Clinical Neurophysiology最新文献

英文中文

Correlation of preoperative and intraoperative motor cortex excitability in brain tumor patients using regressions and machine learning 应用回归和机器学习分析脑肿瘤患者术前和术中运动皮质兴奋性的相关性。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-21 DOI: 10.1016/j.clinph.2025.2111384

Hanna Lenggenhager , Jonathan Wermelinger , Philippe Schucht, Claire Descombes, Andreas Raabe, Katharina Lutz , Kathleen Seidel

Objective

We compared the preoperative navigated transcranial magnetic stimulation (nTMS) resting motor threshold (RMT) with the intraoperative neurophysiological monitoring (IONM) motor threshold (MT) in relation to clinical and tumor characteristics.

Methods

We retrospectively analyzed the data of 65 patients with motor eloquent supratentorial tumors, preoperative nTMS and resection with IONM. An nTMS and IONM threshold ratio was defined by dividing the motor evoked potential (MEP) (R)MT of the tumor-affected side by that of the healthy side. A random forest (machine learning (ML) algorithm) was implemented to distinguish the tumor side from the healthy side based on MEPs.

Results

Tumor side nTMS-RMT and IONM-MT were significantly higher than that of the healthy side, most notably for tumors in the precentral gyrus. A positive linear correlation between nTMS-RMT_ratio and IONM-MT_ratio was observed. The random forest classifier achieved an accuracy of >90 % with the nTMS and IONM MEP data.

Conclusion

We observed lower excitability in the tumor-affected hemisphere in pre- and intraoperative data, particularly with tumors in the precentral gyrus. Low preoperative excitability during nTMS correlated with lower intraoperative excitability.

Significance

Preoperative nTMS mapping might influence the selection of intraoperative stimulation intensities to reduce the risk of false negative mapping.

目的：比较术前导航经颅磁刺激（nTMS）静息运动阈值（RMT）与术中神经生理监测（IONM）运动阈值（MT）与临床和肿瘤特征的关系。方法：回顾性分析65例幕上肿瘤患者术前nTMS及IONM切除的资料。用肿瘤一侧的运动诱发电位（MEP） (R)MT除以健康侧的运动诱发电位(R)MT来定义nTMS和IONM阈值比值。基于mep实现随机森林（机器学习（ML）算法）来区分肿瘤侧和健康侧。结果：肿瘤侧nTMS-RMT和IONM-MT均显著高于健康侧，以中心前回肿瘤最为显著。nTMS-RMTratio与IONM-MTratio呈线性正相关。随机森林分类器在nTMS和IONM MEP数据上的准确率达到了90%。结论：我们在术前和术中观察到肿瘤影响半球的低兴奋性，特别是在中央前回的肿瘤。nTMS期间术前低兴奋性与术中低兴奋性相关。意义：术前nTMS测图可能影响术中刺激强度的选择，以降低假阴性测图的风险。

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引用次数: 0

Risk factors for intraoperative seizures during asleep motor evoked potential monitoring in supratentorial surgery 幕上手术中睡眠运动诱发电位监测术中癫痫发作的危险因素

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-17 DOI: 10.1016/j.clinph.2025.2111387

Cristiano Parisi , Davide Giampiccolo , Vincenzo Tramontano , Pietro Meneghelli , Nicola Tommasi , Marco Galuppo , Federica Basaldella , Francesco Sala

Objective

Intraoperative-seizures(IOS) following direct electrical stimulation(DES) affects intraoperative neurophysiological monitoring(IONM) and may lead to stop surgical resection. We analyzed IOS risk factors during asleep brain surgery.

Methods

We reviewed 232 consecutive patients who underwent surgery for supratentorial brain lesions with IONM, that consisted in motor evoked potentials monitoring and mapping, elicited by DES using the train-of-five technique. Preoperative history of seizures, paresis, use of anti-seizure medications(ASM), stimulated cortical regions, histology, and motor performance were evaluated.

IOS was defined as clinical seizure or an after-discharge.

Results

IOS occurred in 35 patients (15.1 %). IOS risk increased with higher stimulation intensities, younger age, cavernomas, and a history of seizures, especially in patients without ASM at the time of surgery. IOS did not significantly impact the extent of resection or clinical outcome, but prolonged hospital stays.

Conclusion

Our findings suggest that lower stimulation intensities are advisable when operating on patients with specific risk factors for IOS.

Significance

We observed a significant increase in IOS risk with stimulation above 20 mA, thresholds being lower in high-risk patients. Tailored stimulation can reduce the risk of IOS. This study presents a large series on IOS risk factors during asleep surgeries and provides a review of these factors.

目的直接电刺激（DES）后术中癫痫发作（IOS）影响术中神经生理监测（IONM），可能导致手术停止切除。我们分析了睡眠脑外科手术中IOS的危险因素。方法我们回顾了232例连续接受脑幕上病变手术的患者，其中包括运动诱发电位监测和作图，由DES使用五列技术引发。评估术前癫痫发作史、轻瘫、抗癫痫药物（ASM）的使用、受刺激的皮质区域、组织学和运动表现。IOS定义为临床发作或出院后。结果35例患者发生os，占15.1%。刺激强度越高、年龄越小、有海绵状瘤、有癫痫发作史，尤其是手术时无ASM的患者，发生IOS的风险越高。IOS对切除程度或临床结果没有显著影响，但会延长住院时间。结论对于有特定危险因素的患者，宜降低刺激强度。我们观察到，当刺激超过20 mA时，IOS风险显著增加，高危患者的阈值较低。量身定制的刺激可以降低IOS的风险。本研究提出了一系列关于睡眠手术中IOS的危险因素，并对这些因素进行了综述。

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引用次数: 0

Phase cancellations of Aδ sensory fibers revealed by lidocaine 利多卡因显示的Aδ感觉纤维相消

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-17 DOI: 10.1016/j.clinph.2025.2111389

Winfried Raabe

引用次数: 0

Corticospinal imbalance following major upper limb amputation is transiently modulated by continuous theta burst stimulation 主要上肢截肢后的皮质脊髓失衡可通过持续的θ波爆发刺激进行短暂调节

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-16 DOI: 10.1016/j.clinph.2025.2111381

Emma Falato , Federico Ranieri , Gabriella Musumeci , Marco D’Alonzo , Fioravante Capone , Giovanni Di Pino , Fabio Pilato , Vincenzo Di Lazzaro

Objective

Major upper limb amputation (mULA) induces neuroplastic changes that can impact neurorehabilitation and prosthetic control. Previous literature suggested heightened corticospinal excitability (CE) in the hemisphere contralateral to the amputation (CLH). This interhemispheric imbalance in CE might represent a maladaptive process. We aimed to assess baseline CE in individuals with chronic mULA and the acute effects of continuous theta burst stimulation (cTBS) applied to the primary motor cortex (M1) contralateral to the amputation.

Methods

Thirteen adults with chronic transradial or transhumeral mULA underwent electrophysiological assessments before and after unilateral cTBS. CE was measured through motor-evoked potential (MEP) amplitudes at baseline, 5 and 10 min post-stimulation. Linear mixed models assessed the effects of Hemisphere (contralateral vs ipsilateral), Time (baseline, 5, 10 min), and their interaction.

Results

Group-level analyses indicated higher MEP amplitudes in the CLH compared with the ipsilateral hemisphere. cTBS was associated with a transient reduction of MEP amplitudes in the stimulated CLH at 5 minutes, with partial recovery at 10 minutes, leading to a temporary attenuation of interhemispheric asymmetry.

Conclusions

These findings suggest that cTBS may transiently modulate CE in chronic mULA, with effects that appear restricted to the stimulated hemisphere.

Significance

This study provides preliminary evidence of interhemispheric asymmetry in CE after mULA and indicates that cTBS could represent a potential tool to modulate it. Further studies are needed to establish robustness and clinical relevance.

目的：主要上肢截肢（mULA）引起神经可塑性改变，影响神经康复和假肢控制。先前的文献表明，在截肢（CLH）的对侧半球皮质脊髓兴奋性（CE）升高。CE的这种半球间失衡可能代表了一种适应不良的过程。我们的目的是评估慢性mULA患者的基线CE和持续θ波爆发刺激（cTBS）对截肢侧初级运动皮质（M1）的急性效果。方法对13例成人慢性经桡骨或肱骨mULA患者行单侧cTBS前后电生理评估。通过运动诱发电位（MEP）在基线、刺激后5和10分钟测量CE。线性混合模型评估了半球（对侧与同侧）、时间（基线、5分钟、10分钟）及其相互作用的影响。结果组水平分析显示，与同侧半球相比，CLH的MEP振幅更高。cTBS与受刺激CLH的MEP振幅在5分钟内短暂降低有关，在10分钟后部分恢复，导致半球间不对称性暂时减弱。这些发现表明cTBS可能会短暂地调节慢性mULA的CE，其作用似乎仅限于受刺激的半球。本研究提供了mULA后CE半球间不对称的初步证据，表明cTBS可能是一种潜在的调节工具。需要进一步的研究来建立稳健性和临床相关性。

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引用次数: 0

Attenuated theta-band activity and cross-frequency coupling in schizophrenia during affective response inhibition 情感反应抑制期间精神分裂症的θ波段活性减弱和交叉频率耦合。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-15 DOI: 10.1016/j.clinph.2025.2111386

Jacob D. Kraft , Takakuni Suzuki , Margo W. Menkes , Carolyn M. Andrews , Melvin G. McInnis , Patricia J. Deldin , Ivy F. Tso

Objective

Schizophrenia (SZ) is marked by impaired cognitive control; however, the underlying neural mechanisms remain unclear. This study examined theta-band (4–7 Hz) neural oscillatory activity and cross-frequency coupling with gamma (30–50 Hz) in an affective cognitive control paradigm in SZ in comparison with healthy controls (HC) and those with bipolar disorder (BD). Methods: Thirty-two participants with SZ, 67 with BD, and 48 HC completed an affective Go/No-Go Task with emotional face stimuli during electroencephalography recording. Time-frequency decomposition quantified theta-band power and intertrial phase consistency (ITPC) over midline fronto-central areas. Theta-gamma phase-amplitude coupling (PAC; Kullback-Leibler Modulation Index) was indexed within the midline frontal area and cross-regionally between midline frontal theta and bilateral parietal gamma. Results: Participants with SZ displayed decreased midline frontal theta power, ITPC, and local midline frontal theta-gamma PAC compared to HC, with BD falling in between SZ and HC groups across all these measures. Theta power, ITPC, and theta-gamma PAC were correlated with behavioral performance, particularly in the SZ group. Conclusion: Findings show abnormalities across the amplitude, phase consistency, and cross-frequency coordination aspects of theta-related activity when individuals with SZ engage in affective cognitive control. Significance: This study supports the assertion that SZ is associated with abnormal theta-related neural activity.

目的：精神分裂症（SZ）以认知控制功能受损为特征；然而，潜在的神经机制尚不清楚。本研究考察了情感认知控制范式下SZ与健康对照（HC）和双相情感障碍（BD）患者的theta波段（4- 7hz）神经振荡活动和与gamma （30- 50hz）的交叉频率耦合。方法：在脑电图记录中，32例SZ、67例BD和48例HC患者完成了情绪性面部刺激的情感性Go/No-Go任务。时频分解量化了中线前中央区域的波段功率和试验间相位一致性。theta -gamma相位振幅耦合（PAC； Kullback-Leibler调制指数）在额叶中线区域内以及额叶中线θ和双侧顶叶伽马之间的跨区域被索引。结果：与HC组相比，SZ组的参与者表现出较低的中线额波功率、ITPC和局部中线额波theta-gamma PAC，在所有这些测量中，BD介于SZ组和HC组之间。Theta功率、ITPC和Theta -gamma PAC与行为表现相关，尤其是在SZ组。结论：研究结果显示，当SZ患者参与情感认知控制时，theta相关活动的振幅、相位一致性和交叉频率协调方面都存在异常。意义：本研究支持SZ与异常的θ相关神经活动相关的论断。

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引用次数: 0

Progress in the combined application of Brain-Computer Interface and non-invasive brain stimulation for post-stroke motor recovery 脑机接口与无创脑刺激联合应用在脑卒中后运动恢复中的研究进展。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-12 DOI: 10.1016/j.clinph.2025.2111383

Ailipinai Yasen , Wanting Sun , Yan Gong , Guangxu Xu

Stroke remains one of the leading causes of disability and death among adults globally. Both Brain-Computer Interface (BCI) and Non-invasive Brain Stimulation (NIBS) have shown significant potential in facilitating motor recovery in stroke patients. The combination of BCI and NIBS enhances brain functional reorganization and accelerates motor recovery post-stroke through a real-time feedback mechanism. By modulating neural plasticity, this combined approach can alter the trajectory of motor recovery, offering a novel therapeutic avenue for stroke rehabilitation. This review examines the application and recent advancements of BCI integrated with NIBS in motor function rehabilitation for stroke patients. Specifically, it outlines the advantages and challenges of this combined approach, including the use of TMS, tDCS, tACS, and other emerging neurostimulation technologies. While the integration of BCI and NIBS is still in the early stages of exploration, a unified, standardized protocol has yet to be established. Future research should focus on optimizing multimodal integration, investigating the underlying neuroplasticity mechanisms, and evaluating the long-term efficacy of BCI combined with NIBS.

中风仍然是全球成年人致残和死亡的主要原因之一。脑机接口（BCI）和非侵入性脑刺激（NIBS）在促进脑卒中患者运动恢复方面显示出显著的潜力。脑机接口与NIBS联合使用通过实时反馈机制增强脑功能重组，加速脑卒中后运动恢复。通过调节神经可塑性，这种联合方法可以改变运动恢复的轨迹，为中风康复提供了新的治疗途径。本文综述脑机接口与脑功能刺激联合治疗在脑卒中患者运动功能康复中的应用及最新进展。具体来说，它概述了这种综合方法的优点和挑战，包括使用TMS， tDCS， tACS和其他新兴的神经刺激技术。脑机接口与NIBS的融合尚处于探索初期，尚未建立统一、规范的协议。未来的研究应着眼于优化多模态整合，探讨潜在的神经可塑性机制，并评估脑机接口联合NIBS的长期疗效。

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引用次数: 0

Abnormal mu rhythm state-related cortical and corticospinal responses in chronic stroke 慢性脑卒中中异常mu节律状态相关的皮层和皮质脊髓反应。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-12 DOI: 10.1016/j.clinph.2025.2111385

Miles Wischnewski , Zachary J. Haigh , Taylor A. Berger , Jonna Rotteveel , Tessa van Oijen , Nipun D. Perera , Sina Shirinpour , Ivan Alekseichuk , Rachel L. Hawe , Alexander Opitz

Objective

The motor cortex’s activity is state-dependent. Specifically, the sensorimotor mu rhythm phase relates to the variability of primary motor cortex (M1) excitability, previously demonstrated in young and healthy volunteers. It is unknown whether this observation is generalizable to individuals with stroke-related brain lesions.

Methods

We investigated the phase relationship between mu oscillations and cortical excitability by combining real-time processing of electroencephalography (EEG) and transcranial magnetic stimulation (TMS) of M1. In N = 23 volunteers (chronic stroke survivors and healthy controls), we applied TMS to M1 at four phases of the mu oscillation. We investigated motor-evoked (MEP) and TMS-evoked potential (TEP) amplitudes.

Results

MEP amplitude in stroke survivors and older volunteers showed a phase-dependency with increased MEPs at the trough and decreased MEPs at the peak of the mu rhythm. However, individuals with stronger stroke-related motor symptoms showed a decreased phase preference. Phase-dependency of TEPs was reduced in the stroke-affected hemisphere, compared to the non-affected hemisphere. In healthy volunteers, no hemispheric difference was found.

Conclusion

Our preliminary results indicate that the strength of phase preference of TMS motor responses could indicate the severity of motor impairment.

Significance

These results could enable the development of improved TMS paradigms for recovery of motor impairment after stroke.

目的：运动皮层的活动具有状态依赖性。具体来说，感觉运动mu节律期与初级运动皮层（M1）兴奋性的变异性有关，这在年轻和健康的志愿者中已经得到证实。目前尚不清楚这一观察结果是否适用于中风相关脑损伤患者。方法：结合脑电图实时处理和经颅磁刺激（TMS）对M1进行脑电刺激，研究mu振荡与皮层兴奋性的相位关系。在N = 23名志愿者（慢性中风幸存者和健康对照）中，我们在mu振荡的四个阶段对M1应用TMS。我们研究了运动诱发电位（MEP）和颅磁诱发电位（TEP）的振幅。结果：脑卒中幸存者和老年志愿者的MEP振幅表现出相依赖性，在mu节律波谷时MEP增加，在峰值时MEP减少。然而，与中风相关的运动症状较强的个体表现出较低的相偏好。与未受影响的脑半球相比，受中风影响的脑半球tep的相位依赖性降低。在健康志愿者中，没有发现半球差异。结论：经颅磁刺激运动反应的相位偏好强度可以反映运动损伤的严重程度。意义：本研究结果为脑卒中后运动功能障碍恢复的经颅磁刺激模式的发展提供了基础。

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引用次数: 0

Neurophysiological evaluation of third window syndrome 第三窗综合征的神经生理学评价。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-11 DOI: 10.1016/j.clinph.2025.2111375

Eleftherios S. Papathanasiou

引用次数: 0

Enhanced cortical facilitation after intermittent theta burst stimulation with increased stimulation intensity 随着刺激强度的增加，间歇性θ波爆发刺激后皮层易化性增强。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-11 DOI: 10.1016/j.clinph.2025.2111382

Francisco Benavides , Robert Chen , Hang Jin Jo

Objective

Intermittent theta burst stimulation (iTBS) can modulate the neuronal activity in the primary motor cortex. However, the responsiveness to the protocol shows high inter-individual variability which remains not fully understood. This study investigated whether responsiveness to iTBS depends on stimulation intensity.

Methods

We conducted a sham-controlled, single-blinded experiment. Sixteen healthy volunteers participated in three sessions: iTBS at 80% of the active motor threshold (80%AMT), iTBS at 80% of the resting motor threshold (80%RMT), and a sham iTBS. Stimulation was applied to the hand representation of the primary motor cortex. The aftereffects of iTBS were assessed by changes in the amplitude of motor evoked potentials (MEPs) measured in posterior-anterior (PA) and anterior-posterior (AP) coil orientations to understand if there is differential effect in cortical networks.

Results

Our results showed significant facilitation of both PA and AP MEPs following iTBS at 80%RMT but not after iTBS at 80%AMT or sham stimulation. Additionally, the number of responders was greater following iTBS at 80%RMT compared to iTBS at 80%AMT.

Conclusions

Our results suggest that higher intensity iTBS may more effectively increase cortical excitability.

Significance

This finding has the potential to improve the efficacy of various iTBS applications and facilitate their clinical application.

目的：间歇θ波爆发刺激（iTBS）可调节初级运动皮层的神经元活动。然而，对方案的响应性显示出高度的个体间变异性，这仍未完全了解。本研究探讨iTBS的反应性是否取决于刺激强度。方法：采用假对照、单盲实验。16名健康志愿者参加了三个阶段：在80%的活动运动阈值下进行iTBS (80% amt)，在80%的静息运动阈值下进行iTBS (80% rmt)，以及假iTBS。刺激应用于初级运动皮层的手部表征。iTBS的后遗症是通过测量后-前（PA）和前后-后（AP）线圈取向的运动诱发电位（MEPs）振幅的变化来评估的，以了解皮层网络是否存在差异效应。结果：我们的研究结果显示，在80%RMT的iTBS后，PA和AP的MEPs都有显著的促进作用，而在80%AMT或假刺激的iTBS后，PA和AP MEPs没有显著的促进作用。此外，80%RMT时的iTBS应答者数量比80%AMT时的iTBS应答者数量更多。结论：我们的研究结果表明，高强度iTBS可能更有效地增加皮质兴奋性。意义：这一发现有可能提高各种iTBS应用的疗效，促进其临床应用。

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引用次数: 0

When continuity on EEG does not herald good prognosis after cardiac arrest 当脑电图连续性不能预示心脏骤停后预后良好时。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology

Pub Date : 2025-10-10 DOI: 10.1016/j.clinph.2025.2111379

Gregory Lepeu, Andrea O. Rossetti

引用次数: 0

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