Pub Date : 2025-12-04DOI: 10.1016/j.clinph.2025.2111462
Florian Mayer , Johannes Zielke , Birgit Pimpel , Katharina Moser , Clara Köller , Sarah Glatter , Gregor Kasprian , Amedeo A. Azizi , Johannes Gojo , Matthias Tomschik , Christian Dorfer , Karl Roessler , Martha Feucht
Objective
To assess the prognostic value of interictal epileptiform discharges (iEDs) on postoperative video-EEG in children and adolescents undergoing epilepsy surgery for low-grade developmental and epilepsy-associated tumors (LEATs).
Methods
This retrospective single-center study analyzed prospectively collected pre- and postoperative EEG data from pediatric LEAT patients. Associations between iED characteristics and seizure outcomes ≥ 24 months after surgery were examined.
Results
Fifty-nine patients with a median postoperative follow-up of 59.0 months (IQR: 36.0–118.0) were included. Univariate analysis identified the presence of a secondary iED focus at 3 months (p = 0.04), persistent iEDs at 12 months (p = 0.007), and a ≥ 50 % increase in iED frequency over time (p = 0.009) as predictors of unfavorable seizure outcomes. Multivariate analysis confirmed that a ≥ 50 % increase in iED frequency within the first 12 months post-surgery was independently associated with unfavorable outcomes (OR: 16.2, 95 % CI: 1.2–555.0, p = 0.037).
Conclusions
Postoperative iEDs, particularly their evolution over time, are valuable predictors of long-term seizure outcomes following LEAT surgery.
Significance
Prognostic models for seizure outcomes in LEAT patients should not only include clinical, radiological and surgical characteristics, but also presence and progression of iEDs in postoperative EEGs.
{"title":"Postoperative epileptiform discharges predict seizure outcomes in pediatric low-grade developmental and epilepsy associated tumors","authors":"Florian Mayer , Johannes Zielke , Birgit Pimpel , Katharina Moser , Clara Köller , Sarah Glatter , Gregor Kasprian , Amedeo A. Azizi , Johannes Gojo , Matthias Tomschik , Christian Dorfer , Karl Roessler , Martha Feucht","doi":"10.1016/j.clinph.2025.2111462","DOIUrl":"10.1016/j.clinph.2025.2111462","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the prognostic value of interictal epileptiform discharges (iEDs) on postoperative video-EEG in children and adolescents undergoing epilepsy surgery for low-grade developmental and epilepsy-associated tumors (LEATs).</div></div><div><h3>Methods</h3><div>This retrospective single-center study analyzed prospectively collected pre- and postoperative EEG data from pediatric LEAT patients. Associations between iED characteristics and seizure outcomes ≥ 24 months after surgery were examined.</div></div><div><h3>Results</h3><div>Fifty-nine patients with a median postoperative follow-up of 59.0 months (IQR: 36.0–118.0) were included. Univariate analysis identified the presence of a secondary iED focus at 3 months (p = 0.04), persistent iEDs at 12 months (p = 0.007), and a ≥ 50 % increase in iED frequency over time (p = 0.009) as predictors of unfavorable seizure outcomes. Multivariate analysis confirmed that a ≥ 50 % increase in iED frequency within the first 12 months post-surgery was independently associated with unfavorable outcomes (OR: 16.2, 95 % CI: 1.2–555.0, p = 0.037).</div></div><div><h3>Conclusions</h3><div>Postoperative iEDs, particularly their evolution over time, are valuable predictors of long-term seizure outcomes following LEAT surgery.</div></div><div><h3>Significance</h3><div>Prognostic models for seizure outcomes in LEAT patients should not only include clinical, radiological and surgical characteristics, but also presence and progression of iEDs in postoperative EEGs.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"183 ","pages":"Article 2111462"},"PeriodicalIF":3.6,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697914","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 : 2025-12-03DOI: 10.1016/j.clinph.2025.2111469
Hugo Ardaillon , Anne Dubois , Kate-Mary Ndocko , Jérôme Etienne , Catherine Tallon-Baudry , Jacques Luauté
Objective
To evaluate heart rate deceleration on affective auditory stimulations as an objective marker of purposeful affective behaviour, as used in the diagnosis of minimally conscious state (MCS) in brain-injured individuals with disorders of consciousness (DoC), awake but unable to communicate.
Methods
We recorded the heart rate of participants (14 healthy controls and 10 brain injured individuals, conscious or with DoC) on repeated exposure to a random sequence of three emotional sounds of neutral, positive, and negative valence, in an unconditioned manner (experiment 1) or in a trace-conditioning procedure (experiment 2), with successful trace-conditioning assumed to indicate consciousness.
Results
In experiment 1, heart rate deceleration after aversive acoustic stimulus was significantly higher in healthy subjects at the group level from the second to the seventh inter-beat interval, with limited sensitivity at the individual level. In experiment 2, there was no evidence of trace-conditioned learning in healthy subjects, precluding any extrapolation to brain-injured individuals.
Conclusions
Heart rate deceleration after aversive acoustic stimulus was significant in passive hearing but not in a trace-conditioning paradigm and was of limited sensitivity at the individual level.
Significance
Heart rate deceleration may constitute an objective marker of purposeful affective behaviour triggered by emotional sounds. The question of whether this response is a reflex or a marker of conscious access needs further study.
{"title":"Detecting emotion in individuals with disorders of consciousness: a pilot study of heart rate deceleration on affective auditory stimuli","authors":"Hugo Ardaillon , Anne Dubois , Kate-Mary Ndocko , Jérôme Etienne , Catherine Tallon-Baudry , Jacques Luauté","doi":"10.1016/j.clinph.2025.2111469","DOIUrl":"10.1016/j.clinph.2025.2111469","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate heart rate deceleration on affective auditory stimulations as an objective marker of purposeful affective behaviour, as used in the diagnosis of minimally conscious state (MCS) in brain-injured individuals with disorders of consciousness (DoC), awake but unable to communicate.</div></div><div><h3>Methods</h3><div>We recorded the heart rate of participants (14 healthy controls and 10 brain injured individuals, conscious or with DoC) on repeated exposure to a random sequence of three emotional sounds of neutral, positive, and negative valence, in an unconditioned manner (experiment 1) or in a trace-conditioning procedure (experiment 2), with successful trace-conditioning assumed to indicate consciousness.</div></div><div><h3>Results</h3><div>In experiment 1, heart rate deceleration after aversive acoustic stimulus was significantly higher in healthy subjects at the group level from the second to the seventh inter-beat interval, with limited sensitivity at the individual level. In experiment 2, there was no evidence of trace-conditioned learning in healthy subjects, precluding any extrapolation to brain-injured individuals.</div></div><div><h3>Conclusions</h3><div>Heart rate deceleration after aversive acoustic stimulus was significant in passive hearing but not in a trace-conditioning paradigm and was of limited sensitivity at the individual level.</div></div><div><h3>Significance</h3><div>Heart rate deceleration may constitute an objective marker of purposeful affective behaviour triggered by emotional sounds. The question of whether this response is a reflex or a marker of conscious access needs further study.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"183 ","pages":"Article 2111469"},"PeriodicalIF":3.6,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735499","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 : 2025-12-03DOI: 10.1016/j.clinph.2025.2111465
Yifat Yaar-Soffer , Brilliant Brilliant , Chava Muchnik , Andrej Kral , Yael Henkin
Objective
To investigate the neural mechanisms underlying auditory processing in older adults (OAs) under conditions of sensory-perceptual (S-P) and auditory-cognitive (A-C) loads.
Methods
Electroencephalography was recorded in 20 OAs (mean age = 69.6 ± 5.2 years) with age-appropriate hearing and preserved cognition, and 20 younger adults (YAs) (mean age = 24.9 ± 1.8 years). Participants performed tasks under S-P load (quiet vs. noise), A-C load (simple vs. demanding task), and combined load. Analyses included event-related potentials and time-frequency representations.
Results
OAs showed delayed early (N1) and late (P3) cortical responses and slower reaction times (RTs) compared to YAs. Increased alpha-band desynchronization emerged as an age-related biomarker, reflecting OAs’ reduced ability to inhibit irrelevant information. Distinct load-specific processing strategies appeared: S-P load was associated with delayed neural responses across cortical stages, longer RTs, and delta- and theta-band activity. A-C load was associated with prolonged late (P3) cortical activity, slower RTs, and broader neural recruitment across all frequency bands. Under combined load, OAs showed P3 latency prolongation, revealing vulnerability to the dual challenge of noise suppression and cognitive demand.
Conclusion
Integrated time- and frequency-domain electroencephalography analyses exposed distinct listening strategies in OAs, characterized by load-specific neural signatures.
Significance
Improved understanding of auditory processing strategies in OAs will advance targeted auditory rehabilitation.
{"title":"Neural signatures of central auditory aging under sensory and cognitive loads","authors":"Yifat Yaar-Soffer , Brilliant Brilliant , Chava Muchnik , Andrej Kral , Yael Henkin","doi":"10.1016/j.clinph.2025.2111465","DOIUrl":"10.1016/j.clinph.2025.2111465","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the neural mechanisms underlying auditory processing in older adults (OAs) under conditions of sensory-perceptual (S-P) and auditory-cognitive (A-C) loads.</div></div><div><h3>Methods</h3><div>Electroencephalography was recorded in 20 OAs (mean age = 69.6 ± 5.2 years) with age-appropriate hearing and preserved cognition, and 20 younger adults (YAs) (mean age = 24.9 ± 1.8 years). Participants performed tasks under S-P load (quiet vs. noise), A-C load (simple vs. demanding task), and combined load. Analyses included event-related potentials and time-frequency representations.</div></div><div><h3>Results</h3><div>OAs showed delayed early (N1) and late (P3) cortical responses and slower reaction times (RTs) compared to YAs. Increased alpha-band desynchronization emerged as an age-related biomarker, reflecting OAs’ reduced ability to inhibit irrelevant information. Distinct load-specific processing strategies appeared: S-P load was associated with delayed neural responses across cortical stages, longer RTs, and delta- and theta-band activity. A-C load was associated with prolonged late (P3) cortical activity, slower RTs, and broader neural recruitment across all frequency bands. Under combined load, OAs showed P3 latency prolongation, revealing vulnerability to the dual challenge of noise suppression and cognitive demand.</div></div><div><h3>Conclusion</h3><div>Integrated time- and frequency-domain electroencephalography analyses exposed distinct listening strategies in OAs, characterized by load-specific neural signatures.</div></div><div><h3>Significance</h3><div>Improved understanding of auditory processing strategies in OAs will advance targeted auditory rehabilitation.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"183 ","pages":"Article 2111465"},"PeriodicalIF":3.6,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735500","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 : 2025-12-02DOI: 10.1016/j.clinph.2025.2111468
Zhongke Mei , Anna-Sophie Hofer , Christian Baumann , Mechtild Uhl , Navrag Singh , William R. Taylor , Lennart Stieglitz , Deepak K. Ravi
Objective
To investigate the relationship between the spatial location of active electrode contacts in subthalamic nucleus deep brain stimulation (STN-DBS) and changes in gait performance in patients with Parkinson’s disease (PwPD).
Methods
This observational study included 49 PwPD who underwent bilateral STN-DBS. Spatiotemporal gait parameters were assessed before surgery and six months post-implantation using motion capture. Both mean values and variability of gait parameters were analyzed. Active contact locations were normalized using a voxel-based approach and statistically associated with gait outcomes.
Results
STN-DBS led to significant reductions in stride time, stance time, swing time, and step time, alongside increased step width and temporal gait variability. Gait improvements were associated with specific stimulation sites: the postero-superior STN region was most effective for enhancing mean spatial parameters (e.g., stride length, walking speed), while the antero-superior region was optimal for reducing temporal variability. Patients stimulated in these regions showed significantly better gait outcomes than those stimulated elsewhere.
Conclusions
Gait improvements were differentially associated with the spatial location of stimulation electrode within the STN, suggesting region-specific modulation of mean spatial and temporal variability gait parameters.
Significance
These findings support precision targeting of stimulation sites to optimize patient-specific gait outcomes, advancing personalized DBS therapy in Parkinson’s disease.
{"title":"The role of electrode placement in subthalamic nucleus deep brain stimulation for improving gait in Parkinson’s Disease","authors":"Zhongke Mei , Anna-Sophie Hofer , Christian Baumann , Mechtild Uhl , Navrag Singh , William R. Taylor , Lennart Stieglitz , Deepak K. Ravi","doi":"10.1016/j.clinph.2025.2111468","DOIUrl":"10.1016/j.clinph.2025.2111468","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the relationship between the spatial location of active electrode contacts in subthalamic nucleus deep brain stimulation (STN-DBS) and changes in gait performance in patients with Parkinson’s disease (PwPD).</div></div><div><h3>Methods</h3><div>This observational study included 49 PwPD who underwent bilateral STN-DBS. Spatiotemporal gait parameters were assessed before surgery and six months post-implantation using motion capture. Both mean values and variability of gait parameters were analyzed. Active contact locations were normalized using a voxel-based approach and statistically associated with gait outcomes.</div></div><div><h3>Results</h3><div>STN-DBS led to significant reductions in stride time, stance time, swing time, and step time, alongside increased step width and temporal gait variability. Gait improvements were associated with specific stimulation sites: the postero-superior STN region was most effective for enhancing mean spatial parameters (e.g., stride length, walking speed), while the antero-superior region was optimal for reducing temporal variability. Patients stimulated in these regions showed significantly better gait outcomes than those stimulated elsewhere.</div></div><div><h3>Conclusions</h3><div>Gait improvements were differentially associated with the spatial location of stimulation electrode within the STN, suggesting region-specific modulation of mean spatial and temporal variability gait parameters.</div></div><div><h3>Significance</h3><div>These findings support precision targeting of stimulation sites to optimize patient-specific gait outcomes, advancing personalized DBS therapy in Parkinson’s disease.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"182 ","pages":"Article 2111468"},"PeriodicalIF":3.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713210","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 : 2025-12-01DOI: 10.1016/j.clinph.2025.2111467
Rocio Rodriguez Capilla , Aislinn M. Hurley , Karthik Kumaravelu , Jennifer J. Peters , Hui-Jie Lee , Dennis A. Turner , Warren M. Grill , Stephen L. Schmidt
Background
Deep brain stimulation reduces the motor symptoms of Parkinson’s disease (PD). Dual target deep brain stimulation (DT DBS) may better reduce symptoms and minimize side effects than single target, but the optimal parameters of DT DBS are unknown.
Objective
To quantify the frequency response of DT DBS on bradykinesia and beta oscillations, and to explore intrahemispheric pulse delay shifts as a means to reduce total energy delivered.
Methods
We applied DT DBS using the Summit RC + S in six participants with PD, varying DBS frequency. We further examined the effects of frequency in a biophysical model.
Results
DT DBS at 50 Hz was effective at reducing bradykinesia, whereas increasing DT DBS frequency up to 125 Hz also led to significantly lower beta power. This frequency effect on beta power was replicated in a biophysical model. The model suggested that 22 Hz DT DBS, with an intrahemispheric delay of 40 ms, can reduce beta power by 87 %.
Conclusion
This exploratory study (n = 6) suggests that 125 Hz DT DBS best reduced bradykinesia. However, low frequency DBS with an appropriate intrahemispheric delay could also improve symptom relief.
Significance
Both 125 Hz and tailored low-frequency DT DBS may achieve equivalent symptomatic control of PD symptoms.
{"title":"Effect of frequency on dual target deep brain stimulation","authors":"Rocio Rodriguez Capilla , Aislinn M. Hurley , Karthik Kumaravelu , Jennifer J. Peters , Hui-Jie Lee , Dennis A. Turner , Warren M. Grill , Stephen L. Schmidt","doi":"10.1016/j.clinph.2025.2111467","DOIUrl":"10.1016/j.clinph.2025.2111467","url":null,"abstract":"<div><h3>Background</h3><div>Deep brain stimulation reduces the motor symptoms of Parkinson’s disease (PD). Dual target deep brain stimulation (DT DBS) may better reduce symptoms and minimize side effects than single target, but the optimal parameters of DT DBS are unknown.</div></div><div><h3>Objective</h3><div>To quantify the frequency response of DT DBS on bradykinesia and beta oscillations, and to explore intrahemispheric pulse delay shifts as a means to reduce total energy delivered.</div></div><div><h3>Methods</h3><div>We applied DT DBS using the Summit RC + S in six participants with PD, varying DBS frequency. We further examined the effects of frequency in a biophysical model.</div></div><div><h3>Results</h3><div>DT DBS at 50 Hz was effective at reducing bradykinesia, whereas increasing DT DBS frequency up to 125 Hz also led to significantly lower beta power. This frequency effect on beta power was replicated in a biophysical model. The model suggested that 22 Hz DT DBS, with an intrahemispheric delay of 40 ms, can reduce beta power by 87 %.</div></div><div><h3>Conclusion</h3><div>This exploratory study (n = 6) suggests that 125 Hz DT DBS best reduced bradykinesia. However, low frequency DBS with an appropriate intrahemispheric delay could also improve symptom relief.</div></div><div><h3>Significance</h3><div>Both 125 Hz and tailored low-frequency DT DBS may achieve equivalent symptomatic control of PD symptoms.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"182 ","pages":"Article 2111467"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682016","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 : 2025-12-01DOI: 10.1016/j.clinph.2025.2111466
Minsoo Kim , Soung Wook Park , Hyun Seok Lee , Sang-Ku Park , Kwan Park
Objective
To determine whether intraoperative lateral spread response (LSR) amplitudes reflect vascular burden and configuration in hemifacial spasm.
Methods
We retrospectively reviewed consecutive microvascular decompressions at a single center. LSR I (mentalis) and LSR II (frontalis) were recorded using a standardized protocol. The primary exposure was arterial vessel count (single vs. multiple); vein-only cases were exploratory owing to imbalance. Amplitudes and derived indices (I/II ratio, I–II difference) were compared using variance-aware parametric and nonparametric tests.
Results
LSRs were obtained in most patients. LSR I exceeded LSR II with a significant paired effect. Arterial burden showed a graded pattern in LSR I, with higher amplitudes in multiple-vessel compression; however, differences across vessels counts were not significant after adjustment. No differences were observed for LSR II. Derived indices better reflected vascular burden, showing significant contrasts where raw amplitudes did not, including single-versus-multiple comparisons. Vein-only cases appeared lower but remained exploratory.
Conclusions
Intraoperative LSR amplitudes, especially at the mentalis muscle, reflect arterial burden, and derived indices improve discrimination. Findings support amplitude-based monitoring, with multicenter studies needed to confirm underlying mechanisms and predictive utility.
Significance
LSR monitoring offers a practical marker of vascular burden, potentially guiding surgical decisions and improving outcomes.
{"title":"Quantitative intraoperative lateral spread response amplitudes in hemifacial Spasm: Associations with vascular burden","authors":"Minsoo Kim , Soung Wook Park , Hyun Seok Lee , Sang-Ku Park , Kwan Park","doi":"10.1016/j.clinph.2025.2111466","DOIUrl":"10.1016/j.clinph.2025.2111466","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether intraoperative lateral spread response (LSR) amplitudes reflect vascular burden and configuration in hemifacial spasm.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive microvascular decompressions at a single center. LSR I (mentalis) and LSR II (frontalis) were recorded using a standardized protocol. The primary exposure was arterial vessel count (single vs. multiple); vein-only cases were exploratory owing to imbalance. Amplitudes and derived indices (I/II ratio, I–II difference) were compared using variance-aware parametric and nonparametric tests.</div></div><div><h3>Results</h3><div>LSRs were obtained in most patients. LSR I exceeded LSR II with a significant paired effect. Arterial burden showed a graded pattern in LSR I, with higher amplitudes in multiple-vessel compression; however, differences across vessels counts were not significant after adjustment. No differences were observed for LSR II. Derived indices better reflected vascular burden, showing significant contrasts where raw amplitudes did not, including single-versus-multiple comparisons. Vein-only cases appeared lower but remained exploratory.</div></div><div><h3>Conclusions</h3><div>Intraoperative LSR amplitudes, especially at the mentalis muscle, reflect arterial burden, and derived indices improve discrimination. Findings support amplitude-based monitoring, with multicenter studies needed to confirm underlying mechanisms and predictive utility.</div></div><div><h3>Significance</h3><div>LSR monitoring offers a practical marker of vascular burden, potentially guiding surgical decisions and improving outcomes.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"182 ","pages":"Article 2111466"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682018","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 : 2025-11-29DOI: 10.1016/j.clinph.2025.2111461
Mariem Ben Mahmoud , Adrien Benard , Delphine Taussig , Pascale Trebon , Dan Cristian Chiforeanu , Yves Sahler , Arnaud Biraben , Anca Nica , Mihai Dragos Maliia
Objective
Distinguishing drug-resistant temporal lobe epilepsy (TLE) caused by isolated hippocampal sclerosis (iHS) from focal cortical dysplasia type IIIa (FCD IIIa) remains a presurgical challenge. This study aimed to compare the clinical characteristics, electrophysiological data, and postsurgical seizure outcomes between these pathologies.
Methods
We retrospectively analyzed a cohort of 50 consecutive TLE patients (mean duration of disease of 22 years) who underwent surgery. The histopathology confirmed either iHS (n = 22) or FCD IIIa (n = 28) and a minimum follow-up of 12 months. The groups were compared on complex presurgical data, surgery type, and outcome.
Results
A history of febrile seizures (p = 0.02, OR = 4.7) was more frequent in the FCD IIIa group, which also had significantly lower intelligence quotient (IQ) scores in all domains. The mean total IQ score for FCD IIIa/iHS was 86/94 (p = 0.02); verbal IQ was 85/92 (p = 0.03); performance IQ was 89/98 (p = 0.02). The effect size was considered medium for all three (Cohen’s d = 0.7, 0.63 and 0.68 respectively). Scalp EEG showed shorter seizures in FCD IIIa (p = 0.03), in SEEG, the temporal pole was more implanted in this group (p = 0.02, 50 % difference, OR = ∞). At a mean follow-up of 8.5 years, similar seizure-freedom rates was found between groups (82 % for FCD IIIa, 95 % for iHS; p = 0.48). Follow-up EEG and neuropsychological assessment at 6 months post-surgery showed no statistical differences.
Significance
FCD IIIa and iHS exhibit several distinct electro-clinical features. The most important is a more impaired general cognitive profile associated with FCD IIIa, without differences in language or global memory.
{"title":"Isolated hippocampal sclerosis and focal dysplasia type IIIa: Comparative study of anatomo-electro-clinical profile and seizure outcome","authors":"Mariem Ben Mahmoud , Adrien Benard , Delphine Taussig , Pascale Trebon , Dan Cristian Chiforeanu , Yves Sahler , Arnaud Biraben , Anca Nica , Mihai Dragos Maliia","doi":"10.1016/j.clinph.2025.2111461","DOIUrl":"10.1016/j.clinph.2025.2111461","url":null,"abstract":"<div><h3>Objective</h3><div>Distinguishing drug-resistant temporal lobe epilepsy (TLE) caused by isolated hippocampal sclerosis (iHS) from focal cortical dysplasia type IIIa (FCD IIIa) remains a presurgical challenge. This study aimed to compare the clinical characteristics, electrophysiological data, and postsurgical seizure outcomes between these pathologies.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed a cohort of 50 consecutive TLE patients (mean duration of disease of 22 years) who underwent surgery. The histopathology confirmed either iHS (n = 22) or FCD IIIa (n = 28) and a minimum follow-up of 12 months. The groups were compared on complex presurgical data, surgery type, and outcome.</div></div><div><h3>Results</h3><div>A history of febrile seizures (p = 0.02, OR = 4.7) was more frequent in the FCD IIIa group, which also had significantly lower intelligence quotient (IQ) scores in all domains. The mean total IQ score for FCD IIIa/iHS was 86/94 (p = 0.02); verbal IQ was 85/92 (p = 0.03); performance IQ was 89/98 (p = 0.02). The effect size was considered medium for all three (Cohen’s <em>d =</em> 0.7, 0.63 and 0.68 respectively<em>).</em> Scalp EEG showed shorter seizures in FCD IIIa (p = 0.03), in SEEG, the temporal pole was more implanted in this group (p = 0.02, 50 % difference, OR = ∞). At a mean follow-up of 8.5 years, similar seizure-freedom rates was found between groups (82 % for FCD IIIa, 95 % for iHS; p = 0.48). Follow-up EEG and neuropsychological assessment at 6 months post-surgery showed no statistical differences.</div></div><div><h3>Significance</h3><div>FCD IIIa and iHS exhibit several distinct electro-clinical features. The most important is a more impaired general cognitive profile associated with FCD IIIa, without differences in language or global memory.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"182 ","pages":"Article 2111461"},"PeriodicalIF":3.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682019","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 : 2025-11-26DOI: 10.1016/j.clinph.2025.2111459
Alberto Benussi , Steve Vucic
This chapter examines how emerging neurophysiological technologies are transforming the early and differential diagnosis of neurological disorders. While imaging and fluid biomarkers have greatly advanced the field, they remain limited by cost, invasiveness, and their inability to directly capture dynamic brain activity. Neurophysiological techniques, particularly transcranial magnetic stimulation (TMS) and TMS combined with EEG, offer a unique, non-invasive means of probing cortical excitability, connectivity, and plasticity with millisecond precision.
Recent technological and analytical breakthroughs are moving these approaches from research laboratories into clinical practice. By detecting subtle network dysfunctions that precede structural degeneration, they open the possibility of identifying disease in its prodromal or even presymptomatic stages, when interventions may be most effective. This chapter outlines the principles of advanced TMS paradigms and TMS-EEG and explores their application across a range of conditions, including amyotrophic lateral sclerosis, dementias, and movement disorders. It also highlights how integrating neurophysiological measures with blood-based biomarkers and computational tools, such as machine learning, can enhance diagnostic accuracy and guide individualized treatment strategies.
Together, these innovations establish neurophysiology as a cornerstone of precision neurology, linking mechanistic insights to clinical decision-making and enabling earlier diagnosis, improved patient stratification, and more targeted therapeutic interventions.
{"title":"Emergent technologies and applications of TMS and TMS-EEG in clinical neurophysiology for early and differential diagnosis: IFCN handbook chapter","authors":"Alberto Benussi , Steve Vucic","doi":"10.1016/j.clinph.2025.2111459","DOIUrl":"10.1016/j.clinph.2025.2111459","url":null,"abstract":"<div><div>This chapter examines how emerging neurophysiological technologies are transforming the early and differential diagnosis of neurological disorders. While imaging and fluid biomarkers have greatly advanced the field, they remain limited by cost, invasiveness, and their inability to directly capture dynamic brain activity. Neurophysiological techniques, particularly transcranial magnetic stimulation (TMS) and TMS combined with EEG, offer a unique, non-invasive means of probing cortical excitability, connectivity, and plasticity with millisecond precision.</div><div>Recent technological and analytical breakthroughs are moving these approaches from research laboratories into clinical practice. By detecting subtle network dysfunctions that precede structural degeneration, they open the possibility of identifying disease in its prodromal or even presymptomatic stages, when interventions may be most effective. This chapter outlines the principles of advanced TMS paradigms and TMS-EEG and explores their application across a range of conditions, including amyotrophic lateral sclerosis, dementias, and movement disorders. It also highlights how integrating neurophysiological measures with blood-based biomarkers and computational tools, such as machine learning, can enhance diagnostic accuracy and guide individualized treatment strategies.</div><div>Together, these innovations establish neurophysiology as a cornerstone of precision neurology, linking mechanistic insights to clinical decision-making and enabling earlier diagnosis, improved patient stratification, and more targeted therapeutic interventions.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"182 ","pages":"Article 2111459"},"PeriodicalIF":3.6,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616624","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 : 2025-11-25DOI: 10.1016/j.clinph.2025.2111460
Thaera Arafat , Zhengchen Cai , Jean Gotman
Simultaneous EEG-fMRI is a unique, noninvasive neuroimaging technique that enables high spatial resolution mapping of metabolic changes linked to EEG epileptic discharges in focal and generalized epilepsy, reflected through fMRI signals. It is increasingly recognized as a valuable tool in the presurgical evaluation of drug-resistant epilepsy, supporting the localization of epileptogenic zones, guiding electrode implantation, and informing surgical strategies and outcome prediction, while also revealing important insights into the networks involved in epileptic activity.
Advances in artifact removal, automated spike detection, and statistical modeling have improved EEG-fMRI’s data quality and clinical utility. It is particularly valuable in diagnostically challenging cases where standard EEG is not localizing, or MRI findings are negative. However, its routine clinical adoption is limited by the complexity of the procedure, the lack of standardized protocols, interpretation criteria, and broader validation across diverse epilepsy populations.
This review highlights EEG-fMRI’s evolving role in localizing epileptic discharges, emphasizing both methodological and clinical aspects. It covers the process from data acquisition through analysis to statistical interpretation and decision-making, with its application in distinguishing generalized from widespread activity, assessing thalamic involvement in focal epilepsy, evaluating status epilepticus, mapping blood oxygen–level dependent responses in relation to structural lesions, and supporting presurgical planning in complex cases, demonstrating its potential to improve diagnostic precision and treatment outcomes.
{"title":"Clinical and methodological advances in EEG-fMRI for epilepsy: a focused review","authors":"Thaera Arafat , Zhengchen Cai , Jean Gotman","doi":"10.1016/j.clinph.2025.2111460","DOIUrl":"10.1016/j.clinph.2025.2111460","url":null,"abstract":"<div><div>Simultaneous EEG-fMRI is a unique, noninvasive neuroimaging technique that enables high spatial resolution mapping of metabolic changes linked to EEG epileptic discharges in focal and generalized epilepsy, reflected through fMRI signals. It is increasingly recognized as a valuable tool in the presurgical evaluation of drug-resistant epilepsy, supporting the localization of epileptogenic zones, guiding electrode implantation, and informing surgical strategies and outcome prediction, while also revealing important insights into the networks involved in epileptic activity.</div><div>Advances in artifact removal, automated spike detection, and statistical modeling have improved EEG-fMRI’s data quality and clinical utility. It is particularly valuable in diagnostically challenging cases where standard EEG is not localizing, or MRI findings are negative. However, its routine clinical adoption is limited by the complexity of the procedure, the lack of standardized protocols, interpretation criteria, and broader validation across diverse epilepsy populations.</div><div>This review highlights EEG-fMRI’s evolving role in localizing epileptic discharges, emphasizing both methodological and clinical aspects. It covers the process from data acquisition through analysis to statistical interpretation and decision-making, with its application in distinguishing generalized from widespread activity, assessing thalamic involvement in focal epilepsy, evaluating status epilepticus, mapping blood oxygen–level dependent responses in relation to structural lesions, and supporting presurgical planning in complex cases, demonstrating its potential to improve diagnostic precision and treatment outcomes.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"182 ","pages":"Article 2111460"},"PeriodicalIF":3.6,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682020","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号