AI in Clinical Neurophysiology: from IED detection to neuroprognostication.

AI in Clinical Neurophysiology from IED detection to neuroprognostication Michel J.A.M. van Putten MD MSc PhD University of Twente & Medisch Spectrum Twente ISCN/BSCN 2025 meeting, Dublin ….. ….. Machine learning Deep Learning Deep Neural networks Human defines features Human generates model abnormalnormal PDR 8-13 Hz? YES NO Human defines features Human generates model Symmetric PDR with a frequency of 9.8 Hz. Reactivity (EC/EO) is within normal limits. f (Hz)f (Hz) Machine Learning William Holbrook Beard Neural Network Neural Network 2018 Here we show, in a ground truth scenario, that a deep neural net can predict sex from scalp electroencephalograms with an accuracy of > 80% (p < 0.0001), revealing that brain rhythms are sex specific. 1 s 1 s 1 s 1 s Eyes open, no response… 1 s + some oxygen 40 Bronder et al, Resusc. Plus, 2022 Continuous background pattern Burst suppression with identical bursts GOOD POOR 2 s Van Putten & Tjepkema (in preparation), 2025 Van Putten & Tjepkema (in preparation), 2025 DeepCRI poor outcome (spec > 99%) sensitivity 37-45% good outcome (spec > 95%) sensitivity 50% < 24 h Van Putten & Tjepkema (in preparation), 2025 poor outcome (spec > 99%) sensitivity 37-45% good outcome (spec > 95%) sensitivity 50% < 24 h Van Putten & Tjepkema (in preparation), 2025 DeepCRI poor outcome (spec > 99%) sensitivity 37-45% good outcome (spec > 95%) sensitivity 50% poor outcome (spec > 99%) sensitivity 81% good outcome (spec > 95%) sensitivity 90% < 24 h Van Putten & Tjepkema (in preparation), 2025 DeepCRI Van Putten & Tjepkema (in preparation), 2025 Detection of anomalies (IEDs) Detection of IEDs Modified from Noebels et al, 2012 Catarina da Silva Lourenço. Clin Neurophys, 2021 IED detection Seizure detection Seizure prediction EEG No IED IED Kural et al, Epilepsia 2022 Accurate identification of EEG recordings with interictal epileptiform discharges using a hybrid approach: Artificial intelligence supervised by human experts Encevis SpikeNet Persyst Sensitivity Specificity Tveit et al, JAMA Neurology, 2023 30.000 routine EEGs SCORE-AI Normal vs abnormal Abnormal: focal IEDs, generalised IEDs, nonepileptiform focal & non-epileptiform diffuse Automated Interpretation of Clinical Electroencephalograms Using Artificial Intelligence Validated 100 EEGs (multicenter, 11 experts) 10000 (single center, 14 experts) 60 EEGs (external reference) Tveit et al, JAMA Neurology, 2023 30.000 routine EEGs SCORE-AI Normal vs abnormal Abnormal: focal IEDs, generalised IEDs, nonepileptiform focal & non-epileptiform diffuse Automated Interpretation of Clinical Electroencephalograms Using Artificial Intelligence Validated 100 EEGs (multicenter, 11 experts) 10000 (single center, 14 experts) 60 EEGs (external reference) Algorithm Sensitivity (%) Specificity (%) SCORE-AI 87 90 Encevis 97 17 Persyst 100 3 SpikeNet 67 63 3 montages Efficient use of clinical EEG data for deep learning in epilepsy Da Silva Lourenço et al, Clin Neurophys 2021 3 montages Temporal shifting Efficient use of clinical EEG data for deep learning in epilepsy Da Silva Lourenço et al, Clin Neurophys 2021 2,200 25,000 IEDS 3 montages Temporal shifting Efficient use of clinical EEG data for deep learning in epilepsy Da Silva Lourenço et al, Clin Neurophys 2021 Explainability Da Silva Lourenço et al., Clinical Neurophysiology, 2021 Occlusion p=0.78p=0.79p=0.45 Input Sample Explainability Da Silva Lourenço et al., Clinical Neurophysiology, 2021 Da Silva Lourenço et al., Clinical Neurophysiology, 2021 Lourenço et al, Clin Neurophys 2021 Sensitivity increased from 63% to 96% at 99% specificity Efficient use of clinical EEG data for deep learning in epilepsy Expert level of detection of interictal discharges with a deep neural network Tjepkema-Cloostermans et al, Epilepsia, 2025 DeepCRI assists in reliable outcome prediction after cardiac arrest Deep Learning for IED detection is on par with human experts Review times can become 10-50 times faster It will have major impact on our clinical work Clinical Neurophysiology