) corresponds to a
preseizure decision while 0 (0 volts) indicates a baseline
period.
FIG. 13 is a circuit diagram of an embodiment of the timing and
control means 44 indicated in the warning system of FIG. 1 and
which is used with the circuits shown in FIGS. 6 and 14. Two
choices were evaluated for timing the 15-second analysis epoch.
Oscillators, especially those which are crystal controlled, provide
an However, means for setting timing accurately. however, the
associated counting and triggering circuitry would have consumed
more power than was considered desirable. The second alternative
consists of integrating a constant voltage and comparing the output
with a fixed threshold. When the threshold is exceeded, a chain of
pulses is triggered, one of which dumps the charge on the capacitor
166 of integrator 168 to initiate the next analysis epoch. The
15-second timing is achieved by adjusting the input resistor 170 or
the output threshold voltage. A Schmitt trigger 172 performs the
output voltage comparison.
The integrator approach was selected primarily because of the lower
power consumption; however, recent advances in timing technology,
particularly crystal-controlled clocks, may make the oscillator and
counting circuitry more feasible in future applications.
One-shot multivibrators are the natural choice for providing the
short timing pulses. However, no commercially available integrated
circuit one-shot was uncovered with a power consumption of less
than 80 mw. Therefore, one-shots 174 and 176 were constructed using
a pair of low-power inverters and a NAND gate with suitable
capacitive coupling as shown in FIG. 13. The duration of the
one-shot pulse is controlled by the value of the coupling
capacitor.
The low-power flip-flop storage element 178 is required to allow
the timing integrator capacitor 166 to discharge fully. At the end
of the 15-second epoch, the timing trigger 172 sets the flip-flop
178 and initiates a chain of two one-shot pulses. The first pulse
from one-shot 174 clocks the output of the decision unit 48 (FIG.
8) into the warning logic shift register 64. (FIG. 14). As the
decision is stored, a signal due to the first pulse from the Q4
circuit dumps the filter integrator capacitors 126 and 128 (FIG. 6)
in preparation for the next analysis epoch. The second pulse from
one-shot 176 clears the flip-flop 178, unlocking the timing
integrator 168.
Two additional one-shots 180 and 182 are included to provide a
capability for clearing and resetting the entire system with an
external pushbutton 184. This feature was very useful in system
checkout but is not available to the subject being monitored to
prevent accidental system interruption. The circuit 186 centered
around transistor Q3 was provided to ensure that the system will
start reliably when the power switch is turned on.
When the power is first turned on, the transistor Q3 conducts such
that the base of transistor Q1 is connected to ground by way of the
diode CR4. Transistor Q1 conducts and back biases diode CR5 so that
field effect transistor Q2 is made conductive to assure discharge
of the 15-second integrating capacitor 166. The transistor Q3
becomes nonconducting when the capacitors in circuit 186 are
suitably charged, and the transistors Q1 and Q2 are also rendered
nonconducting. The rise in potential of the collector of transistor
Q3 further assures that the Q output of flip-flop 178 is set to a 0
(low or ground potential) output condition.
Closing of the momentary bushbutton switch 184 produces a positive
output pulse from the one-shot 180. This (high) pulse is applied
through inverter 188 as a clear (low) signal to the shift register
64 (FIG. 14). The high pulse is also applied to one-shot 182 which
produces an inverted (low or 0) pulse on pin 10 of the NAND gate
190. Since the pin 9 of gate 190 is normally high in potential
(when the capacitor 166 is charging and the Schmitt trigger 172 is
not triggered), an output pulse is produced which is inverted by
inverter 192 and applied to the preset pin 4 of the flip-flop 178
to produce a 0 (low) output from pin 6 and a 1 (high) output from
pin 5 or the Q output. The low output on pin 6 turns on transistor
Q1 to discharge the integrating capacitor 166.
The high output on pin 5 of the flip-flop 178 produces a 1
millisecond output pulse from the one-shot 174. This pulse is
applied too the shift register 64 (FIG. 14) to shift everything in
each register and clock in the output from the decision structure
48 (FIG. 8). The output pulse from the one-shot 174 is inverted by
inverter 194 and applied to transistor Q4 and the one-shot 176. The
transistor Q4 is rendered conductive so that a low (ground) dump
signal is produced and applied to the gates of the field effect
transistors Q5 and Q6 (FIG. 6) to discharge the capacitors 126 and
128. The one-shot 176 produces a 2 millisecond pulse which is
inverted by inverter 196 and applied through diode CR6 to the gate
of transistor Q1 without effect since a low signal is already being
applied from pin 6 of the flip-flop 178.
The trailing edge of the low pulse from inverter 196 through diode
CR6 does result in a rise on the clock input of flip-flop 178,
however, so that its 0 (ground) data input sets the Q output (pin
5) to a 0. Of course, the output on pin 6 of the flip-flop 178 goes
high such that the transistors Q1 and Q2 are turned off and the
capacitor 166 begins charging again. After 15 seconds, the
threshold of the Schmitt trigger 172 is exceeded to produce a low
output signal which is applied to pin 9 of gate 190. This results
in a high output signal from the gate 190, which is inverted by
inverter 192 and applied to the preset input (pin 4) of the
flip-flop 178 to produce a low output on its pin 6 and a high
output on its pin 5 to repeat the cycle.
FIG. 14 is a circuit diagram of the warning logic means (and alarm
circuitry) 42 connecting with the circuits of FIGS. 8 and 13. The
warning logic is designed to satisfy four basic criteria.
1. To reduce the number of false alarms, the number of 15-second
preseizure decisions occuring with a 5-minute period are counted.
If a specified number of preseizure indications is exceeded (18 out
of 20 for subject BJ), a warning must be initiated.
2. The warning must continue as long as this level is exceeded.
3. After the last indication of warning condition (count drops
below 18 for BJ), the subject should remain in a position of safety
for a period of 5.5 minutes, for example.
4. The alarm should be sufficiently annoying to alert the subject;
but once he acknowledges the warning, he should be able to suppress
the audible signal while a less conspicuous visual alarm would
continue.
A 20-bit shift register 64 serves as the memory for the warning
logic system 42 (FIG. 14). The output of the decision unit 48 (FIG.
8) is clocked into the shift register 64 at the end of each
15-second analysis epoch. The 20 parallel outputs of the shift
register 64, representing the output decisions for the immediately
preceding five minutes, are input to a summing amplifier 66 through
equally weighted resistors 198. Thus, the output of the summing
amplifier 66 is directly proportional to the number of preseizure
decisions in the 20-bit memory. The number of counts required to
trigger a seizure warning is controlled by the value of the
threshold input resistor 200.
When the output of the summing amplifier 66 goes negative and the
output of threshold comparator 70 goes positive, indicating a
warning condition, two actions take place. First, the field effect
transistor Q11 of timer 82 is switched on so that timing integrator
202 is set to an initial value and held there by the FET switch.
The new (negative) output of the integrator 202 produces a negative
output from threshold comparator 204 to activate a low frequency
(about 5 Hz) oscillator or pacer 72. The pacer 72 drives transistor
Q8 which controls a tiny light 76, causing it to flash. The second
action is to set a flip-flop 78 which, in turn, permits gating of
the output of the flashing circuit 72 to control a commercially
available audible device 74 incorporated into the system. The 1
(high) data input on pin 12 of flip-flop 78 is clocked or set to
the pin 9 by the rise in potential on pin 11. Gate 206 can,
therefore, produce an oscillating high and low output so that the
control transistor Q9 is turned on and off. Thus, when the warning
is initiated, the subject is presented with a flashing light and an
audible beeping.
At this point, the subject has a choice. If the subject takes no
action, the alarm 74 will continue to beep as long as the light 76
is flashing; however, the subject may press a button 80 that clears
the flip-flop 78, suppressing the audible signal only. This action
has no effect on the operation of the flashing light 76, and the
flip-flop 78 will retrigger the next time a warning condition is
initiated. This feature precludes the possibility of the subject's
suppressing the alarm but forgetting to turn it back on after the
warning subsides.
As long as the warning condition persists, the timing integrator
202 is locked to its initial condition. When the number of
preseizure counts drops below the preset threshold, the FET switch
Q11 is turned off and the timer capacitor 208 is free to integrate.
The rate of integration is adjusted so that 5.5 minutes later the
output voltage of integrator 202 crosses the comparator 204
threshold and the comparator output goes positive, turning off the
pacer 72 and flashing light 76. Should a new warning be initiated
during this period, the integrator 202 will be clamped to its
initial value again, the light 76 will continue to flash, and the
audible alarm 74 will be retriggered. All components, with the
exception of the light 76 itself, are low-power devices.
One of the design difficulties encountered was that the output
voltages of the 20 parallel bits did not change in direct
proportion to battery supply variations. As the supply voltage
decreased, the number of counts required to trigger a warning
changed. To overcome this problem, the threshold input voltage is
supplied by regulator circuit 68 including a logic inverter 210
whose input is tied to ground. This provides a dummy reference
voltage from the operational amplifier 212 that varies exactly as
the shift register 64 output varies with battery supply
changes.
The power requirement of subject RA's warning system is
approximately 1.6 watts. Approximately 75 percent of this power is
used to operate the five integrated circuits that provide the
square of the filter outputs. The remainder of the system requires
approximately 350 milliwatts. These squaring circuits 154 (FIG. 11)
also require .+-. 15 volts, so the battery pack was designed to
supply four nominal voltages, .+-. 5v and .+-. 15v. The power
supply consists of six 450-milliampere-hour rechargeable
nickel-cadmium batteries and has the capacity to provide 10 hours
of continuous operation on a single charge. The battery supply is
about 4 .times. 6 .times. 2 inches and weighs about 2-1/2
pounds.
The BJ system posed a completely different supply problem. Power
consumption for this system is significantly lower, and the device
itself can be much smaller. A single package which is small enough
to fit in a shirt pocket was used to contain the system
electronics, battery supply, and warning means. The system
electronics requires 140 milliwatts and the flashing light in the
alarm system uses an additional 100 milliwatts. Power for the BJ
system is supplied by two 5.4 volt dispoable mercury cell
batteries. The batteries selected each have a capacity of 1,000
milliampere-hours, which is sufficient to drive the systems for
over 40 hours of continuous monitoring. They occupy a space of
about 2-1/4 cubic inches and weigh less than 4 ounces.
The case for the compact BJ seizure warning system is tapered to
fit comfortably in a shirt pocket. It is constructed in two
sections of molded fiberglass. The circuit board, battery holders,
and power switch are mounted on the back section. The front cover
holds the audible alarm 74 (FIGS. 4 and 14), the EEG harness
socket, and the alarm supression button 80. The flashing light 76
is mounted in the top of the back cover, where the subject may
easily check the status of the alarm by a downward glance at the
device. The device also contains a tiny socket 100 (FIG. 5) that
allows operation of the system on tape recorder outputs for test
and demonstration purposes. When the tape recorder jack is plugged
in, the EEG preamplifier 32 is automatically disconnected. The case
is 3-1/8 .times. 6-1/2 inches and the average depth or thickness is
1 inch. The entire system including batteries weighs 13 ounces.
During tests with the subject, the system has been subjected to
severe shocks and crushing loads. The case has withstood these
rigors remarkably well.
The principles involved in the epileptic seizure warning system
are, of course, applicable to other systems in addition to those
for providing warnings of imminent epileptic seizures. Such
principles can be directly applied to, for example, a cardiac
seizure warning system for providing warnings of any imminent heart
attacks. The principles can also be applied to automatic diagnostic
devices. Thus, while an exemplary embodiment of this invention has
been described above and shown in the accompanying drawings, it is
to be understood that such embodiment is merely illustrative of,
and not restrictive on, the broad invention and that we do not
desire to be limited in the scope of our invention to the details
of construction or arrangements described and shown, for obvious
modifications may occur to persons having ordinary skill in the
art.
* * * * *