Clinical Neurophysiology最新文献

英文中文

Infant sleep spindle measures from EEG improve prediction of cerebral palsy 通过脑电图测量婴儿睡眠纺锤体可提高对脑瘫的预测能力

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-09-05 DOI: 10.1016/j.clinph.2024.08.017

Objective

Early identification of infants at risk of cerebral palsy (CP) enables interventions to optimize outcomes. Central sleep spindles reflect thalamocortical sensorimotor circuit function. We hypothesized that abnormal infant central spindle activity would predict later contralateral CP.

Methods

We trained and validated an automated detector to measure spindle rate, duration, and percentage from central electroencephalogram (EEG) channels in high-risk infants (n = 35) and age-matched controls (n = 42). Neonatal magnetic resonance imaging (MRI) findings, infant motor exam, and CP outcomes were obtained from chart review. Using univariable and multivariable logistic regression models, we examined whether spindle activity, MRI abnormalities, and/or motor exam predicted future contralateral CP.

Results

The detector had excellent performance (F1 = 0.50). Spindle rate (p = 0.005, p = 0.0004), duration (p < 0.001, p < 0.001), and percentage (p < 0.001, p < 0.001) were decreased in hemispheres corresponding to future CP compared to those without. In this cohort, PLIC abnormality (p = 0.004) and any MRI abnormality (p = 0.004) also predicted subsequent CP. After controlling for MRI findings, spindle features remained significant predictors and improved model fit (p < 0.001, all tests). Using both spindle duration and MRI findings had highest accuracy to classify hemispheres corresponding to future CP (F1 = 0.98, AUC 0.999).

Conclusion

Decreased central spindle activity improves the prediction of future CP in high-risk infants beyond early MRI or clinical exam alone.

Significance

Decreased central spindle activity provides an early biomarker for CP.

目的及早识别有脑瘫（CP）风险的婴儿，以便采取干预措施，优化治疗效果。中枢睡眠纺锤体反映丘脑皮层感觉运动回路的功能。我们假设，婴儿中枢纺锤体活动异常可预测日后的对侧脑瘫。方法我们训练并验证了一种自动探测器，该探测器可测量高危婴儿（35 人）和年龄匹配对照组（42 人）中枢脑电图（EEG）通道的纺锤体速率、持续时间和百分比。新生儿磁共振成像（MRI）结果、婴儿运动检查和CP结果均来自病历审查。通过单变量和多变量逻辑回归模型，我们研究了纺锤体活动、MRI 异常和/或运动检查是否可预测未来对侧的 CP。与无 CP 的半球相比，有 CP 的半球的纺锤率（p = 0.005，p = 0.0004）、持续时间（p < 0.001，p < 0.001）和百分比（p < 0.001，p < 0.001）均有所下降。在该队列中，PLIC 异常（p = 0.004）和任何 MRI 异常（p = 0.004）也可预测未来的 CP。在控制磁共振成像结果后，纺锤体特征仍是重要的预测因素，并提高了模型的拟合度（p < 0.001，所有测试）。同时使用纺锤体持续时间和核磁共振成像结果对与未来 CP 相对应的半球进行分类的准确性最高（F1 = 0.98，AUC 0.999）。

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引用次数: 0

Insights into EEG dynamics and network changes preceding dream enactment behaviors in REM sleep behavior disorder 洞察快速眼动睡眠行为障碍患者做梦前的脑电图动态和网络变化

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-09-02 DOI: 10.1016/j.clinph.2024.08.020

引用次数: 0

The effect of common parameters of bipolar stimulation on brain evoked potentials 双极刺激的常见参数对大脑诱发电位的影响

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-31 DOI: 10.1016/j.clinph.2024.08.019

Objective

To identify optimal bipolar stimulation parameters for robust generation of brain evoked potentials (BEPs), namely the interelectrode distance (IED) and the intensity of stimulation (IS), in cortical and axonal stimulation.

Methods

In 15 patients who underwent awake surgery for brain tumor removal, BEPs were elicited at different values of IED and IS, respectively: 5 mm-5 mA, 5 mm-10 mA, and 10 mm-10 mA. The number of BEPs elicited by stimulation, as well as the delays and amplitudes of the N1 waves were compared between the different groups of stimulation parameters and according to the stimulated brain structure (cortical vs. axonal).

Results

The amplitudes of N1 increased with the intensity of bipolar stimulation, either in cortical or axonal stimulation, while N1 peak delays were not affected by the stimulation parameters. Furthermore, axonal stimulation produced more N1s than cortical stimulation, with lower latencies.

Conclusions

Understanding the relationship between stimulation parameters and BEP is of utmost importance to determine whether the generated N1 waves accurately reflect the underlying structural anatomy. Other factors, such as stimulation frequency or pulse width and shape, may also play a role and warrant further investigation.

Significance

This study represents the first step in describing the influence of common bipolar stimulation parameters on robustness of BEPs by examining the impact of IED and IS on the N1 wave.

目的确定在皮层和轴突刺激中产生脑诱发电位（BEPs）的最佳双极刺激参数，即电极间距（IED）和刺激强度（IS）。方法在 15 名接受脑肿瘤切除清醒手术的患者中，分别以不同的 IED 和 IS 值诱发 BEPs：5 mm-5 mA、5 mm-10 mA 和 10 mm-10 mA。结果无论是皮层刺激还是轴突刺激，N1 波的振幅都随着双极刺激强度的增加而增加，而 N1 波峰值延迟不受刺激参数的影响。结论了解刺激参数与 BEP 之间的关系对于确定所产生的 N1 波是否准确反映了潜在的结构解剖学至关重要。本研究通过考察 IED 和 IS 对 N1 波的影响，迈出了描述常见双极刺激参数对 BEP 稳健性影响的第一步。

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引用次数: 0

Advanced electrophysiological assessments of long tracts involved in intramedullary myelopathy: Report of two cases 髓内脊髓病变长束的高级电生理评估：两个病例的报告

IF 4.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-30 DOI: 10.1016/j.clinph.2024.08.013

Wen-Che Li, Yan-Siou Dong, Chuan-Hsiu Fu, Yih-Chih Jacinta Kuo, Kai-Hsiang Stanley Chen

引用次数: 0

Aberrant connectivity of the lateralized readiness system in non-syndromic congenital mirror movements

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-30 DOI: 10.1016/j.clinph.2024.08.018

Objectives

Non-syndromic CMM has a complex phenotype. Abnormal corpus callosum and corticospinal tract processes are suggested mechanisms of the mirror movements. To further explore behavioural and neural phenotype(s) the present study tests the hypothesis that the response readiness network comprising supplementary motor area (SMA) and connections with motor cortex (M1) functions abnormally in CMM.

Methods

Twelve participants with (non-syndromic) CMM and a control group (n = 28) were tested on a probabilistic Go-NoGo task while electroencephalography (EEG) was recorded to assess possible group differences in lateralized readiness of voluntary hand movements together with measures of SMA-M1 functional connectivity.

Results

The CMM group demonstrated delayed lateralized readiness and stronger functional connectivity between left-brain SMA-M1 regions. Connectivity strength was correlated with measures of behavioural performance but not with extent of mirroring.

Conclusions

Abnormalities in brain processes upstream of movement output likely reflect neurocompensation as a result of lifelong experience with mirroring in CMM.

Significance

These findings extend the known neural abnormalities in CMM to include brain networks upstream from those involved in motor output and raise the question of whether neurocompensatory plasticity might be involved.

目的非综合征CMM具有复杂的表型。异常的胼胝体和皮质脊髓束过程被认为是镜像运动的机制。为了进一步探讨行为和神经表型，本研究检验了由辅助运动区（SMA）和与运动皮层（M1）连接组成的反应准备网络在 CMM 中功能异常的假设。方法对12名患有（非综合征）CMM的参与者和对照组（n = 28）进行概率性Go-NoGo任务测试，同时记录脑电图（EEG），以评估手部自主运动的侧向准备状态可能存在的组间差异以及SMA-M1功能连接的测量结果。连接强度与行为表现的测量结果相关，但与镜像的程度无关。结论运动输出上游大脑过程的异常可能反映了CMM终生镜像经验所导致的神经补偿。

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引用次数: 0

Determining predictive value of intraoperative electroencephalography changes for delirium development after cardiovascular surgeries 确定术中脑电图变化对心血管手术后出现谵妄的预测价值

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-30 DOI: 10.1016/j.clinph.2024.08.015

引用次数: 0

Predictive modeling based on functional connectivity of interictal scalp EEG for infantile epileptic spasms syndrome 基于发作间期头皮脑电图功能连接的婴儿癫痫痉挛综合征预测模型

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-30 DOI: 10.1016/j.clinph.2024.08.016

Objective

This study aims to delineate the electrophysiological variances between patients with infantile epileptic spasms syndrome (IESS) and healthy controls and to devise a predictive model for long-term seizure outcomes.

Methods

The cohort consisted of 30 individuals in the seizure-free group, 23 in the seizure-residual group, and 20 in the control group. We conducted a comprehensive analysis of pretreatment electroencephalography, including the relative power spectrum (rPS), weighted phase-lag index (wPLI), and network metrics. Follow-up EEGs at 2 years of age were also analyzed to elucidate physiological changes among groups.

Results

Infants in the seizure-residual group exhibited increased rPS in theta and alpha bands at IESS onset compared to the other groups (all p < 0.0001). The control group showed higher rPS in fast frequency bands, indicating potentially enhanced cognitive function. The seizure-free group presented increased wPLI across all frequency bands (all p < 0.0001). Our predictive model utilizing wPLI anticipated long-term outcomes at IESS onset (area under the curve 0.75).

Conclusion

Our findings demonstrated an initial “hypersynchronous state” in the seizure-free group, which was ameliorated following successful treatment.

Significance

This study provides a predictive model utilizing functional connectivity and insights into the diverse electrophysiology observed among outcome groups of IESS.

目的本研究旨在阐明婴儿癫痫性痉挛综合征（IESS）患者与健康对照组之间的电生理差异，并设计一个预测长期癫痫发作结果的模型。方法该队列包括无癫痫发作组 30 人、癫痫残留组 23 人和对照组 20 人。我们对治疗前的脑电图进行了全面分析，包括相对功率谱（rPS）、加权相位滞后指数（wPLI）和网络指标。我们还对 2 岁时的随访脑电图进行了分析，以阐明各组之间的生理变化。结果与其他组相比，癫痫发作后遗症组的婴儿在 IESS 开始时，θ 和 α 波段的 rPS 增加（所有 p 均为 0.0001）。对照组的快速频段 rPS 较高，表明认知功能可能增强。无癫痫发作组在所有频段的 wPLI 均有所增加（所有 p 均为 0.0001）。我们的预测模型利用 wPLI 预测了 IESS 发病时的长期结果（曲线下面积为 0.75）。结论我们的研究结果表明，无癫痫发作组出现了最初的 "超同步状态"，这种状态在成功治疗后得到了改善。

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引用次数: 0

Machine learning for (non–)epileptic tissue detection from the intraoperative electrocorticogram 通过机器学习从术中皮层电图检测（非）癫痫组织

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-24 DOI: 10.1016/j.clinph.2024.08.012

Objective

Clinical visual intraoperative electrocorticography (ioECoG) reading intends to localize epileptic tissue and improve epilepsy surgery outcome. We aimed to understand whether machine learning (ML) could complement ioECoG reading, how subgroups affected performance, and which ioECoG features were most important.

Methods

We included 91 ioECoG-guided epilepsy surgery patients with Engel 1A outcome. We allocated 71 training and 20 test set patients. We trained an extra trees classifier (ETC) with 14 spectral features to classify ioECoG channels as covering resected or non-resected tissue. We compared the ETC’s performance with clinical ioECoG reading and assessed whether patient subgroups affected performance. Explainable artificial intelligence (xAI) unveiled the most important ioECoG features learnt by the ETC.

Results

The ETC outperformed clinical reading in five test set patients, was inferior in six, and both were inconclusive in nine. The ETC performed best in the tumor subgroup (area under ROC curve: 0.84 [95%CI 0.79–0.89]). xAI revealed predictors of resected (relative theta, alpha, and fast ripple power) and non-resected tissue (relative beta and gamma power).

Conclusions

Combinations of subtle spectral ioECoG changes, imperceptible by the human eye, can aid healthy and pathological tissue discrimination.

Significance

ML with spectral ioECoG features can support, rather than replace, clinical ioECoG reading, particularly in tumors.

目的临床视觉术中皮层电图（ioECoG）读取旨在定位癫痫组织并改善癫痫手术效果。我们旨在了解机器学习（ML）是否能补充ioECoG读图，亚组对读图性能有何影响，以及哪些ioECoG特征最重要。我们分配了 71 名训练集患者和 20 名测试集患者。我们使用 14 个频谱特征训练了一个额外树分类器（ETC），用于将 ioECoG 信道分类为覆盖切除组织或未切除组织。我们将 ETC 的性能与临床 ioECoG 读数进行了比较，并评估了患者亚群是否会影响性能。可解释人工智能（xAI）揭示了 ETC 学习到的最重要的 ioECoG 特征。结果在 5 例测试集患者中，ETC 的表现优于临床读图，在 6 例患者中不如临床读图，在 9 例患者中两者均无定论。ETC 在肿瘤亚组中表现最佳（ROC 曲线下面积：0.84 [95%CI 0.79-0.89]）。xAI揭示了切除组织（相对θ、α和快速波纹功率）和未切除组织（相对β和γ功率）的预测因子。

{"title":"Machine learning for (non–)epileptic tissue detection from the intraoperative electrocorticogram","authors":"","doi":"10.1016/j.clinph.2024.08.012","DOIUrl":"10.1016/j.clinph.2024.08.012","url":null,"abstract":"<div><h3>Objective</h3><p>Clinical visual intraoperative electrocorticography (ioECoG) reading intends to localize epileptic tissue and improve epilepsy surgery outcome. We aimed to understand whether machine learning (ML) could complement ioECoG reading, how subgroups affected performance, and which ioECoG features were most important.</p></div><div><h3>Methods</h3><p>We included 91 ioECoG-guided epilepsy surgery patients with Engel 1A outcome. We allocated 71 training and 20 test set patients. We trained an extra trees classifier (ETC) with 14 spectral features to classify ioECoG channels as covering resected or non-resected tissue. We compared the ETC’s performance with clinical ioECoG reading and assessed whether patient subgroups affected performance. Explainable artificial intelligence (xAI) unveiled the most important ioECoG features learnt by the ETC.</p></div><div><h3>Results</h3><p>The ETC outperformed clinical reading in five test set patients, was inferior in six, and both were inconclusive in nine. The ETC performed best in the tumor subgroup (area under ROC curve: 0.84 [95%CI 0.79–0.89]). xAI revealed predictors of resected (relative theta, alpha, and fast ripple power) and non-resected tissue (relative beta and gamma power).</p></div><div><h3>Conclusions</h3><p>Combinations of subtle spectral ioECoG changes, imperceptible by the human eye, can aid healthy and pathological tissue discrimination.</p></div><div><h3>Significance</h3><p>ML with spectral ioECoG features can support, rather than replace, clinical ioECoG reading, particularly in tumors.</p></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169285","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

Nerve sonography to detect intraneural microvascularity in patients with peripheral neuropathy 通过神经超声波检测周围神经病变患者的神经内微血管。

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-24 DOI: 10.1016/j.clinph.2024.08.011

Objective

We assessed microvessel flow within peripheral nerves using nerve sonography in patients with peripheral neuropathy.

Methods

This study included consecutive patients with peripheral neuropathy who were admitted to our hospital. The patients were divided into two groups: inflammatory neuropathies for immune-mediated neuropathies, such as Guillain − Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and the rest were defined as non-inflammatory neuropathies. We assessed nerve size and intraneural blood flow at four sites on each median and ulnar nerve. Blood flow was evaluated using color Doppler imaging, advanced dynamic flow (ADF), and superb microvascular imaging (SMI) techniques.

Results

Thirty-nine patients (median age, 60.0 years; 20 male) were enrolled in this study. An increase in intraneural blood flow was observed in five patients when evaluated by color Doppler, five patients by ADF, and 13 patients by SMI. An overall analysis of the three methods showed that intraneural blood flow was significantly higher in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy (54.2% vs. 0%, p = 0.0005).

Conclusions

Intraneural hypervascularization is more frequent in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy.

Significance

Evaluation of microvessel flow within peripheral nerves may contribute to the diagnosis of peripheral neuropathy.

目的通过神经超声波检查评估周围神经病变患者周围神经内的微血管流量：研究对象包括本院收治的连续性周围神经病患者。这些患者被分为两组：炎症性神经病变为免疫介导的神经病变，如吉兰-巴雷综合征和慢性炎症性脱髓鞘性多发性神经病变；其余患者被定义为非炎症性神经病变。我们分别在正中神经和尺神经的四个部位评估了神经大小和神经内血流。我们使用彩色多普勒成像、高级动态血流（ADF）和超微血管成像（SMI）技术对血流进行了评估：39 名患者（中位年龄 60.0 岁；20 名男性）参加了这项研究。在使用彩色多普勒、ADF 和 SMI 分别对 5 名患者、5 名患者和 13 名患者进行评估时，均观察到硬膜内血流增加。对三种方法的总体分析表明，炎症性神经病变患者的硬膜内血流明显高于非炎症性神经病变患者（54.2% 对 0%，P = 0.0005）：结论：与非炎症性神经病变患者相比，炎症性神经病变患者的硬膜内血管过多更为常见：对周围神经内微血管流动的评估可能有助于周围神经病变的诊断。

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引用次数: 0

Functional and structural maturation of auditory cortex from 2 months to 2 years old 2 个月至 2 岁儿童听觉皮层的功能和结构成熟情况

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2024-08-15 DOI: 10.1016/j.clinph.2024.08.007

Background

In school-age children, the myelination of the auditory radiation thalamocortical pathway is associated with the latency of auditory evoked responses, with the myelination of thalamocortical axons facilitating the rapid propagation of acoustic information. Little is known regarding this auditory system function-structure association in infants and toddlers.

Methods and Participants

The present study tested the hypothesis that maturation of auditory radiation white-matter microstructure (e.g., fractional anisotropy (FA); measured using diffusion-weighted MRI) is associated with the latency of the infant auditory response (the P2m response, measured using magnetoencephalography, MEG) in a cross-sectional (N = 47, 2 to 24 months, 19 females) as well as longitudinal cohort (N = 18, 2 to 29 months, 8 females) of typically developing infants and toddlers. Of 18 longitudinal infants, 2 infants had data from 3 timepoints and 16 infants had data from 2 timepoints.

Results

In the cross-sectional sample, non-linear maturation of P2m latency and auditory radiation diffusion measures were observed. Auditory radiation diffusion accounted for significant variance in P2m latency, even after removing the variance associated with age in both P2m latency and auditory radiation diffusion measures. In the longitudinal sample, latency and FA associations could be observed at the level of a single child.

Conclusions

Findings provide strong support for the hypothesis that an increase in thalamocortical neural conduction velocity, due to increased axon diameter and/or myelin maturation, contributes to a decrease in the infant P2m auditory evoked response latency.

Significance

Infant multimodal brain imaging identifies brain mechanisms contributing to the rapid changes in neural circuit activity during the first two years of life.

背景在学龄儿童中，听觉辐射丘脑皮层通路的髓鞘化与听觉诱发反应的潜伏期有关，丘脑皮层轴突的髓鞘化有利于声音信息的快速传播。本研究测试了听觉辐射白质微结构（如分数各向异性（fractional anisotropy））成熟的假设、本研究测试了听觉辐射白质微结构（如分数各向异性（FA）；使用弥散加权核磁共振成像测量）的成熟与婴儿听觉反应（P2m 反应，使用脑磁图测量）的潜伏期相关性的假设，研究对象为横向（47 人，2 至 24 个月，19 名女性）和纵向（18 人，2 至 29 个月，8 名女性）的发育典型婴儿和学步儿童。结果在横断面样本中，观察到 P2m 潜伏期和听觉辐射扩散测量的非线性成熟。即使剔除了 P2m 潜伏期和听觉辐射扩散测量中与年龄相关的方差，听觉辐射扩散也能显著反映 P2m 潜伏期的方差。在纵向样本中，可以在单个儿童的水平上观察到潜伏期和FA的关联。结论研究结果有力地支持了以下假设：由于轴突直径增加和/或髓鞘成熟，丘脑皮质神经传导速度增加，导致婴儿P2m听觉诱发反应潜伏期缩短。

{"title":"Functional and structural maturation of auditory cortex from 2 months to 2 years old","authors":"","doi":"10.1016/j.clinph.2024.08.007","DOIUrl":"10.1016/j.clinph.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>In school-age children, the myelination of the auditory radiation thalamocortical pathway is associated with the latency of auditory evoked responses, with the myelination of thalamocortical axons facilitating the rapid propagation of acoustic information. Little is known regarding this auditory system function-structure association in infants and toddlers.</p></div><div><h3>Methods and Participants</h3><p>The present study tested the hypothesis that maturation of auditory radiation white-matter microstructure (e.g., fractional anisotropy (FA); measured using diffusion-weighted MRI) is associated with the latency of the infant auditory response (the P2m response, measured using magnetoencephalography, MEG) in a cross-sectional (<em>N</em> = 47, 2 to 24 months, 19 females) as well as longitudinal cohort (<em>N</em> = 18, 2 to 29 months, 8 females) of typically developing infants and toddlers. Of 18 longitudinal infants, 2 infants had data from 3 timepoints and 16 infants had data from 2 timepoints.</p></div><div><h3>Results</h3><p>In the cross-sectional sample, non-linear maturation of P2m latency and auditory radiation diffusion measures were observed. Auditory radiation diffusion accounted for significant variance in P2m latency, even after removing the variance associated with age in both P2m latency and auditory radiation diffusion measures. In the longitudinal sample, latency and FA associations could be observed at the level of a single child.</p></div><div><h3>Conclusions</h3><p>Findings provide strong support for the hypothesis that an increase in thalamocortical neural conduction velocity, due to increased axon diameter and/or myelin maturation, contributes to a decrease in the infant P2m auditory evoked response latency.</p></div><div><h3>Significance</h3><p>Infant multimodal brain imaging identifies brain mechanisms contributing to the rapid changes in neural circuit activity during the first two years of life.</p></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1388245724002359/pdfft?md5=9eaebb1f32782d80425cc9cbfc5b7f36&pid=1-s2.0-S1388245724002359-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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