Pub Date : 2024-10-26DOI: 10.1016/j.clinph.2024.10.010
Anny Maza , Sandra Goizueta , María Dolores Navarro , Enrique Noé , Joan Ferri , Valery Naranjo , Roberto Llorens
Objective
To investigate the differences in the brain responses of healthy controls (HC) and patients with disorders of consciousness (DOC) to familiar and non-familiar audiovisual stimuli and their consistency with the clinical progress.
Methods
EEG responses of 19 HC and 19 patients with DOC were recorded while watching emotionally-valenced familiar and non-familiar videos. Differential entropy of the EEG recordings was used to train machine learning models aimed to distinguish brain responses to stimuli type. The consistency of brain responses with the clinical progress of the patients was also evaluated.
Results
Models trained using data from HC outperformed those for patients. However, the performance of the models for patients was not influenced by their clinical condition. The models were successfully trained for over 75% of participants, regardless of their clinical condition. More than 75% of patients whose CRS-R scores increased post-study displayed distinguishable brain responses to both stimuli.
Conclusions
Responses to emotionally-valenced stimuli enabled modelling classifiers that were sensitive to the familiarity of the stimuli, regardless of the clinical condition of the participants and were consistent with their clinical progress in most cases.
Significance
EEG responses are sensitive to familiarity of emotionally-valenced stimuli in HC and patients with DOC.
{"title":"EEG-based responses of patients with disorders of consciousness and healthy controls to familiar and non-familiar emotional videos","authors":"Anny Maza , Sandra Goizueta , María Dolores Navarro , Enrique Noé , Joan Ferri , Valery Naranjo , Roberto Llorens","doi":"10.1016/j.clinph.2024.10.010","DOIUrl":"10.1016/j.clinph.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the differences in the brain responses of healthy controls (HC) and patients with disorders of consciousness (DOC) to familiar and non-familiar audiovisual stimuli and their consistency with the clinical progress.</div></div><div><h3>Methods</h3><div>EEG responses of 19 HC and 19 patients with DOC were recorded while watching emotionally-valenced familiar and non-familiar videos. Differential entropy of the EEG recordings was used to train machine learning models aimed to distinguish brain responses to stimuli type. The consistency of brain responses with the clinical progress of the patients was also evaluated.</div></div><div><h3>Results</h3><div>Models trained using data from HC outperformed those for patients. However, the performance of the models for patients was not influenced by their clinical condition. The models were successfully trained for over 75% of participants, regardless of their clinical condition. More than 75% of patients whose CRS-R scores increased post-study displayed distinguishable brain responses to both stimuli.</div></div><div><h3>Conclusions</h3><div>Responses to emotionally-valenced stimuli enabled modelling classifiers that were sensitive to the familiarity of the stimuli, regardless of the clinical condition of the participants and were consistent with their clinical progress in most cases.</div></div><div><h3>Significance</h3><div>EEG responses are sensitive to familiarity of emotionally-valenced stimuli in HC and patients with DOC.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 104-120"},"PeriodicalIF":3.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561143","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}
Pub Date : 2024-10-25DOI: 10.1016/j.clinph.2024.10.009
Jiajia Liu, Xing Fan, Lirui Yang, Xiaorong Tao, Yanwen Jin, Ke Li, Jun Yang, Hui Qiao
{"title":"Reply to \"intraoperativecorticobulbar motor evoked potentials and blink reflex during skull base surgery: Significance of anesthetic Regime\".","authors":"Jiajia Liu, Xing Fan, Lirui Yang, Xiaorong Tao, Yanwen Jin, Ke Li, Jun Yang, Hui Qiao","doi":"10.1016/j.clinph.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.clinph.2024.10.009","url":null,"abstract":"","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581467","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}
Pub Date : 2024-10-25DOI: 10.1016/j.clinph.2024.10.011
Luca Pierantoni , Fabrizio Vecchio , Francesca Miraglia , Cristiano Pecchioli , Francesco Iodice , Claudia Carrarini , Mattia Pinardi , Giovanni Di Pino , Silvestro Micera , Paolo Maria Rossini
Objective
To investigate the effects of transcutaneous spinal direct current stimulation (tsDCS) on spinal cord excitability using neurophysiological methods.
Methods
Spinal cord motoneuron excitability was assessed using various neurophysiological techniques in a sham-controlled randomized experiment, which involved delivering 2 mA tsDCS and testing four different montages. Transcranial magnetic stimulation (TMS), F-waves to supramaximal ulnar nerve stimulation and somatosensory evoked potentials to upper limb nerves stimulation were measured in the participants with the electrode configuration that yielded the greatest effect, for a total of about 18 min. 18 young volunteers were recruited.
Results
Among the tested ones, the most promising tsDCS montage was the one with the anode placed on the 7th cervical spinous process and the cathode on the glottis. With this configuration, a significant enhancement of motor responses in the hand muscles to TMS of the contralateral hand motor area was observed during tsDCS (), reaching a plateau after 6 min. This facilitation rapidly declined within a few minutes after the tsDCS was stopped.
Conclusion
Results of the different techniques suggest a possible contribution to facilitatory neuromodulation of the motoneurons at the cervical spine level.
Significance
The occurrence of enhanced excitability after tsDCS suggests potential application in individuals with partial corticospinal fiber impairment affecting hand motor function.
目的 通过神经生理学方法研究经皮脊髓直流电刺激（tsDCS）对脊髓兴奋性的影响。方法 在一项假对照随机实验中，使用各种神经生理学技术评估脊髓运动神经元的兴奋性，其中包括提供 2 mA tsDCS 和测试四种不同的单体。结果 在测试的四种tsDCS组合中，阳极位于第7颈椎棘突、阴极位于声门的组合最有希望。通过这种配置，在tsDCS期间观察到手部肌肉对对侧手部运动区TMS的运动反应明显增强（p<0.00001），6分钟后达到高峰。tsDCS停止后几分钟内，这种促进作用迅速减弱。意义tsDCS后兴奋性增强的现象表明，它有可能应用于影响手部运动功能的部分皮质脊髓纤维损伤患者。
{"title":"Effects of cervical transcutaneous spinal direct current stimulation on spinal excitability","authors":"Luca Pierantoni , Fabrizio Vecchio , Francesca Miraglia , Cristiano Pecchioli , Francesco Iodice , Claudia Carrarini , Mattia Pinardi , Giovanni Di Pino , Silvestro Micera , Paolo Maria Rossini","doi":"10.1016/j.clinph.2024.10.011","DOIUrl":"10.1016/j.clinph.2024.10.011","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effects of transcutaneous spinal direct current stimulation (tsDCS) on spinal cord excitability using neurophysiological methods.</div></div><div><h3>Methods</h3><div>Spinal cord motoneuron excitability was assessed using various neurophysiological techniques in a sham-controlled randomized experiment, which involved delivering 2 mA tsDCS and testing four different montages. Transcranial magnetic stimulation (TMS), F-waves to supramaximal ulnar nerve stimulation and somatosensory evoked potentials to upper limb nerves stimulation were measured in the participants with the electrode configuration that yielded the greatest effect, for a total of about 18 min. 18 young volunteers were recruited.</div></div><div><h3>Results</h3><div>Among the tested ones, the most promising tsDCS montage was the one with the anode placed on the 7th cervical spinous process and the cathode on the glottis. With this configuration, a significant enhancement of motor responses in the hand muscles to TMS of the contralateral hand motor area was observed during tsDCS (<span><math><mrow><mi>p</mi><mo><</mo><mn>0.00001</mn></mrow></math></span>), reaching a plateau after 6 min. This facilitation rapidly declined within a few minutes after the tsDCS was stopped.</div></div><div><h3>Conclusion</h3><div>Results of the different techniques suggest a possible contribution to facilitatory neuromodulation of the motoneurons at the cervical spine level.</div></div><div><h3>Significance</h3><div>The occurrence of enhanced excitability after tsDCS suggests potential application in individuals with partial corticospinal fiber impairment affecting hand motor function.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 95-103"},"PeriodicalIF":3.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554613","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}
Pub Date : 2024-10-20DOI: 10.1016/j.clinph.2024.10.008
Syed Ameen Ahmad , Christopher Primiani , Michael Porambo , Tran Dang , Peter W. Kaplan , Vivek Yedavalli , Khalil S. Husari
Objective
CT hyper-perfusion has been reported in non-convulsive status epilepticus (NCSE), while its occurrence and relevance after single seizures or with rhythmic and periodic patterns (RPPs) that lie along the ictal-interictal continuum (IIC), remain unclear. The goal of the study is to assess the role of CT perfusion (CTP) in diagnosing patients with clinical seizures, subclinical seizures, or RPPs that lie along the IIC, to help in the clinical assessment of these entities.
Methods
We retrospectively reviewed inpatients who underwent a CTP and an EEG within 6 h of each other. CTP and EEGs were blindly reviewed independent of electronic medical records.
Results
Out of 103 patients, 15 patients (15 %) demonstrated hyper-perfusion, 40 patients (39 %) had hypo-perfusion, while 48 patients (47 %) had normal CTP. Patients with focal CTP hyperperfusion were more likely to have clinical seizures, electrographic seizures, and/or lateralized rhythmic periodic patterns (RPPs) compared to those without CTP hyperperfusion. Focal CTP hyper-perfusion had 34 % sensitivity and 96 % specificity for identifying patients with clinical seizures, and a 40 % sensitivity and 92 % specificity for identifying patients with electrographic seizures or lateralized RPP. Although the numbers were small, none of the patients with generalized periodic discharges or generalized rhythmic delta activity had CTP hyper-perfusion.
Conclusions
Focal CTP hyper-perfusion has low sensitivity but high specificity for identifying patients with seizures and lateralized RPPs, and may be considered in the clinical assessment of patients where the clinical information are unclear or insufficient.
Significance
The presence of CTP hyper-perfusion should alert the physician to the possibility of an ictal related etiology accounting for the patient’s symptoms.
{"title":"Utility of CT perfusion in seizures and rhythmic and periodic patterns","authors":"Syed Ameen Ahmad , Christopher Primiani , Michael Porambo , Tran Dang , Peter W. Kaplan , Vivek Yedavalli , Khalil S. Husari","doi":"10.1016/j.clinph.2024.10.008","DOIUrl":"10.1016/j.clinph.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>CT hyper-perfusion has been reported in non-convulsive status epilepticus (NCSE), while its occurrence and relevance after single seizures or with rhythmic and periodic patterns (RPPs) that lie along the ictal-interictal continuum (IIC), remain unclear. The goal of the study is to assess the role of CT perfusion (CTP) in diagnosing patients with clinical seizures, subclinical seizures, or RPPs that lie along the IIC, to help in the clinical assessment of these entities.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed inpatients who underwent a CTP and an EEG within 6 h of each other. CTP and EEGs were blindly reviewed independent of electronic medical records.</div></div><div><h3>Results</h3><div>Out of 103 patients, 15 patients (15 %) demonstrated hyper-perfusion, 40 patients (39 %) had hypo-perfusion, while 48 patients (47 %) had normal CTP. Patients with focal CTP hyperperfusion were more likely to have clinical seizures, electrographic seizures, and/or lateralized rhythmic periodic patterns (RPPs) compared to those without CTP hyperperfusion<strong>.</strong> Focal CTP hyper-perfusion had 34 % sensitivity and 96 % specificity for identifying patients with clinical seizures, and a 40 % sensitivity and 92 % specificity for identifying patients with electrographic seizures or lateralized RPP. Although the numbers were small, none of the patients with generalized periodic discharges or generalized rhythmic delta activity had CTP hyper-perfusion.</div></div><div><h3>Conclusions</h3><div>Focal CTP hyper-perfusion has low sensitivity but high specificity for identifying patients with seizures and lateralized RPPs, and may be considered in the clinical assessment of patients where the clinical information are unclear or insufficient.</div></div><div><h3>Significance</h3><div>The presence of CTP hyper-perfusion should alert the physician to the possibility of an ictal related etiology accounting for the patient’s symptoms.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 121-128"},"PeriodicalIF":3.7,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567848","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}
Pub Date : 2024-10-19DOI: 10.1016/j.clinph.2024.10.006
David A. Isaacs , Andrew Xue , Alexander C. Conley , Alexandra P. Key
Background
Over 80% of adults with chronic tic disorder (CTD) experience sensory over-responsivity (SOR), defined as heightened awareness of and/or behavioral reactivity to commonplace environmental stimuli. One potential mechanism underpinning SOR is sensory gating impairment. Sensory gating is the physiologic process whereby redundant stimuli are filtered out in early perceptual stages. In this study, we compared sensory gating between neurotypical and CTD adults and determined if gating indices associated with SOR.
Methods
Neurotypical (n = 31) and CTD adults (n = 26) completed a clinical assessment, including two SOR measures (Sensory Gating Inventory, SGI; Sensory Perception Quotient, SPQ), and an auditory gating paradigm while monitored on EEG.
Results
CTD adults exhibited greater SOR. Neurotypical and CTD adults did not differ in P50, N100, or P200 gating ratios. In regression analyses, N100 gating ratio was significantly associated with SGI score; the magnitude of this association was greater for neurotypical than CTD adults. No other significant associations emerged between gating ratios and SOR measures.
Conclusion
Findings do not support sensory gating impairment as a mechanism underpinning SOR in CTD.
The relationship between N100 gating and SOR warrants further investigation.
Significance
This is the first study to examine auditory gating in individuals with CTD.
背景：超过 80% 的慢性抽搐症（CTD）成人患者会出现感觉过度反应（SOR），即对普通环境刺激的意识和/或行为反应增强。造成 SOR 的一个潜在机制是感觉门控障碍。感觉门控是在早期感知阶段过滤多余刺激的生理过程。在这项研究中，我们比较了神经畸形和 CTD 成年人的感觉门控，并确定门控指数是否与 SOR 相关：神经畸形（n = 31）和 CTD 成人（n = 26）完成了一项临床评估，包括两项 SOR 测量（感觉门控量表，SGI；感觉知觉商数，SPQ）和一项听觉门控范式，同时进行脑电图监测：结果：CTD 成人表现出更大的 SOR。神经畸形成人和 CTD 成人在 P50、N100 或 P200 门控比率上没有差异。在回归分析中，N100 门控比与 SGI 评分显著相关；神经畸形成人的相关程度高于 CTD 成人。门控比率与 SOR 测量之间没有其他重要关联：结论：研究结果不支持将感觉门控障碍作为导致 CTD SOR 的机制。N100门控与SOR之间的关系值得进一步研究：这是首次研究 CTD 患者的听觉门控。
{"title":"Auditory gating and its clinical correlates in adults with chronic tic disorder and neurotypical adults","authors":"David A. Isaacs , Andrew Xue , Alexander C. Conley , Alexandra P. Key","doi":"10.1016/j.clinph.2024.10.006","DOIUrl":"10.1016/j.clinph.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Over 80% of adults with chronic tic disorder (CTD) experience sensory over-responsivity (SOR), defined as heightened awareness of and/or behavioral reactivity to commonplace environmental stimuli. One potential mechanism underpinning SOR is sensory gating impairment. Sensory gating is the physiologic process whereby redundant stimuli are filtered out in early perceptual stages. In this study, we compared sensory gating between neurotypical and CTD adults and determined if gating indices associated with SOR.</div></div><div><h3>Methods</h3><div>Neurotypical (n = 31) and CTD adults (n = 26) completed a clinical assessment, including two SOR measures (Sensory Gating Inventory, SGI; Sensory Perception Quotient, SPQ), and an auditory gating paradigm while monitored on EEG.</div></div><div><h3>Results</h3><div>CTD adults exhibited greater SOR. Neurotypical and CTD adults did not differ in P50, N100, or P200 gating ratios. In regression analyses, N100 gating ratio was significantly associated with SGI score; the magnitude of this association was greater for neurotypical than CTD adults. No other significant associations emerged between gating ratios and SOR measures.</div></div><div><h3>Conclusion</h3><div>Findings do not support sensory gating impairment as a mechanism underpinning SOR in CTD.</div><div>The relationship between N100 gating and SOR warrants further investigation.</div></div><div><h3>Significance</h3><div>This is the first study to examine auditory gating in individuals with CTD.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 72-82"},"PeriodicalIF":3.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544199","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}
Pub Date : 2024-10-19DOI: 10.1016/j.clinph.2024.10.003
Ana Rita Barreiros , Isabella B. Breukelaar , Anthony W.F. Harris , Mayuresh S. Korgaonkar
Objectives
Functional magnetic resonance imaging (fMRI) neurofeedback has emerged as a potential treatment modality for depression, but little is known about its mechanism of action. This study aims to investigate the efficacy of fMRI neurofeedback in modulating neural networks in depression.
Methods
Following PRISMA guidelines, a systematic review was conducted focusing on fMRI neurofeedback interventions in depression. A comprehensive search across multiple databases yielded 16 eligible studies for review.
Results
The review demonstrated that fMRI neurofeedback can modulate BOLD activity even in strategy-free protocols and within a single session, with a significant learning effect evident over sessions. Neurofeedback targeting specific regions led to changes in connectivity across broad neural networks, including the default-mode and executive control networks, with effects being region-specific. However, methodological diversity and the absence of standardized protocols in the reviewed studies highlighted the need for more uniform research approaches.
Conclusions
fMRI neurofeedback shows promise as a modulatory technique for depression, with the potential to induce significant changes in neural activity and connectivity of networks implicated in depression.
Significance
The review underscores the necessity for standardized, reproducible neurofeedback protocols with control groups to enhance research comparability and generalizability.
{"title":"fMRI neurofeedback for the modulation of the neural networks associated with depression","authors":"Ana Rita Barreiros , Isabella B. Breukelaar , Anthony W.F. Harris , Mayuresh S. Korgaonkar","doi":"10.1016/j.clinph.2024.10.003","DOIUrl":"10.1016/j.clinph.2024.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Functional magnetic resonance imaging (fMRI) neurofeedback has emerged as a potential treatment modality for depression, but little is known about its mechanism of action. This study aims to investigate the efficacy of fMRI neurofeedback in modulating neural networks in depression.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, a systematic review was conducted focusing on fMRI neurofeedback interventions in depression. A comprehensive search across multiple databases yielded 16 eligible studies for review.</div></div><div><h3>Results</h3><div>The review demonstrated that fMRI neurofeedback can modulate BOLD activity even in strategy-free protocols and within a single session, with a significant learning effect evident over sessions. Neurofeedback targeting specific regions led to changes in connectivity across broad neural networks, including the default-mode and executive control networks, with effects being region-specific. However, methodological diversity and the absence of standardized protocols in the reviewed studies highlighted the need for more uniform research approaches.</div></div><div><h3>Conclusions</h3><div>fMRI neurofeedback shows promise as a modulatory technique for depression, with the potential to induce significant changes in neural activity and connectivity of networks implicated in depression.</div></div><div><h3>Significance</h3><div>The review underscores the necessity for standardized, reproducible neurofeedback protocols with control groups to enhance research comparability and generalizability.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 34-42"},"PeriodicalIF":3.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496564","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}
Pub Date : 2024-10-19DOI: 10.1016/j.clinph.2024.10.007
Sebastian Siller , Sylvain Duell , Joerg-Christian Tonn , Andrea Szelenyi
Objective
D-wave can safely monitor the corticospinal-tract (CST)-function regarding gross-motor outcome of lower extremities, but it is still unknown whether i)D-wave can also safely monitor the gross-motor outcome of distal upper extremities in those patients undergoing high-cervical intramedullary-spinal-cord-tumor (IMSCT)-resection (enabling epidural D-wave-placement below C5) and ii)multimodal IONM can also predict fine-motor/complex hand function.
Methods
We prospectively assessed 20 patients undergoing IMSCT-surgery above the C4/5-level with multimodal IONM (D-wave/mMEPs/EMG/SSEPs). Detailed gross-/fine-motor and complex hand function was assessed pre- and postoperatively and during long-term follow-up (mean:29.5 ± 18.8 months) and correlated with IONM-findings.
Results
D-wave monitoring was without intraoperative critical changes in all patients and none had any permanent postoperative gross-motor deficits. However, D-wave did not allow to predict the occurrence of mild permanent postoperative deficits affecting fine-motor function which was the case in 8% for distal upper extremities. The complex distal upper extremities’ function assessed by Nine-Hole-Peg-Test (reflecting the complex motor/sensory interaction for hand-usability) was permanently deteriorated in 15% postoperatively and only the combination of D-wave/mMEPs/EMG/SSEPs was able to provide a viable predictive power (specificity:79%/sensitivity:43%).
Conclusions
In high-cervical IMSCT-surgery, unimpaired D-wave reliably predicts preserved gross-motor function, but fails to sufficiently cover distal upper extremities’ fine-motor/complex function.
Significance
Our study underlines the importance of multimodal IONM for fine-motor/complex hand function.
目的：D波可以安全地监测皮质脊髓束（CST）功能对下肢粗大运动的影响，但对于接受高颈椎髓内脊髓肿瘤（IMSCT）切除术（可在C5以下硬膜外置入D波）的患者，i)D波是否也能安全地监测上肢远端粗大运动的影响，ii)多模式IONM是否也能预测精细运动/复杂手功能，目前仍是未知数：我们对20名接受C4/5水平以上IMSCT手术的患者进行了多模式IONM（D波/mMEPs/EMG/SSEPs）前瞻性评估。在术前、术后和长期随访期间（平均：29.5 ± 18.8 个月），对患者的粗大运动/精细运动和复杂手部功能进行了详细评估，并将评估结果与 IONM 结果进行了关联：结果：所有患者的 D 波监测均未出现术中临界变化，术后均未出现永久性粗大运动障碍。然而，D 波并不能预测术后轻度永久性精细运动功能障碍的发生，上肢远端出现这种情况的比例为 8%。通过九孔钉测试评估的复杂上肢远端功能（反映手部使用能力的复杂运动/感觉相互作用）在术后永久性恶化的比例为 15%，而只有 D 波/MEPs/EMG/SSEPs 组合才能提供可行的预测能力（特异性：79%/敏感性：43%）：结论：在高颈椎IMSCT手术中，未受损的D波能可靠地预测粗大运动功能的保留，但不能充分涵盖上肢远端的精细运动/复合功能：我们的研究强调了多模式 IONM 对精细运动/复杂手部功能的重要性。
{"title":"Multimodal intraoperative neurophysiological monitoring may better predict postoperative distal upper extremities’ complex-functional outcome than spinal and muscular motor evoked potentials alone in high-cervical intramedullary spinal cord tumor surgery","authors":"Sebastian Siller , Sylvain Duell , Joerg-Christian Tonn , Andrea Szelenyi","doi":"10.1016/j.clinph.2024.10.007","DOIUrl":"10.1016/j.clinph.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>D-wave can safely monitor the corticospinal-tract (CST)-function regarding gross-motor outcome of lower extremities, but it is still unknown whether i)D-wave can also safely monitor the gross-motor outcome of distal upper extremities in those patients undergoing high-cervical intramedullary-spinal-cord-tumor (IMSCT)-resection (enabling epidural D-wave-placement below C5) and ii)multimodal IONM can also predict fine-motor/complex hand function.</div></div><div><h3>Methods</h3><div>We prospectively assessed 20 patients undergoing IMSCT-surgery above the C4/5-level with multimodal IONM (D-wave/mMEPs/EMG/SSEPs). Detailed gross-/fine-motor and complex hand function was assessed pre- and postoperatively and during long-term follow-up (mean:29.5 ± 18.8 months) and correlated with IONM-findings.</div></div><div><h3>Results</h3><div>D-wave monitoring was without intraoperative critical changes in all patients and none had any permanent postoperative gross-motor deficits. However, D-wave did not allow to predict the occurrence of mild permanent postoperative deficits affecting fine-motor function which was the case in 8% for distal upper extremities. The complex distal upper extremities’ function assessed by Nine-Hole-Peg-Test (reflecting the complex motor/sensory interaction for hand-usability) was permanently deteriorated in 15% postoperatively and only the combination of D-wave/mMEPs/EMG/SSEPs was able to provide a viable predictive power (specificity:79%/sensitivity:43%).</div></div><div><h3>Conclusions</h3><div>In high-cervical IMSCT-surgery, unimpaired D-wave reliably predicts preserved gross-motor function, but fails to sufficiently cover distal upper extremities’ fine-motor/complex function.</div></div><div><h3>Significance</h3><div>Our study underlines the importance of multimodal IONM for fine-motor/complex hand function.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 52-60"},"PeriodicalIF":3.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496566","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}
Pub Date : 2024-10-18DOI: 10.1016/j.clinph.2024.10.002
Katherine A Zarroli, Ramon Edmundo D Bautista
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Complex visual hallucinations (VH) are a core feature of dementia with Lewy bodies (DLB), though they may not occur in all patients. Power spectral density (PSD) analysis of resting-state EEG (rs-EEG) shows associations between some frequency bands (e.g., theta), individual alpha frequency (IAF) and VH. However, new tools that improve early differential diagnosis and symptom-based stratification with higher sensitivity and specificity, even within the DLB population, are desirable. We aimed to assess differences in rs-EEG data between DLB patients with VH (DLB-VH+) and without VH (DLB-VH-), comparing innovative non-linear approaches with more traditional linear ones.
Methods
We retrospectively analyzed rs-EEG recordings of DLB-VH+, DLB-VH-, Alzheimer’s disease patients and age-matched healthy controls. EEG was analyzed using the nonlinear Higuchi’s Fractal Dimension (FD) measure, and the results were compared with those of entropy and standard linear methods based on PSD and IAF.
Results
Only the FD measure could discriminate between DLB-VH+ and DLB-VH-.
Conclusions
In conclusion, rs-EEG differences between DLB-VH+ and DLB-VH- are better characterized by FD analysis than by a more traditional power spectrum approach.
Significance
This suggests that the presence of complex VH is associated with less complex brain dynamics at rest, as reflected by the FD measure.
{"title":"Resting-state EEG spectral and fractal features in dementia with Lewy bodies with and without visual hallucinations","authors":"Antonino Vallesi , Camillo Porcaro , Antonino Visalli , Davide Fasolato , Francesco Rossato , Cinzia Bussè , Annachiara Cagnin","doi":"10.1016/j.clinph.2024.10.004","DOIUrl":"10.1016/j.clinph.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>Complex visual hallucinations (VH) are a core feature of dementia with Lewy bodies (DLB), though they may not occur in all patients. Power spectral density (PSD) analysis of resting-state EEG (rs-EEG) shows associations between some frequency bands (e.g., theta), individual alpha frequency (IAF) and VH. However, new tools that improve early differential diagnosis and symptom-based stratification with higher sensitivity and specificity, even within the DLB population, are desirable. We aimed to assess differences in rs-EEG data between DLB patients with VH (DLB-VH+) and without VH (DLB-VH-), comparing innovative non-linear approaches with more traditional linear ones.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed rs-EEG recordings of DLB-VH+, DLB-VH-, Alzheimer’s disease patients and age-matched healthy controls. EEG was analyzed using the nonlinear Higuchi’s Fractal Dimension (FD) measure, and the results were compared with those of entropy and standard linear methods based on PSD and IAF.</div></div><div><h3>Results</h3><div>Only the FD measure could discriminate between DLB-VH+ and DLB-VH-.</div></div><div><h3>Conclusions</h3><div>In conclusion, rs-EEG differences between DLB-VH+ and DLB-VH- are better characterized by FD analysis than by a more traditional power spectrum approach.</div></div><div><h3>Significance</h3><div>This suggests that the presence of complex VH is associated with less complex brain dynamics at rest, as reflected by the FD measure.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 43-51"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496567","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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