Window in the Brain

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Seizures are common in critically ill infants and children, and they affect how well their brains recover from illness. Knowing if or when seizures happen allows doctors and nurses to treat them promptly, which can improve a patient’s outcome, but currently more than half of seizures can go undetected in Paediatric Intensive Care Units (PICU). Accurate seizure detection relies on neurophysiologists to collect brainwave recordings (EEG), followed by expert interpretation  by a consultant paediatric neurologist. It is not possible, logistically or financially, for these specialists to be available round-the-clock on a PICU, which means EEG collection and interpretations cannot be provided at all times.

Innovating solutions for clinical staff

As a consultant paediatric intensivist, Dr Tsz-Yan Milly Lo was frustrated that the lack of accurate seizure detection methods PICU staff could use at the bedside was limiting their ability to provide prompt seizure detection and treatments. With the correct software, brainwaves from EEG may be expressed as complex numbers and allow quantitative brain functional connectivity assessments. Such mathematical EEG assessments show changes before and during seizures. Milly knew these brain connectivity changes on brainwaves could predict seizures accurately without specialist knowledge in research settings, and they were keen to find a way to bring this technology to the bedside and benefit future patients.

Building on ideas from the MRC Proximity to Discovery grant, Milly contacted long-term collaborator Dr Javier Escudero Rodriguez, a biomedical engineer based in the University of Edinburgh’s School of Engineering, and Dr Vera Nenadovic, a former research colleague who had established a brain health diagnostics spinout company, BrainsView Inc, and asked them both to collaborate on a clinical-academic-industry partnership to develop a seizure detection tool suitable for frontline PICU clinical use. An enthusiastic ‘yes’ from both parties led to the trio to successfully securing the MRC Confidence in Concept (CiC) grant. Edinburgh Innovations put a collaboration agreement in place, signalling that the budding Window in the Brain (WiB) team were ready to get to work. 

As an intensivist, Milly knew that global clinical uptake of the team’s technology would depend on mapping their software directly on to existing EEG hardware configurations in use in PICU. The main challenge, therefore, was to make BrainsView’s analytic software adaptable to work with only four EEG channels, a montage PICU bedside staff were already trained to apply. Through the CiC grant, post-doctoral research fellow Dr. Shima Abdullateef joined the WiB team in 2020 and together they successfully adapted the BrainsView software to pair with four-channel EEG recordings from a single paediatric centre to accurately detect seizure. This was achieved by adding an extra analytic feature (cross-channel amplitude coherence) to the existing phase synchrony (PS) based seizure detection algorithm. This innovative software adaptation allows the WiB software to detect seizure effectively with the four-channels EEG montage as it was with eight or more channels.  This highly significant milestone means PS based seizure detection is now possible using an EEG montage that can be applied by the PICU bedside team independent of expert input for the very first time. 

Closer to clarity on seizure detection

The WiB team are accelerating towards impact with further studies. Using the CiC pilot data, the team successfully secured a Chief Scientist Office Response Mode grant in 2022 to further refine their software in the current multi-centre pilot study. Together with clinicians and anonymised EEG data from 10 UK children’s hospitals in the KidsBrainIT network, the WiB team is expected to co-create a refined seizure detection tool before moving to the next phase and validate the prototype to facilitate future clinical uptake.

With skill and determination, Milly and team are making great strides towards their ultimate aim: delivering real-time EEG analytic software that can quantitatively identify seizures, alert clinical staff to initiate treatment, and evaluate treatment effectiveness. By doing so, Window in the Brain’s innovative technology is set to improve patient treatments and outcomes for critically ill infants and children, save costs for the NHS, and revolutionise PICU bedside seizure detection worldwide.