Obstructive sleep apnea syndrome (OSAS) is observed in approximately 2% of children. Heart rate variability (HRV) is a potentially simple, non-invasive diagnostic screening tool for OSAS. In this study, we investigated the diagnostic... more
Obstructive sleep apnea syndrome (OSAS) is observed in approximately 2% of children. Heart rate variability (HRV) is a potentially simple, non-invasive diagnostic screening tool for OSAS. In this study, we investigated the diagnostic potential of HRV using power spectral analysis, numerical titration, sample entropy, and detrended fluctuation analysis. Effects of sleep stages (REM and NREM sleep) are evaluated. The results show that the heart rate chaos intensity, as measured by the noise limit in numerical titration, is significantly higher during REM sleep than NREM sleep in all patient groups. By using the receiver-operating characteristic analysis, the detection of OSAS yielded a specificity of 72.2% and sensitivity of 81.3% using the numerical-titration technique. The findings suggest that sleep state and disordered breathing are important determinants of cardiac autonomic control. Nonlinear techniques such as numerical titration, when used in conjunction with spectral analysis of HRV could be an effective screening tool for pediatric OSAS.
Research Interests: Cardiology, Biomechanics, Nonlinear dynamics, Numerical Analysis, Sensitivity Analysis, and 14 morePaediatrics, Heart rate variability, Humans, Child, Obstructive sleep apnea, Heart rate, Sleep, Incidence, Autonomous Control, Eye, Wakefulness, Rem Sleep, Detrended Fluctuation Analysis, and Sleep Stages
Blinded studies with transcranial magnetic stimulation (TMS) require a valid sham condition. A wide range of sham approaches have been implemented but they have various limitations including residual electric field in the brain,... more
Blinded studies with transcranial magnetic stimulation (TMS) require a valid sham condition. A wide range of sham approaches have been implemented but they have various limitations including residual electric field in the brain, inadequate reproduction of auditory and cutaneous sensations, and/or need for electrical stimulation with scalp electrodes. We propose a quadrupole TMS coil configuration that can be electronically switched between active and sham modes. In active mode, the quadrupole coil has electric field characteristics similar to a conventional figure-8 coil. In sham mode, the quadrupole coil compared to the reverse-current sham figure-8 coil has 50% less electric field penetration depth, is 97% more focal, produces 35% less intense field in the brain, and induces scalp electric field characteristics closer to those of active TMS.
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We present a quantitative comparison of two metrics-neural stimulation strength and focality-in electrocon-vulsive therapy (ECT) and magnetic seizure therapy (MST) using finite-element method (FEM) simulation in a spherical head model.... more
We present a quantitative comparison of two metrics-neural stimulation strength and focality-in electrocon-vulsive therapy (ECT) and magnetic seizure therapy (MST) using finite-element method (FEM) simulation in a spherical head model. Five stimulation modalities were modeled, including bilateral ECT, unilateral ECT, focal electrically administered seizure therapy (FEAST), and MST with circular and double-cone coils, with stimulation parameters identical to those applied in clinical practice. We further examine the effect on the stimulation metrics of individual-, sex- and age-related variability in tissue layer thickness and conductivity. Neural stimulation by MST is shown to be more focal and superficial than ECT. This result suggests that it may be advantageous to reduce the current used in ECT. The stimulation strength in MST is also less sensitive to variations in head geometry and tissue conductivity than in ECT. Individualization of pulse amplitude in both ECT and MST could c...
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Accurate processing of electrocardiogram (ECG) signals requires a sensitive and robust QRS detection method. In this study, three methods are quantitatively compared using a similar algorithm structure but applying different transforms to... more
Accurate processing of electrocardiogram (ECG) signals requires a sensitive and robust QRS detection method. In this study, three methods are quantitatively compared using a similar algorithm structure but applying different transforms to the differentiated ECG. The three transforms used are the Hilbert transformer, the squaring function, and a second discrete derivative stage. The first two have been widely used in ECG and heart rate variability analysis while the second derivative method aims to explain the success of the Hilbert transform. The algorithms were compared in terms of the number of false positive and false negative detections produced for records of the MIT/BIH Arrhythmia Database. The Hilbert transformer and the squaring function both produced a sensitivity and positive predictivity of over 99%, though the squaring function had a lower overall detection error rate. The second derivative resulted in the highest overall detection error rate. Different algorithms performed better for diverse ECG characteristics; suggesting that an algorithm can be specified for different recordings, the algorithms can be combined based on each one's characteristics to determine a new more accurate method, or an additional detection stage can be added to reduce the number of false negatives.
Research Interests: Algorithms, Artificial Intelligence, Quantitative analysis, Electrocardiography, Heart rate variability, and 14 moreHumans, Hilbert transform, Heart rate, Bit Error Rate, Cardiac Arrhythmias, Electrocardiogram, Reproducibility of Results, Square function, Quantitative Analysis, Arrhythmia, Sensitivity and Specificity, False Negative, Detection Algorithm, and False Positive
The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the... more
The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBS electrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants.
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The safety of transcranial magnetic stimulation (TMS) in patients with an implanted deep brain stimulation (DBS) systems has not been thoroughly investigated. One potential safety hazard is the induction of significant voltages in the... more
The safety of transcranial magnetic stimulation (TMS) in patients with an implanted deep brain stimulation (DBS) systems has not been thoroughly investigated. One potential safety hazard is the induction of significant voltages in the subcutaneous leads in the scalp that could result in unintended electrical currents in the DBS electrode contacts. We measured ex-vivo the TMS-induced voltages and currents in DBS electrodes with the implantable pulse generator (IPG) set in various modes of operation. We show that voltages as high as 100 V resulting in currents as high as 83 mA can be induced in the DBS leads by a TMS pulse in all IPG modes. These currents are an order of magnitude higher than the normal DBS pulses, and could result in tissue damage. When the IPG is turned off, electrode currents flow only if the TMS-induced voltage exceeds 5 V.
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The goal of this study is to investigate the influence of white matter conductivity anisotropy on the electric field strength induced by electroconvulsive therapy (ECT). We created an anatomically-realistic finite element human head model... more
The goal of this study is to investigate the influence of white matter conductivity anisotropy on the electric field strength induced by electroconvulsive therapy (ECT). We created an anatomically-realistic finite element human head model incorporating tissue heterogeneity and white matter conductivity anisotropy using structural magnetic resonance imaging (MRI) and diffusion tensor MRI data. The electric field spatial distributions of three
Research Interests: Finite element method, Finite Element, Anisotropy, Electroconvulsive therapy, Brain, and 12 moreHumans, Computer Simulation, Electromagnetic Fields, Spatial Distribution, Radiometry, White matter, Side Effect, Electric Field, Electric Conductivity, Region of Interest, Medical Treatment, and Magnetic resonance image
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Brain stimulation, in the form of electroconvulsive therapy (ECT), has long been a gold standard treatment for depression, but today, the field of neuromodulation is rapidly changing with the advent of newer and more precise tools to... more
Brain stimulation, in the form of electroconvulsive therapy (ECT), has long been a gold standard treatment for depression, but today, the field of neuromodulation is rapidly changing with the advent of newer and more precise tools to alter neuroplasticity and to treat brain-based disorders. Now there are new means to induce focal seizures, as with magnetic seizure therapy (MST), or modifications to ECT. There are also surgical approaches to target brain circuits via implanted stimulators placed in the brain or on cranial nerves. Finally, there are noninvasive subconvulsive approaches for the transcranial application of either electric or magnetic fields. Collectively, these tools have transformed the face of neurotherapeutics and informed our understanding of the brain basis of complex neurobehavioral conditions.
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Research Interests: Algorithms, Biophysics, Magnetic Resonance Imaging, Treatment Outcome, Finite Element, and 16 moreAnisotropy, Finite Element Analysis, Electroconvulsive therapy, Hippocampus, Brain, Humans, Spatial Distribution, Finite element simulation, Head, White matter, Reproducibility of Results, Side Effect, Electrodes, Electric Field, Region of Interest, and Magnetic resonance image
Understanding the relationship between the stimulus parameters of electroconvulsive therapy (ECT) and the electric field characteristics could guide studies on improving risk/benefit ratio. We aimed to determine the effect of current... more
Understanding the relationship between the stimulus parameters of electroconvulsive therapy (ECT) and the electric field characteristics could guide studies on improving risk/benefit ratio. We aimed to determine the effect of current amplitude and electrode size and spacing on the ECT electric field characteristics, compare ECT focality with magnetic seizure therapy (MST), and evaluate stimulus individualization by current amplitude adjustment. Electroconvulsive therapy and double-cone-coil MST electric field was simulated in a 5-shell spherical human head model. A range of ECT electrode diameters (2-5 cm), spacing (1-25 cm), and current amplitudes (0-900 mA) was explored. The head model parameters were varied to examine the stimulus current adjustment required to compensate for interindividual anatomical differences. By reducing the electrode size, spacing, and current, the ECT electric field can be more focal and superficial without increasing scalp current density. By appropriately adjusting the electrode configuration and current, the ECT electric field characteristics can be made to approximate those of MST within 15%. Most electric field characteristics in ECT are more sensitive to head anatomy variation than in MST, especially for close electrode spacing. Nevertheless, ECT current amplitude adjustment of less than 70% can compensate for interindividual anatomical variability. The strength and focality of ECT can be varied over a wide range by adjusting the electrode size, spacing, and current. If desirable, ECT can be made as focal as MST while using simpler stimulation equipment. Current amplitude individualization can compensate for interindividual anatomical variability.