An AI smartwatch that detects seizures Rosalind Picard
This is Henry,
a cute boy,
and when Henry was three,
his mom found him having
some febrile seizures.
Febrile seizures are seizures that occur
when you also have a fever,
and the doctor said,
“Don’t worry too much.
Kids usually outgrow these.”
When he was four,
he had a convulsive seizure,
the kind that you lose
consciousness and shake –
a generalized tonic-clonic seizure –
and while the diagnosis of epilepsy
was in the mail,
Henry’s mom went to get him
out of bed one morning,
and as she went in his room,
she found his cold, lifeless body.
Henry died of SUDEP,
sudden unexpected death in epilepsy.
I’m curious how many of you
have heard of SUDEP.
This is a very well-educated audience,
and I see only a few hands.
SUDEP is when an otherwise
healthy person with epilepsy
dies and they can’t attribute it
to anything they can find in an autopsy.
There is a SUDEP
every seven to nine minutes.
That’s on average two per TED Talk.
Now, a normal brain
has electrical activity.
You can see some of the electrical waves
coming out of this picture
of a brain here.
And these should look
like typical electrical activity
that an EEG could read on the surface.
When you have a seizure,
it’s a bit of unusual electrical activity,
and it can be focal.
It can take place
in just a small part of your brain.
When that happens,
you might have a strange sensation.
Several could be happening
here in the audience right now,
and the person next to you
might not even know.
However, if you have a seizure
where that little brush fire spreads
like a forest fire over the brain,
then it generalizes,
and that generalized seizure
takes your consciousness away
and causes you to convulse.
There are more SUDEPs
in the United States every year
than sudden infant death syndrome.
Now, how many of you have heard
of sudden infant death syndrome?
Right? Pretty much every hand goes up.
So what’s going on here?
Why is this so much more common
and yet people haven’t heard of it?
And what can you do to prevent it?
Well, there are two things,
scientifically shown,
that prevent or reduce the risk of SUDEP.
The first is: “Follow
your doctor’s instructions,
take your medications.”
Two-thirds of people who have epilepsy
get it under control
with their medications.
The second thing that reduces
the risk of SUDEP is companionship.
It’s having somebody there
at the time that you have a seizure.
Now, SUDEP, even though
most of you have never heard of it,
is actually the number two cause
of years of potential life lost
of all neurological disorders.
The vertical axis is the number of deaths
times the remaining life span,
so higher is much worse impact.
SUDEP, however, unlike these others,
is something that people right here
could do something to push that down.
Now, what is Roz Picard, an AI researcher,
doing here telling you about SUDEP, right?
I’m not a neurologist.
When I was working at the Media Lab
on measurement of emotion,
trying to make our machines
more intelligent about our emotions,
we started doing a lot of work
measuring stress.
We built lots of sensors
that measured it
in lots of different ways.
But one of them in particular
grew out of some of this very old work
with measuring sweaty palms
with an electrical signal.
This is a signal of skin conductance
that’s known to go up
when you get nervous,
but it turns out it also goes up with
a lot of other interesting conditions.
But measuring it with wires on your hand
is really inconvenient.
So we invented a bunch of other ways
of doing this at the MIT Media Lab.
And with these wearables,
we started to collect the first-ever
clinical quality data 24-7.
Here’s a picture of what that looked like
the first time an MIT student collected
skin conductance on the wrist 24-7.
Let’s zoom in a little bit here.
What you see is 24 hours
from left to right,
and here is two days of data.
And first, what surprised us
was sleep was the biggest
peak of the day.
Now, that sounds broken, right?
You’re calm when you’re asleep,
so what’s going on here?
Well, it turns out
that our physiology during sleep
is very different
than our physiology during wake,
and while there’s still a bit of a mystery
why these peaks are usually
the biggest of the day during sleep,
we now believe they’re related
to memory consolidation
and memory formation during sleep.
We also saw things
that were exactly what we expected.
When an MIT student
is working hard in the lab
or on homeworks,
there is not only emotional stress,
but there’s cognitive load,
and it turns out that cognitive load,
cognitive effort, mental engagement,
excitement about learning something –
those things also make the signal go up.
Unfortunately, to the embarrassment
of we MIT professors,
(Laughter)
the low point every day
is classroom activity.
Now, I am just showing you
one person’s data here,
but this, unfortunately,
is true in general.
This sweatband has inside it
a homebuilt skin-conductance sensor,
and one day, one of our undergrads
knocked on my door
right at the end of the December semester,
and he said, “Professor Picard,
can I please borrow
one of your wristband sensors?
My little brother has autism,
he can’t talk,
and I want to see
what’s stressing him out.”
And I said, “Sure, in fact,
don’t just take one, take two,”
because they broke easily back then.
So he took them home,
he put them on his little brother.
Now, I was back in MIT,
looking at the data on my laptop,
and the first day, I thought,
“Hmm, that’s odd,
he put them on both wrists
instead of waiting for one to break.
OK, fine, don’t follow my instructions.”
I’m glad he didn’t.
Second day – chill.
Looked like classroom activity.
(Laughter)
A few more days ahead.
The next day, one wrist signal was flat
and the other had
the biggest peak I’ve ever seen,
and I thought, “What’s going on?
We’ve stressed people out at MIT
every way imaginable.
I’ve never seen a peak this big.”
And it was only on one side.
How can you be stressed on one side
of your body and not the other?
So I thought one or both sensors
must be broken.
Now, I’m an electroengineer by training,
so I started a whole bunch of stuff
to try to debug this,
and long story short,
I could not reproduce this.
So I resorted to old-fashioned debugging.
I called the student at home on vacation.
“Hi, how’s your little brother?
How’s your Christmas?
Hey, do you have any idea
what happened to him?”
And I gave this particular date and time,
and the data.
And he said, “I don’t know,
I’ll check the diary.”
Diary? An MIT student keeps a diary?
So I waited and he came back.
He had the exact date and time,
and he says, “That was right before
he had a grand mal seizure.”
Now, at the time, I didn’t know
anything about epilepsy,
and did a bunch of research,
realized that another student’s dad
is chief of neurosurgery
at Children’s Hospital Boston,
screwed up my courage
and called Dr. Joe Madsen.
“Hi, Dr. Madsen,
my name’s Rosalind Picard.
Is it possible somebody could have
a huge sympathetic
nervous system surge” –
that’s what drives the skin conductance –
“20 minutes before a seizure?”
And he says, “Probably not.”
He says, “It’s interesting.
We’ve had people whose hair
stands on end on one arm
20 minutes before a seizure.”
And I’m like, “On one arm?”
I didn’t want to tell him that, initially,
because I thought this was too ridiculous.
He explained how this could
happen in the brain,
and he got interested.
I showed him the data.
We made a whole bunch more devices,
got them safety certified.
90 families were being
enrolled in a study,
all with children who were going
to be monitored 24-7
with gold-standard EEG on their scalp
for reading the brain activity,
video to watch the behavior,
electrocardiogram – ECG –
and now EDA, electrodermal activity,
to see if there was
something in this periphery
that we could easily pick up,
related to a seizure.
We found, in 100 percent
of the first batch of grand mal seizures,
this whopper of responses
in the skin conductance.
The blue in the middle, the boy’s sleep,
is usually the biggest peak of the day.
These three seizures you see here
are popping out of the forest
like redwood trees.
Furthermore, when you couple
the skin conductance at the top
with the movement from the wrist
and you get lots of data
and train machine learning and AI on it,
you can build an automated AI
that detects these patterns
much better than just
a shake detector can do.
So we realized that we needed
to get this out,
and with the PhD work of Ming-Zher Poh
and later great improvements by Empatica,
this has made progress and the seizure
detection is much more accurate.
But we also learned some other things
about SUDEP during this.
One thing we learned is that SUDEP,
while it’s rare after
a generalized tonic-clonic seizure,
that’s when it’s most likely
to happen – after that type.
And when it happens,
it doesn’t happen during the seizure,
and it doesn’t usually happen
immediately afterwards,
but immediately afterwards,
when the person just seems
very still and quiet,
they may go into another phase,
where the breathing stops,
and then after the breathing stops,
later the heart stops.
So there’s some time
to get somebody there.
We also learned that there is a region
deep in the brain called the amygdala,
which we had been studying
in our emotion research a lot.
We have two amygdalas,
and if you stimulate the right one,
you get a big right
skin conductance response.
Now, you have to sign up right now
for a craniotomy to get this done,
not exactly something
we’re going to volunteer to do,
but it causes a big right skin
conductance response.
Stimulate the left one, big left
skin conductance response on the palm.
And furthermore, when somebody
stimulates your amygdala
while you’re sitting there
and you might just be working,
you don’t show any signs of distress,
but you stop breathing,
and you don’t start again
until somebody stimulates you.
“Hey, Roz, are you there?”
And you open your mouth to talk.
As you take that breath to speak,
you start breathing again.
So we had started with work on stress,
which had enabled us
to build lots of sensors
that were gathering
high quality enough data
that we could leave the lab
and start to get this in the wild;
accidentally found a whopper
of a response with the seizure,
neurological activation that can cause
a much bigger response
than traditional stressors;
lots of partnership with hospitals
and an epilepsy monitoring unit,
especially Children’s Hospital Boston
and the Brigham;
and machine learning and AI on top of this
to take and collect lots more data
in service of trying
to understand these events
and if we could prevent SUDEP.
This is now commercialized by Empatica,
a start-up that I had
the privilege to cofound,
and the team there has done an amazing job
improving the technology
to make a very beautiful sensor
that not only tells time and does steps
and sleep and all that good stuff,
but this is running real-time
AI and machine learning
to detect generalized
tonic-clonic seizures
and send an alert for help
if I were to have a seizure
and lose consciousness.
This just got FDA-approved
as the first smartwatch
to get approved in neurology.
(Applause)
Now, the next slide is what made
my skin conductance go up.
One morning, I’m checking my email
and I see a story from a mom
who said she was in the shower,
and her phone was
on the counter by the shower,
and it said her daughter
might need her help.
So she interrupts her shower and goes
running to her daughter’s bedroom,
and she finds her daughter
facedown in bed, blue and not breathing.
She flips her over – human stimulation –
and her daughter takes a breath,
and another breath,
and her daughter turns pink and is fine.
I think I turned white reading this email.
My first response is,
“Oh no, it’s not perfect.
The Bluetooth could break,
the battery could die.
All these things could go wrong.
Don’t rely on this.”
And she said, “It’s OK.
I know no technology is perfect.
None of us can always
be there all the time.
But this, this device plus AI
enabled me to get there in time
to save my daughter’s life.”
Now, I’ve been mentioning children,
but SUDEP peaks, actually,
among people in their 20s, 30s and 40s,
and the next line I’m going to put up
is probably going to make
some people uncomfortable,
but it’s less uncomfortable
than we’ll all be
if this list is extended
to somebody you know.
Could this happen to somebody you know?
And the reason I bring up
this uncomfortable question
is because one in 26 of you
will have epilepsy at some point,
and from what I’ve been learning,
people with epilepsy often don’t tell
their friends and their neighbors
that they have it.
So if you’re willing to let them
use an AI or whatever
to summon you in a moment
of possible need,
if you would let them know that,
you could make a difference in their life.
Why do all this hard work to build AIs?
A couple of reasons here:
one is Natasha, the girl who lived,
and her family wanted me
to tell you her name.
Another is her family
and the wonderful people out there
who want to be there to support people
who have conditions
that they’ve felt uncomfortable
in the past mentioning to others.
And the other reason is all of you,
because we have the opportunity
to shape the future of AI.
We can actually change it,
because we are the ones building it.
So let’s build AI
that makes everybody’s lives better.
Thank you.
(Applause)