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“Brain Stethoscope” Hears Sounds of Silent Seizures in Coma Patients

Credits: Pixabay Creative Commons

 

Neurologists at Stanford Neurosciences Institute and Child Health Research Institute can now say for certain if a comatose patient is going through a silent seizure---- they  listen to his brain.

 

The stethoscope is an acoustic medical device with small-disc resonator placed over the chest to listen to stomach, lung and heart sounds and other parts of the body. But this traditional stethoscope can not hear the brain. So patients suffering from silent seizures, a neurological condition with no visible convulsions, do not stand a chance of prompt detection that leads to their recovery.

 

However, a pioneering device called “brain stethoscope” that converts brain waves to sound can change the epilepsia landscape. Stanford neurologists worked with a computer music specialist for years to develop the “brain stethoscope.” This particular “stethoscope” doesn’t even resemble the traditional stethoscope. It is an algorithm which converts the brain’s electrical activity into perceptible sounds.


 

“Brain Stethoscope” vs. Physician-assessed EEGs

Critical patients’ situation requires critical detection tool. According to  Dr. Josef Parvizi, professor of Neurology and Neurological Sciences at Stanford University Medical Center, “majority of seizures in critically ill patients are non-convulsive and many comatose patients do not recover because their brains keep seizing. Kids with these silent seizures, if they survive, will leave the hospitals with major cognitive impairment."

 

The study published in Epilepsia Journal yesterday illustrated that non-EEG (electroencephalogram) specialists such as nurses or medical students can now detect ongoing seizures in comatose patients through the device.

 

It used to be that assessment of waveforms of epileptic patients necessitated EEG-trained physician in real time. Diagnosis of silent seizures can be a drawn-out process where a trained technician record the brain activity by attaching sensors on a patient’s skull. The technician will then record and send the results to a neurology specialist like Parvizi. Critical time is lost from the moment  the technician is called and travelled to the hospital and to the succeedings steps to complete the detection process. The diagnosis usually comes back hours later.

This is an impractical approach during critical settings.  Immediate assessment of patients with suspected subclinical seizures such as nonconvulsive status epilepticus is required. Thus, with the brain stethoscope, the non-specialists can listen and detect promptly and reliably the silent seizures.


 

Credits: Pixabay Creative Commons

 

The Brain Needs Listening

Seizure happens when electrical waves in the brain go berserk. Such eccentric brain activity leads to convulsion, but not always though.  Not all seizures are obvious and doctors may not be able to detect them especially during a coma, or prolong state of unconsciousness.

 

Parvizi explained that not all seizures may cause convulsions when a patient go through the fits, visibly shake and fall on the floor. But this is not the case for critical patients in in the intensive care units."Close to 90% of those patients will have silent seizures though not visible they can still damage the brain if they are prolonged” he said.

 

As such,  the desperate need to listen to the brain emboldened the researchers to find solutions. Soon the solution came to Parvizi after watching a performance based on data recorded by a scientific instrument aboard the Voyager space probe. He realized it could be possible to do the same thing with brain waves.

 

Parvizi collaborated with Chris Chafe, the music and Duca family professor and also a member of Bio-X and the Neurosciences Institute. The idea was to attach music synthesis to a person’s brain.

 

Parvizi recalled, "Once he sent me the files and I listened to them, I was literally in shock, because it was so intuitive."  He was able to hear the transition from non-seizure to seizure so easily. And as a trained neurologist, he tested the potentials of the collaboration with Chafe. He wanted to know if the non-EEG specialists can hear and easily distinguish the difference between normal brain activity and a seizure.

 

With Bio-X seed grant, Parvazi along with Babak Razavi, a clinical assistant professor of neurology and Kapil Gururangan, a medical student embarked on the study of 84 brain waves samples of EEGs.  About 32 of the samples were either actual seizure or seizure-like brain waves. About 34 medical students and 30 nurses at Stanford listened to the samples converted to music using Chafe's algorithm.

 

 

Credits: Pixabay Creative Commons

 

Study Findings

Results of the experience showed that even without training in EEG diagnosis of epilepsy, the participants were able to discern seizures and seizure-like activity from normal brain waves. They were also correct in identifying the seizure-like samples and normal activity sample three-quarters of the time.

 

"The ability of an untrained medical student or nurse to read an EEG is pretty dismal—it's 50 percent. But when the EEG was converted into sounds, the participants were accurate in their detection of seizures 95% of the time” Gururangan said.

 

The positive results of the study led the team to more questions as to how the physicians will will be able to utilize both the tool and the information in the decision process.