Journal of Clinical Neurophysiology最新文献

Purpose: This study aims to show the impact of multimodal intraoperative neurophysiologic monitoring (IOM) in glioma surgery in preventing severe neurologic injury and increasing tumor removal by comparing the historical cases where IOM was not used.

Methods: Fifty-nine patients with glial tumors located nearby the eloquent area, operated by the same surgeon, were included in the study. Between 2008 and 2012, 21 patients were operated on without IOM (non-IOM); between 2018 and 2021, 38 patients were operated on with IOM.

Results: The preoperative Karnofsky performance status scale (KPSS) scores were not statistically significant between non-IOM and IOM groups ( P = 0.351). Postoperative KPSS (mean 97.9) scores were 15.7% higher than preoperative KPSS (mean 84.6) in the IOM group ( P < 0.001). Conversely, there was no significant difference between preoperative and postoperative KPSS scores (mean 78.5 and 81.5, respectively) in the non-IOM group ( P = 0.472). Moreover, postoperative KPSS scores were 20% higher in the IOM group than in the non-IOM group ( P < 0.001). Preoperative tumor sizes were double the size in the non-IOM group compared with those in the IOM group ( P = 0.007). Nevertheless, the postsurgery tumor residue volume was almost four times higher in the non-IOM group than that in the IOM group ( P = 0.035). A median of 93.35% of the tumor volume was resected in the IOM group, but only 77.26% of the tumor was removed in the non-IOM group ( P < 0.001).

Conclusions: Intraoperative neurophysiologic monitoring helps in a more radical tumor resection in glial tumors located close to the eloquent area, improves postoperative neurologic outcomes, and maintains the patient's quality of life.

Purpose: Rolandic epileptiform discharges with tangential dipole (T-dipole) configurations are associated with favorable prognosis. Whether the same is true for T-dipole epileptiform discharges in other brain regions is less established and is the objective of this study.

Methods: Over 20 years, patients with epileptiform discharges were identified as follows: frontal (F = 176), temporal (T = 196), central (C = 201), parietal (P = 120), and occipital (O = 205). T-dipoles were documented. Clinical features of children with and without T-dipole were compared both regardless of brain region and separately for each brain region.

Results: The prevalence of T-dipoles was 232/898 (25.8%) overall and within different regions as follows: T = 104 (53.1%), O = 51 (24.9%), P = 23 (19.2%), C = 35 (17.4%), and F = 19 (10.8%). Most had epilepsy (T-dipole: 193 [83.2%] and nondipole: 532 [79.9%]). Regardless of region, T-dipole was associated with less drug-resistant epilepsy (11 [4.7%] vs. 202 [30.3%], P < 0.001), developmental delay (57 [24.6%] vs. 436 [51.0%], P < 0.001), school performance difficulties (SPD) (101 [43.5%] vs. 410 [61.6%], P < 0.001), autism (30 [12.9%] vs. 127 [19.1%], P = 0.037), and abnormal examination (28 [12.1%] vs. 257 [38.6%], P < 0.001]). Within different brain regions, on logistic regression, T-dipole was associated with lower odds of drug-resistant epilepsy (F, T, C, P, and O), developmental delay (F, T, C, and P), SPD (F, T, and C), autism (F and T), abnormal examination (F, T, C, and O), and abnormal neuroimaging (T, C, P, and O).

Conclusions: On routine EEG analysis, focal epileptiform discharges with T-dipoles, regardless of brain region, are associated with a more favorable clinical course.

Purpose: This work investigates the presence of common anatomic regions associated with interictal activity in patients with hyperkinetic seizures type I by means of concurrent electroencephalography and functional magnetic resonance imaging.

Methods: Six patients with hyperkinetic seizures type I were evaluated with video-EEG and electroencephalography and functional magnetic resonance imaging in the context of their presurgical evaluation. Statistical Parametric Mapping was used to perform a correlation study between the occurrence of interictal spikes on EEG and suprathreshold blood oxygen level-dependent changes in the whole-brain volume.

Results: In all patients, Statistical Parametric Mapping revealed suprathreshold blood oxygen level-dependent clusters in the mesial anterior frontal areas, including the rostral mesial superior frontal gyrus and the anterior cingulate, associated with the patients' typical interictal activity.

Conclusions: The electroencephalography and functional magnetic resonance imaging findings contribute to our understanding of hyperkinetic seizures type I semiology generation and can inform stereo-EEG targeting for surgical planning in refractory cases.

Summary: Versive head turns, characterized by forced and involuntary head movements leading to sustained unnatural positioning, are consistently recognized as reliable indicators of contralateral hemisphere involvement. This study presents a case demonstrating ictal semiology marked by the simultaneous onset of blurred vision, spinning, distorted voice, and an early left-versive head turn. The versive head turn semiology correlated with rapid ictal discharges in the ipsilateral posterior cingulate gyrus and was reproducible with direct cortical stimulation during stereoelectroencephalography evaluation. A comprehensive literature review (from 1994 to 2023) was conducted to investigate the relationship between early ictal head version semiology, either contralateral or ipsilateral, and localization of the ictal onset regions. Analysis of 105 patients revealed that 87% exhibited early contralateral head version noted from seizures originating from anterior regions (frontal lobe or anterior/midcingulate regions), compared with 56% in posterior regions (parietal, occipital, or posterior cingulate areas) and 44% in the temporal lobe. When comparing anterior to temporal regions, the anterior group had an eightfold higher likelihood of contralateral versive seizures (odds ratios = 8.1, 95% confidence interest, 1.72-38.35, P = 0.0038), indicating a significantly higher likelihood of ipsilateral early head version in temporal lobe seizures. There was no significant difference in the likelihood of ipsilateral head version between the anterior and posterior groups or between the posterior and temporal groups. These findings underscore the need for cautious interpretation of early head versive signs alone as indicators of contralateral hemisphere epileptogenic zone, advocating for consideration of ipsilateral hemisphere epileptogenic zone involvement in presurgical hypotheses, in selected patients.

Summary: Thalamic neuromodulation has emerged as a promising treatment for drug-resistant epilepsy, with deep brain stimulation of the anterior nucleus of the thalamus currently Food and Drug Administration approved for this purpose. The Stimulation of the Anterior Nucleus of Thalamus for Epilepsy trial demonstrated that chronic anterior nucleus of the thalamus stimulation can significantly reduce seizure burden. In addition, the centromedian nucleus is gaining interest as a potential neuromodulation target among epilepsy experts, though its use remains off-label. Effective selection of neuromodulation targets requires reliable biomarkers, ideally with real-time feedback, yet studies on the acute effects of thalamic stimulation on epileptiform activity remain limited. Our cases provide novel evidence of acute suppression of epileptiform activity in the cerebral cortex-specifically, the cingulate and insular cortices-after anterior nucleus of the thalamus and centromedian nucleus stimulation, respectively, through stereoelectroencephalography electrodes. This finding enhances our understanding of cortical responses to thalamic stimulation and supports its therapeutic potential in both chronic and acute settings. Emerging research suggests that other thalamic nuclei may also play a role in managing epilepsy originating from different brain regions. We emphasize that routine stereoelectroencephalography implantation in thalamic nuclei may provide valuable clinical insights and aid in selecting the optimal target for stimulation. This case mini-series contributes to the growing evidence supporting the therapeutic potential of thalamic neuromodulation in epilepsy treatment.

Summary: In the 18th century, Luigi Galvani proposed the hypothesis of animal electricity, which is produced by the brain and distributed through the nerves to the muscles. This was the cornerstone of what is known today as the modern study of nerve function, earning him the title of the Father of Clinical Neurophysiology. The 19th century was subsequently marked by two major figures: Santiago Ramón y Cajal (Neuron Theory) and Hans Berger, known for describing cerebral electrical activity and recording the first electroencephalograms. In Mexico, Clinical Neurophysiology emerged in the late 19th century and consolidated itself in the first half of the 20th century. In the year of 1938, Dr. Clemente Robles and Teodoro Flores Covarrubias built the first electroencephalograph, marking the beginning of the era of Clinical Neurophysiology. Initially, this diagnostic tool was primarily applied to psychiatric patients, as there was no clear separation between psychiatry and neurology and patients were treated jointly at the largest psychiatric center of that time, "La Castañeda." In 1968, the Mexican Society of Electroencephalography A.C. was founded and later changed its name to the Mexican Society of Clinical Neurophysiology A.C. Simultaneously, its members achieved universal recognition of the medical specialty, which has become established in clinical practice and has shown progressive academic and scientific growth in Mexico.