RADAR-CNS

Scientists from IMI’s RADAR-CNS project have been awarded the Harald Frey prize for their work on the use of wearables to gauge the likelihood of sudden unexpected death in epilepsy (SUDEP).### The prize recognises the best scientific research on causes of SUDEP, as well as prevention methods and coping strategies.

Wearable sensors can be used to detect seizures in people with epilepsy. The RADAR-CNS team suspected that they could also be used to detect not only the seizure itself, but also to measure post-ictal immobility, or the absence of motion following a seizure, a warning sign that the person is at increased risk of a complication that can cause SUDEP.

The researchers fitted accelerometers, which measure sudden motion, on people presenting with convulsive seizures at a hospital epilepsy monitoring unit. Of 22 seizures, 20 were followed by post-ictal immobility while two were followed by agitation. The results from the wearable’s algorithm matched that of experts who watched video recordings of the patients. The study, published in Epilepsia, showed that wearables could offer hope as a continuous, non-invasive, long-term way to identify risk factors associated with seizures, with potentially great clinical importance.

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RADAR-CNS is investigating how wearable technologies and mobile phones can track and help prevent depression, epilepsy and multiple sclerosis. Now, the project has teamed up with dancers, musicians and technology experts to portray in dance symptoms which may be hard to express in words. The result is Feedback Loops, which was performed at Science in the City, Malta’s national science and arts festival.###

The performance responds to a quote from a member of the RADAR-CNS Patient Advisory Board: ‘A lot of my symptoms are invisible and people find it hard to understand what I’m going through.’

‘With slow, forceful heaviness as an overriding movement quality throughout the piece, I have depicted some of the visible and invisible symptoms of depression,’ says dancer Anna Spink. ‘I have included changes of focus, lower planes of motion and specific gestures to abstractly demonstrate guilt, difficulty making decisions and feeling “itchy” or uncomfortable in one’s own skin.’

Dan Wimperis explains the music: ‘Throughout the performance the dancer’s movements controls which notes are being played, the blood volume pulse (the graph on a heart rate monitor) is controlling the probability of notes being played and the volume of the notes (how hard a pianos key is pressed) and the electrodermal activity (the amount of sweat on their skin) is controlling how the notes sound, either bright or dark, far away or close etc.’

‘It’s been such an exciting project to work on with collaborators based in London, Bristol and Milan,’ says producer Alina Ivan of the RADAR-CNS project, who is based at King’s College London. ‘It has been very satisfying to have this shared intellectual space where we could share ideas (especially throughout the lockdown!) and work towards a shared goal!’

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• Read the RADAR-CNS news item
• Watch a recording of the performance (starts at 10m30s)

When Slovenian artist Sanela Jahić was working on a thought-provoking installation about how art and creativity can be turned into dispassionate data points, she came across a scientific paper by RADAR-CNS scientist Dr Nick Cummins.### The paper suggests that depression can affect the way people speak – the voices of those affected sound breathy, tense or tight. Dr Cummins and fellow researcher Judith Dineley from the University of Augsburg provided Jahić with their insights into how depression affects speech and how machine learning can be used to analyse this.

The result is PATAKA, a visual and auditory journey named after a vocal exercise used by speech pathologists – how someone says ‘PATAKA’ can offer clues as to their mental state. As part of the exhibition, parrots were trained to repeat the PATAKA sequence, and the cacophony was combined with data visualisations to make a point about what our own voices can tell machines about us.

Although doctors can use speech in a subjective way to aid diagnosis, the researchers hope that applying artificial intelligence to the field will contribute to making diagnoses more objective. RADAR-CNS is using wearable tech and smartphones to detect and validate biosignatures not only for depression but also epilepsy and multiple sclerosis. The research covers other biosignatures, including heart rate, physical and social activity, facial muscle movements and EEG signals. Dr Cummins and Dr Dineley extract the meaningful information from these raw signals recorded during clinical trials before aggregating them for further analysis.

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The generic architecture of the RADAR-CNS project’s RADAR-base forms a reusable, flexible IT platform that allows for the remote monitoring of different diseases and conditions using a large variety of technologies. ###The project is testing how practical and useful smartphones and wearables can be to continuously monitor the symptoms of people with major depression, epilepsy or multiple sclerosis. While the team singled out these conditions to test the value of this kind of remote assessment, ultimately, they want to leave behind a data collection platform that is flexible enough that it can be used for other kinds of diseases, conditions and scenarios. New wearables for physiological monitoring are appearing on the market all the time, so the intention is to create a platform architecture that is generic and flexible enough to incorporate any new technology.

'The idea was to build a piece of software that would enable data collection remotely from a variety of sources: sensors, questionnaires and digital tests, from people going about their day-to-day lives,' explains Amos Folarin from King’s College London.

The project is working on extending RADAR-base's functionality to incorporate new means of passive and active remote measurement while supporting a growing open-source community of code contributors and new studies adopting RADAR-Base. They’re also collecting information from patients, clinicians and regulators about barriers to its adoption in both research and clinical domains. The data generated by the RADAR-base platform adhere to principles of clearly documented and structured data. These therefore enable projects using RADAR-base to comply with the FAIR (‘findable, accessible, interoperable, reusable’) principles.

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• Read the full news article
• Visit the RADAR-CNS website
• Visit the RADAR-base platform

A new RADAR-CNS study reveals some of the factors that could influence the use of mobile technologies and wearable devices to track patients’ condition over time. The results of the study, published in the journal JMIR mHealth and uHealth will contribute to the outputs of the project. ###RADAR-CNS is working to develop new ways of monitoring major depressive disorder, epilepsy, and multiple sclerosis using wearable devices and smartphone technology. The hope is that these technologies would make it possible to detect changes in behaviour, sleep, or mood before the individual themselves is aware of it. This could help them to predict – or even avoid – a relapse. The project is working with patients to discuss their attitude towards the use of these technologies to monitor their condition. In this latest study, the project discussed the technologies with adults with experience of depression from Spain, Italy and the UK. In all three countries, the patients raised issues regarding their motivation levels, the potential impact of the technologies on mood and anxiety, aspects of inconvenience, and ease of use.

‘Since the very beginning of RADAR-CNS, we have been committed to integrating the views and perspectives of people living with multiple sclerosis, epilepsy and depression into the design of the mobile technology,’ said first author Sara Simblett of King’s College London. ‘Each health condition is likely to present different challenges and barriers, and depression presents its own particular factors affecting motivation and engagement. This study has provided us with valuable information that will help us to produce something that really works for people in their everyday lives.’

Under conventional medical practice, monitoring long-term patients is done in the clinic or hospital, assessing such things as treatment effects, adverse events and disease course. In some cases, visits may not be frequent enough to identify individuals at risk of significant changes in disease state, including relapse. On the other hand, having to repeat monitoring procedures too often can be burdensome to both patients and healthcare providers.###

The goal of IMI’s RADAR-CNS project is to improve the patient-monitoring process through remote assessment. Project team members are creating a process for developing, testing and implementing wearable technologies for the remote measurement of depression, multiple sclerosis and epilepsy. Although remote monitoring is still in its infancy, interest is growing in the application of such technologies in healthcare. For example, smartphone and wearable sensor technologies have already enabled a significant increase in the volume of patient information that can be collected unobtrusively and at low cost. The RADAR-CNS team believe such technologies can be used to monitor long-term outcomes of patients, at scale, and provide detailed information on outcomes. The resulting data can be made available for review in real time by patients, clinicians and researchers and at low cost, enabling medical services to offer more responsive and efficient care.

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• Visit the RADAR-CNS website and factsheet

The RADAR-CNS project has recruited the first participants to the multiple sclerosis (MS) component of the project. The participants will wear a Fitbit device for up to 24 hours a day. This will capture information about mobility, heart rate and sleep quality.### In the following weeks, the participants will also receive a chest-worn device, the eFaros, which will be used for a week every three months to better characterise balance, gait variability, falls and heart rate variability. Professor Giancarlo Comi of the Vita-Salute San Raffaele University, Milan, Italy said: ‘We are very pleased to have recruited our first participant in Milan. It’s an exciting time for us as we enrol and recruit more people to our MS studies.’ In total, RADAR-CNS hopes to recruit 400 participants with MS to assess changes in disability and fatigue over time. In addition, the project will recruit 240 people with MS for a study on mood changes (in particular on depressive feelings) in people with a recent diagnosis of MS. Studies of patients with major depressive disorder and epilepsy got underway in 2017.

Professor Matthew Hotopf, co-lead of IMI’s RADAR-CNS project, has been awarded a CBE (Commander of the Order of the British Empire) for services to psychiatric research in the Queen’s birthday honours list. ###The Queen’s honours recognise the achievements and service of a wide range of people. ‘I am deeply honoured to receive this award,’ said Professor Hotopf, who is Vice Dean of Research at Institute of Psychiatry, Psychology & Neuroscience at King’s College London and Director of the NIHR Maudsley Biomedical Research Centre. ‘It represents the contributions of a huge number of people in my research team working to improve the profile of mental health research and ultimately to benefit people with mental health problems.’ Professor Hotopf's research explores the interaction between mental and physical health. He has worked extensively in areas where mental health relates to other walks of life – including military health, mental health law, and epidemiological studies on the impact of mental disorders. The RADAR-CNS project aims to develop new ways of monitoring major depressive disorder, epilepsy, and multiple sclerosis using wearable devices and smartphone technology.

• Watch the new RADAR-CNS video

A research platform developed by IMI’s RADAR-CNS project has won a ‘Best of Show’ award in the data integration and management category at the Bio-IT World Conference & Expo in Boston, US in May. RADAR-CNS is working to develop new ways of measuring major depressive disorder, epilepsy and multiple sclerosis (MS) using wearable devices and smartphone technology. ###The project’s open source RADAR-base platform allows RADAR-CNS study participants to share their health data (e.g. from sensors and questionnaires) with clinicians and researchers in a secure way, keeping identifiable data local while linking to other non-identifiable data centrally. ‘RADAR-base provides an exciting, unique opportunity to empower research with data from both medical-grade and consumer-grade devices,’ said RADAR-base project lead Amos Folarin of King’s College London. ‘RADAR-base gives researchers and device manufacturers a place to build open systems to share, manage, host, and actually use these data to support the next generation of healthcare.’

• Read the BIO-IT World news story

IMI’s RADAR-CNS project has recruited the first participants in the depression component of its study. The aim of RADAR-CNS is to develop new ways of measuring major depressive disorder, epilepsy and multiple sclerosis (MS) using wearable devices and smartphone technology. ###The first depression study participants have now received FitBit Charge 2 devices as well as smartphone apps. The participants will wear the FitBit for up to 24 hours a day, allowing it to capture information on their heart rate, sleep quality, and physical activity levels. Every few weeks, they will answer a short series of questions via the RADAR-CNS apps. Faith Matcham, post-doctoral research associate at RADAR-CNS, hopes to recruit around fifty more people over the coming months. ‘We’re so excited to be starting recruitment – this study will provide important information about how useable the RADAR-CNS platform is, as well as providing us with data which might be invaluable for improving our understanding of the course of major depression,’ she said. The epilepsy component of the study got underway in June last year, and the project team hopes to start recruitment for the multiple sclerosis study soon.