Clinical Neurophysiology最新文献

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.

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.

Objective

We aim to investigate the relationship between the core symptoms of autism, anxiety levels, and attention deficit hyperactivity disorder (ADHD) traits, and a non-autism-specific, neurophysiological metric, the Delta-Beta phase-amplitude coupling (PAC), extracted from the resting-state EEG for autistic and non-autistic populations across three different age groups (children, adolescents, and adults).

Methods

We analyze the eyes-open resting-state EEG of 371 individuals. We applied a phase de-biasing PAC algorithm expected to result in a more accurate PAC estimate than other PAC methodologies available in the literature.

Results

In the adult group, we found a significant increase of the delta-beta PAC in the autistic subgroup who met the Autism Diagnostic Observation Schedule-2 (ADOS-2) Autism Diagnostic Interview-Revised (ADR-R) ADOS-2/ADI-R threshold compared to non-autistic individuals. The differences seem age-specific since we found no statistically significant differences in the children and adolescent populations. Moreover, we found a significant positive correlation with the restricted and repetitive behaviours score of the ADOS-2 diagnostic instrument and with ADHD hyperactivity/impulsivity in the entire autistic cohort.

Conclusions

The neurophysiological differences we found only in the autistic individuals that meet the thresholds also point out the need for future studies that look for autistic neurodiverse subgroups beyond age.

Significance

The delta-beta debiasing PAC (dPAC) may potentially serve as a severity biomarker in the autistic population.

Objective

Methods

Results

Conclusions

Significance

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.

Objective

Repeated spaced sessions of repetitive transcranial magnetic stimulation (TMS) to the human primary motor cortex can lead to dose-dependent increases in motor cortical excitability. However, this has yet to be demonstrated in a defined cortical circuit. We aimed to examine the effects of repeated spaced cortical paired associative stimulation (cPAS) on excitability in the motor cortex.

Methods

cPAS was delivered to the primary motor cortex (M1) and posterior parietal cortex (PPC) with two coils. In the multi-dose condition, three sessions of cPAS were delivered 50-min apart. The single-dose condition had one session of cPAS, followed by two sessions of a control cPAS protocol. Motor-evoked potentials were evaluated before and up to 40 min after each cPAS session as a measure of cortical excitability.

Results

Compared to a single dose of cPAS, motor cortical excitability significantly increased after multi-dose cPAS. Increasing the number of cPAS sessions resulted in a cumulative, dose-dependent effect on excitability in the motor cortex, with each successive cPAS session leading to notable increases in potentiation.

Conclusion

Repeated spaced cPAS sessions summate to increase motor cortical excitability induced by single cPAS.

Significance

Repeated spaced cPAS could potentially restore abilities lost due to disorders like stroke.

Objective

Clinical exploitation of transcranial electrical stimulation for focal epilepsy treatment lacks quantification of the underlying neurophysiological changes. This study explores the immediate effects of transcranial alternating (tACS) and direct (tDCS) current stimulation on local and network brain activity using simultaneous stereoelectroencephalography (SEEG) recordings.

Methods

Patients were randomized for personalized tACS (n = 5) or tDCS (n = 6). Active stimulation (20 min) was preceded by sham stimulation (20 min). Changes in interictal epileptiform discharges (IED), functional connectivity (FC) and power spectral density (PSD) were quantified against baseline.

Results

Results demonstrated variable responses. Spike rate decreased in 2/6 subjects following sham and tDCS, while 2/6 showed an increase. Alpha power and aperiodic PSD components generally increased during and after tDCS but decreased following tACS. FC changes varied among subjects and were detectable even during sham sessions.

Conclusions

Strong variability suggests that tES does not have a univocal effect on immediate changes in IED or FC, possibly due to the single session format and challenges in affecting subcortical areas.

Significance

This is the first study to examine intracranial FC changes during tACS and tDCS, highlighting the importance of sham comparisons and individual variability in tES response, offering valuable insights into its application for epilepsy treatment.

Objective

Auditory and somatosensory prepulses are commonly used to assess prepulse inhibition (PPI). The effect of a vestibular prepulse upon blink reflex excitability has not been hitherto assessed.

Methods

Twenty-two healthy subjects and two patients with bilateral peripheral vestibular failure took part in the study. Whole body yaw rotation in the dark provided a vestibular inertial prepulse. Blink reflex was electrically evoked after the end of the rotation. The amplitude of R1 and the area-under-the-curve (area) of the blink reflex R2 and R2c responses were recorded and analysed.

Results

A vestibular prepulse inhibited the R2 (p < 0.001) and R2c area (p < 0.05). Increasing the angular acceleration did not increase the R2 and R2c inhibition (p > 0.05). Voluntary suppression of the vestibulo-ocular reflex did not affect the magnitude of inhibition (p > 0.05). Patients with peripheral vestibular failure did not show any inhibition.

Conclusions

Our data support a vestibular gating mechanism in humans.

Significance

The main brainstem nucleus mediating PPI – the pedunculopontine nucleus (PPN) – is heavily vestibular responsive, which is consistent with our findings of a vestibular-mediated PPI. Our technique may be used to interrogate the fidelity of brain circuits mediating vestibular-related PPN functions. Given the PPN’s importance in human postural control, our technique may also provide a neurophysiological biomarker of balance.

Objectives

Motor symptoms of Parkinson’s disease improve during REM sleep behavior disorder movement episodes. Our aim was to study cortical activity during these movement episodes, in patients with and without Parkinson’s disease, in order to investigate the cortical involvement in the generation of its electromyographic activity and its potential relationship with Parkinson’s disease.

Methods

We looked retrospectively in our polysomnography database for patients with REM sleep behavior disorder, analyzing fifteen patients in total, seven with idiopathic REM sleep behavior disorder and eight associated with Parkinson’s disease. We selected segments of REM sleep with the presence of movements (evidenced by electromyographic activation), and studied movement-related changes in cortical activity by averaging the electroencephalographic signal (premotor potential) and by means of time/frequency transforms.

Results

We found a premotor potential and an energy decrease of alpha–beta oscillatory activity preceding the onset of electromyographic activity, together with an increase of gamma activity for the duration of the movement. All these changes were similarly present in REM sleep behavior disorder patients with and without Parkinson’s disease.

Conclusions

Movement-related changes in electroencephalographic activity observed in REM sleep behavior disorder are similar to those observed during voluntary movements, regardless of the presence of Parkinson’s disease motor symptoms.

Significance

These results suggest a main involvement of the cortex in the generation of the movements during REM sleep.