Distributed brain co-processor for tracking electrophysiology and behavior during electrical brain stimulation

Early implantable epilepsy therapy devices provided open-loop electrical stimulation without brain sensing, computing, or an interface for synchronized behavioral inputs from patients. Recent epilepsy stimulation devices provide brain sensing but have not yet developed analytics for accurately tracking and quantifying behavior and seizures. Here we describe a distributed brain co-processor providing an intuitive bi-directional interface between patient, implanted neural stimulation and sensing device, and local and distributed computing resources. Automated analysis of continuous streaming electrophysiology is synchronized with patient reports using a hand-held device and integrated with distributed cloud computing resources for quantifying seizures, interictal epileptiform spikes, and patient symptoms during therapeutic electrical brain stimulation. The classification algorithms for interictal epileptiform spikes and seizures were developed and parameterized using long-term ambulatory data from 9 humans and 8 canines with epilepsy, and then implemented prospectively in out-of-sample testing in 2 pet canines and 4 humans with drug resistant epilepsy living in their natural environments. ### Competing Interest Statement GW, VK and BB declare intellectual property related to behavioral state classification analytics. GW, BB, and BNL declare intellectual property licensed to Cadence Neuroscience Inc. GW has licensed intellectual property to NeuroOne, Inc. GW and BNL are investigators for the Medtronic Deep Brain Stimulation Therapy for Epilepsy Post-Approval Study (EPAS). VM is a paid summer intern at Med-tronic. GW previously assisted in a Mayo Clinic Medtronic sponsored FDA-IDE for the investiga-tional Medtronic Activa PC+S device. The remaining authors declare that they have no competing interests. The investigational Medtronic Summit RC+STM devices used in this research were provided free of charge as part of NIH Brain Initiative UH2/UH3-NS95495. * ANT : Anterior Nucleus Thalamus AUPRC : Area Under Precision Recall Curve AUROC : Area Under Receiver Operator Curve CNN : Convolutional Neural Network EBS : Electrical Brain Stimulation ECoG : Electrocorticography FFT : Fast Fourier Transform iEEG : intracranial Electroencephalography IES : Interictal Epileptiform Spikes LSTM : Long-Short-Term-Memory NV : NeuroVista PRC : Precision Recall Curve RC+S™ : investigational Medtronic Summit RC+S™ ROC : Receiver Operator Curve STFT : Short Time Fourier Transform TLE : Temporal Lobe Epilepsy