Clinical Neurophysiology最新文献

Objective

Our aim is to explore the value of intraoperative facial motor evoked potentials (FMEP) for facial outcomes in cerebellopontine angle (CPA) tumor surgery to provide an evidence-based consensus standard for future clinical practice and prospective studies.

Methods

Electronic databases were searched from inception to June 2023. Study quality was assessed with the QUADAS-2 tool. Bivariate and random-effects models for meta-analysis and meta-regression generated summary receiver operating characteristic curves (ROC) and forest plots for estimates of sensitivity and specificity.

Results

We included 17 studies (1,206 participants). Sensitivity was lower in the immediate (IM) post-operative (0.76, 95% CI 0.65–0.84) compared to follow-up (FU) period (0.82, 95% CI 0.74–0.88) while specificity was similar in both groups (IM, 0.94, 95% CI 0.89–0.97; FU, 0.93, 95% CI 0.87–0.96). Data driven estimates improved FMEP performance but require confirmation from future studies. Amplitude cutoff criteria and studies that scored new deficits as worse than House-Brackmann (HB) grade 2 yielded best sensitivities.

Conclusions

FMEP demonstrated statistically significant accuracy for facial function monitoring. Implementation of FMEPs varied widely across studies.

Significance

Our study is the first systematic review with meta-analysis to demonstrate that intraoperative FMEP is valuable in CPA tumor surgery for facial outcomes. Meta-regression identified the methods that were most useful in the application of FMEPs.

Objective

To assess the value of combining brain and autonomic measures to discriminate the subjective perception of pain from other sensory-cognitive activations.

Methods

20 healthy individuals received 2 types of tonic painful stimulation delivered to the hand: electrical stimuli and immersion in 10 Celsius degree (°C) water, which were contrasted with non-painful immersion in 15 °C water, and stressful cognitive testing. High-density electroencephalography (EEG) and autonomic measures (pupillary, electrodermal and cardiovascular) were continuously recorded, and the accuracy of pain detection based on combinations of electrophysiological features was assessed using machine learning procedures.

Results

Painful stimuli induced a significant decrease in contralateral EEG alpha power. Cardiac, electrodermal and pupillary reactivities occurred in both painful and stressful conditions. Classification models, trained on leave-one-out cross-validation folds, showed low accuracy (61–73%) of cortical and autonomic features taken independently, while their combination significantly improved accuracy to 93% in individual reports.

Conclusions

Changes in cortical oscillations reflecting somatosensory salience and autonomic changes reflecting arousal can be triggered by many activating signals other than pain; conversely, the simultaneous occurrence of somatosensory activation plus strong autonomic arousal has great probability of reflecting pain uniquely.

Significance

Combining changes in cortical and autonomic reactivities appears critical to derive accurate indexes of acute pain perception.

Objective

Cortical spreading depolarization is one possible pathogenesis of migraine, of which slow neurophysiological change is barely recorded in conventional EEG settings. Using wide-band EEG conditions, we reappraised the features of EEG in migraineurs, including subdelta-band EEG changes.

Methods

This retrospective study included 144 patients with migraine. We delineated EEG of focal delta slow (FDS) (1–4 Hz) by time constant (TC) 0.3 s and focal subdelta slow (FSDS) (< 1 Hz) by TC 2 s. Relationships between clinical variables and EEG findings were evaluated.

Results

Of 144 patients, 39 had aura and 105 did not. FSDS and FDS were observed in 38 and 58 patients, respectively. No EEG was recorded during the aura. In multivariate analysis with the phase of migraine, family history, age, and percentage of sleep during EEG recording, the phase of migraine was related to the occurrence of FSDS (postdrome vs interictal, prodrome, and headache respectively (OR = 49.00 [95% CI = 3.89–616.66], 46.28 [2.99–715.78], 32.79 [2.23–481.96], p = 0.0026, 0.0061, 0.011). FDS was clinically unremarkable for differential evaluation.

Conclusions

Wide-band EEG abnormality in migraineurs, i.e., FSDS, can be affected by migraine phase.

Significance

Wide-band EEG finding could be a biomarker related to clinical variables in migraines.

Objectives

Individuals with dyslexia perceive and utilize statistical features in the auditory input deficiently. The present study investigates whether affected children also benefit less from repeating context tones as perceptual anchors for subsequent speech processing.

Methods

In an event-related potential study, eleven-year-old children with dyslexia (n = 21) and without dyslexia (n = 20) heard syllable pairs, with the first syllable either receiving a constant pitch (anchor) or variable pitch (no-anchor), while second syllables were identical across conditions.

Results

Children with and without dyslexia showed smaller auditory P2 responses to constant-pitch versus variable-pitch first syllables, while only control children additionally showed smaller N1 and faster P1 responses. This suggests less automatic processing of anchor repetitions in dyslexia. For the second syllables, both groups showed faster P2 responses following anchor than no-anchor first syllables, but only controls additionally showed smaller P2 responses.

Conclusions

Children with and without dyslexia show differences in anchor effects. While both groups seem to allocate less attention to speech stimuli after contextual repetitions, children with dyslexia display less facilitation in speech processing from acoustic anchors.

Significance

Altered anchoring in the linguistic domain may contribute to the difficulties of individuals with dyslexia in establishing long-term representations of speech.

Objective

The study aimed to address the challenge of early assessment of neonatal hypoxic-ischemic encephalopathy (HIE) severity to identify candidates for therapeutic hypothermia (TH). The objective was to develop an automated classification model for neonatal EEGs, enabling accurate HIE severity assessment 24/7.

Methods

EEGs recorded within 6 h of life after perinatal anoxia were visually graded into 3 severity groups (HIE French Classification) and quantified using 6 qEEG markers measuring amplitude, continuity and frequency content. Machine learning models were developed on a dataset of 90 EEGs and validated on an independent dataset of 60 EEGs.

Results

The selected model achieved an overall accuracy of 80.6% in the development phase and 80% in the validation phase. Notably, the model accurately identified 28 out of 30 children for whom TH was indicated after visual EEG analysis, with only 2 cases (moderate EEG abnormalities) not recommended for cooling.

Conclusions

The combination of clinically relevant qEEG markers led to the development of an effective automated EEG classification model, particularly suited for the post-anoxic latency phase. This model successfully discriminated neonates requiring TH.

Significance

The proposed model has potential as a bedside clinical decision support tool for TH.

Objective

Motor Unit Number Estimation (MUNE) techniques are crucial in assessing lower motor neuron loss. MScanFit MUNE (MScanFit) is a novel tool which estimates MUNE values from compound muscle action potential (CMAP) scans by considering the probabilistic nature of motor unit firing. We conducted a prospective study to evaluate the diagnostic utility of MScanFit compared to quantitative electromyography (qEMG) in ALS patients.

Methods

We enrolled 35 patients diagnosed with amyotrophic lateral sclerosis (ALS) and 14 healthy controls, assessing qEMG and MScanFit MUNE in abductor pollicis brevis, abductor digiti minimi and tibialis anterior muscles.

Results

We found higher sensitivity of qEMG in detecting abnormalities compared to MScanFit, with a high concordance rate between the two techniques. Notably, a few muscles exhibited abnormal MUNE but normal qEMG findings, suggesting a potential complementary role for MScanFit in ALS diagnosis. Neurophysiological parameters from MScanFit showed good correlations with qEMG measures. Subclinical neurophysiological involvement was observed in muscles with normal strength, emphasizing the importance of sensitive diagnostic tools.

Conclusion

MScanFit demonstrated validity in distinguishing ALS patients from healthy subjects and correlated well with qEMG parameters.

Significance

Our study confirmed the diagnostic utility of MScanFit MUNE in ALS, highlighting its role as a supplementary diagnostic tool.

Objective

The Corollary Discharge (CD) mechanism inhibits self-generated speech sound perception, appearing disrupted in schizophrenia and potentially contributing to Anomalous Self-Experiences (ASEs). However, it remains unclear if this alteration and its correlation with ASEs extend to other psychotic disorders.

Methods

Electroencephalography was used to study the N1 Event-Related Potential (ERP) as an index of CD-mediated suppression in the auditory cortex across thirty-five participants with schizophrenia, twenty-six with bipolar disorder, and thirty healthy controls. Auditory N1 was elicited by two conditions: real-time listening to self-pronounced vowels while speaking through connected microphone and earphones (listen/talk −or talk condition in previous literature-) and passive listening to the same previously recorded self-uttered vowels (listen/no talk −or listen condition-).

Results

N1 ERP amplitude was lower in the listen/talk condition compared to listen/no talk across all groups. However, N1 suppression was significantly reduced in schizophrenia, with bipolar patients showing intermediate attenuation between both groups (i.e., non-significantly different from controls). Furthermore, N1 suppression inversely correlated with ASEs severity only in schizophrenia.

Conclusions

Dysfunction of the CD mechanism may be a defining feature of schizophrenia, where it is connected to ASEs.

Significance

These results corroborate previous findings linking auditory N1 ERP suppression with disrupted CD mechanism in schizophrenia, but not in bipolar disorder.

Objective

This study aimed to identify electroencephalogram correlates of dream enactment behaviors (DEBs) and elucidate their cortical dynamics in patients with isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD).

Methods

This cross-sectional study included 15 patients with iRBD. Two REM sleep periods in routine polysomnography were compared: the 60 s preceding the DEBs (“pre-representative behavior” [preR]), and the 60 s with the least submental electromyogram activity (“background” [BG]). Six EEG frequency bands and electrooculogram were analyzed; power spectra, coherence and phase-locking values in four 15-s periods were examined to assess trends. These indices were also compared between preR and BG.

Results

Compared with BG, significantly higher delta power in the F3 channel and gamma power in the F4 and O2 channels were observed during preR. For functional connectivity, the widespread beta-band connectivity was significantly increased during preR than BG.

Conclusion

Before notable REM sleep behaviors, uneven distributed higher EEG spectral power in both very low and high frequencies, and increased wide-range beta band functional connectivity, were observed over 60 s, suggesting cortical correlates to subsequent DEBs.

Significance

This study may shed light on the pathological mechanisms underlies RBD through the routine vPSG analysis, leading to detection of DEBs.

Objective

The purpose of this study was to evaluate the applicability of visual evoked potentials (VEP) for intraoperative visual pathway monitoring in epilepsy surgery of the posterior hemispheric quadrant (PHQ) and to correlate it with post-operative visual field status.

Methods

VEP monitoring was performed in 16 patients (12 females, 7 children). Flash-induced VEP were recorded with strip electrodes from the banks of the calcarine cortex. Latency and amplitude of the first component of VEP (V1-lat, V1-amp) were monitored. Evaluation of the visual field was performed pre- and post-operatively in all patients.

Results

All procedures were successfully completed without adverse events.

In 10 patients the strip covered both the inferior and superior calcarine banks, while only one bank was sampled in 6 cases (inferior in 4, superior in 2). Considering one of the two calcarine banks, at the end of the resection VEP had disappeared in 4 patients, whereas a decrease >33.3% in 4 and <20% of V1-amp was recorded in 5 and in 4 cases respectively. The percentage of V1-amp reduction was significantly higher for the patients who experienced a post-operative visual field reduction (p < 0.001). Post-operative visual field deficits were found in patients presenting a reduction >33.3% of V1-amp.

Conclusions

VEP monitoring is possible and safe in epilepsy surgery under general anesthesia.

Significance

Intraoperative recording of VEP from the banks of the calcarine cortex allows monitoring the integrity of post-geniculate visual pathways during PHQ resections for epilepsy and it is pivotal to prevent disabling visual field defects, including hemianopia and inferior quadrantanopia.

Objectives

The mental parsing of linguistic hierarchy is crucial for language comprehension, and while there is growing interest in the cortical tracking of auditory speech, the neurophysiological substrates for tracking written language are still unclear.

Methods

We recorded electroencephalographic (EEG) responses from participants exposed to auditory and visual streams of either random syllables or tri-syllabic real words. Using a frequency-tagging approach, we analyzed the neural representations of physically presented (i.e., syllables) and mentally constructed (i.e., words) linguistic units and compared them between the two sensory modalities.

Results

We found that tracking syllables is partially modality dependent, with anterior and posterior scalp regions more involved in the tracking of spoken and written syllables, respectively. The cortical tracking of spoken and written words instead was found to involve a shared anterior region to a similar degree, suggesting a modality-independent process for word tracking.

Conclusion

Our study suggests that basic linguistic features are represented in a sensory modality-specific manner, while more abstract ones are modality-unspecific during the online processing of continuous language input.

Significance

The current methodology may be utilized in future research to examine the development of reading skills, especially the deficiencies in fluent reading among those with dyslexia.