Abstract

The Hospital for Sick Children, University of Toronto, Toronto, Canada.

Abstract Winner: Medical Imaging & Biomedical Diagnostics


Author: Danny Eytan

Introduction: Acquired brain injury is a common cause for hospitalization in the pediatric and adult intensive care units associated with an immense personal, social and economic burden. The goals during treatment in the intensive care are to minimize secondary injury and tailor interventions to optimize outcomes. Timely detection of secondary events or periods of deterioration are critical to allow intervention in order to modify the course of disease. Our present-day ability to monitor brain function continuously in these patients is very limited and accordingly, advanced and affordable bedside neuro-monitoring systems can offer opportunities for early detection of neurological deterioration and lead to improved outcomes. Initial Results: We recently developed and tested the feasibility of a novel bedside functional imaging set-up aimed at examining cortical brain activation patterns by combining high density EEG recordings, multi-modal sensory stimulation (auditory, visual and somatosensory) and EEG source modeling. We validated this set-up in both healthy and critically-ill brain-injured children and demonstrated modality-specific source-reconstructed cortical activation patterns. By combining stimulation with different modalities, most of the cortical surface can be monitored for changes in functional activation. Application of this set-up in children with anatomically well-defined brain injury suggested an association between these injuries and the activation patterns. Moreover, we demonstrated the use of this set-up to examine higher-level cortical processing and its potential to serve as an online monitor of brain function. Future Work: Even though this novel system is capable of monitoring cortical activity at the bedside with unprecedented resolution, it requires a high density EEG set-up which entails a technological challenge and a multi-dimensional broadband data stream as output for analysis. We plan to use machine learning techniques to examine the potential to reduce the number of recording electrodes with minimal loss of information and diagnostic potential. Moreover, we plan to use dimensionality reduction tools such as PCA or nonlinear methods such as manifold learning for feature extraction and to enable a fast real-time analysis of the cortical activation patterns. At a final stage, supervised classification algorithms will be tested for automatic detection and identification of changes in brain function. Conclusions: Thus far we have developed and tested a novel tool with the potential to serve as a bedside functional neuroimaging system and an online monitor for secondary deteriorations. Future work will focus on simplification of the recording system on the one hand and automatization of its detection capabilities.

Co Author/Co-Investigator Names/Professional Title: Danny Eytan, MD PhD, Department of Critical Care Medicine, Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Elizabeth W. Pang, PhD, Division of Neurology, Department of Paediatrics, Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Sam Doesburg, PhD, Department of Diagnostic Imaging, Division of Magnetoencephalography, Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Vera Nenadovic, PhD NP, Division of Neurology, Department of Paediatrics, Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Anne-Marie Guerguerian, MD PhD, Department of Critical Care, Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Peter Laussen, MBBS, FCICM. Department of Critical Care, David and Stacey Cynamon Chair in Critical Care Medicine, The Hospital for Sick Children; Department of Anaesthesia, University of Toronto, Toronto, Canada.

Funding Acknowledgement (If Applicable): Department of Critical Care Research Fund. Canadian Foundation for Innovation (CFI) for the Centre for the Investigation of Neuroplasticity and Developmental Disorders 2006-2011. Project #11954.