Clinical Neurophysiology最新文献

英文中文

DICOM encoding of annotation and montage data for waveform recordings

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-21 DOI: 10.1016/j.clinph.2025.04.002

J.J. Halford , B.A. Brinkmann , S. Rampp , J. Rémi , S. Poznikoff , K.B. Nilsen , J.A. Ehrenberg , S. Winkler

引用次数: 0

Systematic comparison of Commercial seizure detection Software: Update equals Upgrade?

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-21 DOI: 10.1016/j.clinph.2025.04.003

Johannes Koren , Kady Colabrese , Manfred Hartmann , Moritz Feigl , Clemens Lang , Sebastian Hafner , Nicolas Nierenberg , Tilmann Kluge , Christoph Baumgartner

Objective

To compare two updated commercially available seizure detection software packages (encevis 2.0 and Persyst 14) in a large video-EEG monitoring dataset comprising 80 patients with 6826 h of EEG and 912 seizures.

Methods

We conducted a follow up study of two seizure detection software packages with a significant update since 2021 using different sensitivity settings.

Results

Mean overall seizure count was 11.4 and mean tonic-clonic seizure rate was 0.7 per patient. Detection rates (DR) per patient were 80.7% to 89.1% for encevis 2.0 and 67.3% to 71.1% for Persyst 14. False positive rates (FPR) per day were 12 to 22 for encevis 2.0 and 2 to 4 for Persyst 14.

Conclusions

Encevis 2.0 showed a significantly higher DR than Persyst 14, whereas Persyst 14 showed a significantly lower FPR than encevis 2.0.

Significance

Updated FDA and CE certified seizure detection software showed opposite changes: encevis improved in sensitivity and deteriorated in FPR, while Persyst improved in FPR and deteriorated in sensitivity. In agreement with previous publications, automatic seizure detection software is ready for routine clinical use, but specialized personnel with sound neurophysiological knowledge and awareness of the strengths and weaknesses of the specific software package used is critical.

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引用次数: 0

Neural Correlates of taVNS: Scalp EEG and insular sEEG heartbeat evoked potentials modulation in an Epileptic patient case study

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-20 DOI: 10.1016/j.clinph.2025.04.013

Enrique Germany Morrison , Manon Dumoulin , Vincent Joris , Roberto Santalucia , Venethia Danthine , Inci Cakiroglu , Giulia Liberati , Antoine Nonclercq , Riëm El Tahry

引用次数: 0

Enhancing diagnostic sensitivity in Myasthenia Gravis: The combined role of CMAP area and amplitude decrements in repetitive nerve stimulation

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-20 DOI: 10.1016/j.clinph.2025.04.004

Ângelo Fonseca , Marco Almeida , Cristina Duque , Luís Negrão , Anabela Matos , Luciano Almendra

Objective

To evaluate the diagnostic utility of using CMAP area decrement, in addition to CMAP amplitude decrement, in RNS testing for patients with suspected MG.

Methods

This retrospective study analyzed EMG data from January 2019 to December 2023 on patients with suspected MG. CMAP area and amplitude decrements of ≥10 % were considered abnormal, and MG diagnosis was based on clinical presentation, antibody testing, or response to treatment.

Results

A total of 204 patients were included in the final analysis. MG was diagnosed in 71 patients (29.8%). The sensitivity of the amplitude decrement was 29.6%, while the sensitivity of the area decrement was 38%, with specificities of 99.2% and 96.12%, respectively. Combining both criteria yielded a sensitivity of 43.7%, representing a 14.1% improvement over amplitude decrement alone.

Conclusion

Incorporating CMAP area decrement into RNS testing significantly enhances diagnostic sensitivity for MG, particularly in ocular forms, without compromising specificity. This combined approach presents a promising improvement over existing diagnostic tools for MG, especially in cases where traditional methods have limitations. Future research is needed to validate these findings.

Significance

This study introduces a practical and easy to adopt enhancement to repetitive nerve stimulation, significantly improving diagnostic sensitivity for Myasthenia Gravis.

{"title":"Enhancing diagnostic sensitivity in Myasthenia Gravis: The combined role of CMAP area and amplitude decrements in repetitive nerve stimulation","authors":"Ângelo Fonseca , Marco Almeida , Cristina Duque , Luís Negrão , Anabela Matos , Luciano Almendra","doi":"10.1016/j.clinph.2025.04.004","DOIUrl":"10.1016/j.clinph.2025.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic utility of using CMAP area decrement, in addition to CMAP amplitude decrement, in RNS testing for patients with suspected MG.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed EMG data from January 2019 to December 2023 on patients with suspected MG. CMAP area and amplitude decrements of ≥10 % were considered abnormal, and MG diagnosis was based on clinical presentation, antibody testing, or response to treatment.</div></div><div><h3>Results</h3><div>A total of 204 patients were included in the final analysis. MG was diagnosed in 71 patients (29.8%). The sensitivity of the amplitude decrement was 29.6%, while the sensitivity of the area decrement was 38%, with specificities of 99.2% and 96.12%, respectively. Combining both criteria yielded a sensitivity of 43.7%, representing a 14.1% improvement over amplitude decrement alone.</div></div><div><h3>Conclusion</h3><div>Incorporating CMAP area decrement into RNS testing significantly enhances diagnostic sensitivity for MG, particularly in ocular forms, without compromising specificity. This combined approach presents a promising improvement over existing diagnostic tools for MG, especially in cases where traditional methods have limitations. Future research is needed to validate these findings.</div></div><div><h3>Significance</h3><div>This study introduces a practical and easy to adopt enhancement to repetitive nerve stimulation, significantly improving diagnostic sensitivity for Myasthenia Gravis.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"174 ","pages":"Pages 169-172"},"PeriodicalIF":3.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A single session of motor imagery paired with spinal stimulation improves manual dexterity and increases cortical excitability after spinal cord injury

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-20 DOI: 10.1016/j.clinph.2025.03.047

Antonio Capozio , Madison Graham , Ronaldo Ichiyama , Sarah L. Astill

Objective

Non-invasive stimulation of the spinal cord at the cervical level (TSCS) can induce neural plasticity and improve upper limb function in people living with cervical spinal cord injury (SCI) when paired with task practice. The aim of this study was to investigate the effects of a session of motor imagery (MI) paired with TSCS on manual dexterity, corticospinal and spinal excitability in people living with cervical SCI.

Methods

Eight participants (4 females, mean age 46yrs ± 17) completed three sessions of: 1) MI; 2) TSCS at C5–C6 level; 3) MI + TSCS, listening to the MI script while receiving TSCS. Manual dexterity was assessed with the Purdue Pegboard Test (PPT), corticospinal excitability was assessed with Transcranial Magnetic Stimulation (TMS) delivered at motor threshold and suprathreshold (120 % intensities, and spinal excitability delivered at motor threshold and suprathreshold (110 %, 120 %) intensities was assessed with single pulses of TSCS.

Results

Manual dexterity increased from baseline after all three conditions (p = 0.016). Corticospinal excitability increased from baseline after MI (p = 0.002] and MI + TSCS (p = 0.031], but not TSCS (p = 0.343). Spinal excitability was not affected by any of the conditions (p = 0.425).

Conclusions

These findings demonstrate that a single session of MI and TSCS, either alone or in combination, can increase manual dexterity in people living with cervical SCI. The increase in dexterity was paralleled by increases in corticospinal excitability for the MI and MI + TSCS conditions.

Significance

Our findings indicate that MI and TSCS improve manual dexterity and increase corticospinal excitability in people living with cervical SCI when employed in isolation or in combination.

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引用次数: 0

Electrodiagnostic characteristics of neuromuscular disease in paediatric intensive care

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-17 DOI: 10.1016/j.clinph.2025.04.005

Laura Nastasi , Amjad Aldrees , Daniyal Motan , Sheba Azam , Matthew Pitt , Gerald Cooray , Jacquie Deeb

Objective

Assessing peripheral electrodiagnostic (EDX) tests in paediatric intensive care.

Methods

Data from patients who had undergone EDX test/s between 2010 and 2019 at a tertiary centre were retrospectively analysed, including final neuromuscular diagnoses, EDX results and demographic information. EDX data included motor and sensory nerve conduction study, needle electromyography (EMG), repetitive nerve stimulation and stimulated single fiber EMG. Final clinical diagnosis was based on several investigations including muscle biopsy, MR imaging, gene testing, EDX-tests and clinical phenotype.

Results

351 patients were identified (56 % male, average age 42.5 months), with diagnoses categorised into the following groups: no identifiable neuromuscular disorders (45 %), neuropathy (13 %), motor neuron disease (9 %), isolated bulbar palsy (6 %), myopathy (14 %), neuromuscular junction disorders (5 %), and critical illness neuromyopathy (8 %). EDX data was stratified into 7 electrodiagnostic categories: normal, neuropathy, motor neuron disease, isolated bulbar palsy, myopathy, neuromuscular junction disorders, and critical illness neuromyopathy. With this stratification we were able to predict the final diagnosis with acceptable accuracy.

Conclusion

The prevalence of neuromuscular disease groups in paediatric ICU was defined together with their corresponding EDX characteristics.

Significance

The study confirms the utility of electrophysiology as a valuable tool for diagnosing and managing neuromuscular conditions in paediatric ICU.

方法回顾性分析 2010 年至 2019 年期间在一家三级医疗中心接受 EDX 测试的患者数据，包括最终的神经肌肉诊断、EDX 结果和人口统计学信息。EDX数据包括运动和感觉神经传导研究、针刺肌电图（EMG）、重复神经刺激和刺激性单纤维EMG。最终的临床诊断基于多项检查，包括肌肉活检、核磁共振成像、基因测试、EDX 测试和临床表型。5 个月），诊断结果分为以下几组：无法确定的神经肌肉疾病（45%）、神经病（13%）、运动神经元疾病（9%）、孤立性球麻痹（6%）、肌病（14%）、神经肌肉接头疾病（5%）和危重病神经肌病（8%）。EDX 数据被分为 7 个电诊断类别：正常、神经病、运动神经元病、孤立性球麻痹、肌病、神经肌肉接头紊乱和重症神经肌病。该研究证实，电生理学是诊断和管理儿科重症监护病房神经肌肉疾病的重要工具。

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引用次数: 0

Subclinical involvement of small hand muscles in early amyotrophic lateral sclerosis: Selective susceptibility leads to ‘split hand’ phenomenon

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-14 DOI: 10.1016/j.clinph.2025.04.007

Mamede de Carvalho , Miguel Oliveira Santos , Michael Swash

Objectives

Split-hand phenomenon is common in patients with amyotrophic lateral sclerosis (ALS), but it is unknown if first dorsal interosseous (FDI) and abductor pollicis brevis (ABP) are affected earlier than abductor digiti minimi (ADM). We aimed to address this issue.

Methods

One clinically normal hand from ALS patients was investigated, including needle EMG of the FDI, motor amplitude, distal latency, F-waves, neurophysiological index (NI) and split-hand index (SHI). Hands were categorised as G1 (normal FDI) and G2 (FDI with neurogenic changes). In patients who agreed EMG of the 3 muscles was done. A subset of G1 patients underwent a second evaluation 4–5 months later.

Results

We studied 133 patients; EMG of the 3 muscles was done in 77 patients. There was no evidence for an earlier loss of motor units in FDI/ABP. In G2 patients, CMAP amplitude and NI were significantly lower (p < 0.001), but ADM changes were minor. Reassessment of G1 patients confirmed significant SHI, and amplitude and NI decrease in all muscles, but F-waves frequency remained stable in ADM.

Conclusions

Loss of motor units in the 3 hand muscles began in parallel, but ADM spinal motoneurons showed stronger resistance to degeneration.

Significance

Dysfunction of intrinsic spinal circuits can influence split-hand phenomenon.

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引用次数: 0

Towards early diagnosis of amyotrophic lateral sclerosis using near fibre EMG

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-14 DOI: 10.1016/j.clinph.2025.04.006

Oscar Garnés-Camarena , Ignacio Mahíllo-Fernández , Pedro Martínez-Ulloa , Ross Mandeville , Oscar Lorenzo , Daniel W. Stashuk

Objective

Amyotrophic lateral sclerosis (ALS) is characterized by progressive loss of motor neurons and diagnosis is usually delayed several months. The continuous denervation and reinnervation associated with ALS are manifest in EMG signals as changes in motor unit potential (MUP) size, temporal dispersion and instability. Near Fibre EMG is a novel method to assess early changes in MUP temporal dispersion and instability using routinely recorded EMG signals in a semi-automated manner.

Methods

Near Fibre EMG values from 2318 MUs, retrospectively sampled at the time of ALS diagnosis, from 96 muscles of 15 patients were compared with values from 3954 MUs sampled from 109 muscles of 84 reference subjects.

Results

30.1% and 46.1% of ALS MUs had MUPs with increased complexity or instability, respectively, and 17.4% had both. The potential importance and heightened sensitivity of NFEMG was highlighted when analyzing normal-sized motor units; as many as 24% of the normal-sized MUPs actually had significant instability, while 14% had increased complexity, and 7.4% had both.

Conclusions

Near Fibre EMG can characterize motor unit electrophysiological status and hence help quantify the degree, and course of denervation and reinnervation.

Significance

Near-Fiber EMG offers the potential to facilitate earlier ALS diagnosis, which, as promising therapies become available, can be consequential.

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引用次数: 0

Diagnostic utility of threshold tracking TMS paradigms in early amyotrophic lateral sclerosis

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-12 DOI: 10.1016/j.clinph.2025.03.044

Aicee Dawn Calma , Nathan Pavey , Cláudia Santos Silva , Mehdi A.J. van den Bos , Con Yiannikas , Michelle A. Farrar , Matthew C Kiernan , Parvathi Menon , Steve Vucic

Objective

Threshold tracking transcranial magnetic stimulation (TMS) has exhibited utility as a diagnostic technique in Amyotrophic Lateral Sclerosis (ALS). Different threshold tracking paradigms have recently been proposed. The present study assessed the diagnostic utility of serial ascending and parallel threshold tracking TMS in ALS.

Methods

Threshold tracking TMS was undertaken on 90 prospectively recruited participants suspected of ALS. Short interval intracortical inhibition (SICI) was recorded with serial ascending and parallel threshold tracking paradigms between Interstimulus Interval (ISI) 1-to-7 ms. The primary outcome measure was differences in diagnostic utility of the paradigms in differentiating ALS from ALS mimicking disorders using receiver operating characteristic (ROC) analysis (DeLong statistical method).

Results

Reduction in SICI reliably differentiated ALS from mimic disorders, irrespective of the threshold tracking paradigm. Comparison of area under the curve (AUC) established a significantly higher value for mean SICI (1–7 ms) with the serial ascending SICI paradigm (0.81, 95 % confidence interval 0.72–0.91) compared to the parallel paradigm (SICI 0.72, 95 % confidence interval 0.61–0.83, p = 0.0065). The better diagnostic utility of serial ascending paradigm was evident for SICI recorded between 1-to-5 ms, and was maintained irrespective of disease onset site, degree of functional impairment, and the degree of lower motor neuron dysfunction. A comparable diagnostic utility across threshold tracking paradigms was evident in ALS participants who presented with a relative paucity of upper motor neuron signs.

Conclusion

While threshold tracking TMS reliably differentiated ALS from mimic disorders, the present study established better diagnostic utility with the serial ascending threshold tracking TMS paradigm.

Significance

The serial ascending threshold tracking TMS should be used in a clinical setting as a diagnostic tool for ALS.

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引用次数: 0

Electrophysiological hemispheric asymmetries induced by parietal stimulation eliciting visual percepts

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-04-11 DOI: 10.1016/j.clinph.2025.03.041

D. Bonfanti , E. Bertacco , L.C. Parra , C. Mazzi , S. Savazzi

Objective

We aimed to establish if the electrophysiological activity resulting from the direct stimulation of the intraparietal sulcus and eliciting visual percepts is hemispheric-specific.

Methods

We tested nineteen participants. Each received 360 TMS pulses at phosphene threshold intensity over right and left IPS while recording EEG. After each pulse, participants had to report if they had seen a phosphene.

Results

Parietal phosphene perception is associated with hemispheric-specific activations: phosphenes elicited by left TMS involve central and frontal electrodes at about 30 ms, and frontal, central and parieto-occipital electrodes from 120 to 250 ms; phosphenes elicited by right parietal TMS involve parietal and centro-parietal electrodes at about 60 ms, and frontal, central and parietal electrodes from 150 to 250 ms. Correlated Component Analysis shows that primary visual areas are not activated when phosphenes are produced by TMS over IPS.

Conclusions

Our results show that direct stimulation of IPS gives rise to sustained patterns of activity specific to the stimulated hemisphere. Moreover, elicited parietal phosphenes are associated with evoked activity specific to the stimulated hemisphere and located outside early visual processing areas.

Significance

This study highlights hemispheric differences in the electrophysiological dynamics related to parietal phosphenes, and shows that the dorsal pathway can give rise to visual conscious percepts.

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