Pub Date : 2024-11-01DOI: 10.1016/j.neucli.2024.103023
Fabrice Bartolomei
The advent of advanced brain imaging techniques has significantly enhanced the understanding and treatment of focal epilepsies, with identifiable brain lesions present in 80 % of cases. Despite this, surgical outcomes remain varied, often influenced by lesion type and location. Traditional lesion-centric approaches may overlook the complex organization of the epileptogenic zone (EZ), which often extends beyond the visible lesion, emphasizing the need for comprehensive presurgical evaluations like stereo-electroencephalography (SEEG) in some cases. This article delves into the concept of epileptogenic networks, moving beyond the notion of a lesional epileptic focus. Through SEEG, three primary network types have been identified: the Epileptogenic Zone Network (EZN), characterized by regions with heightened epileptogenicity and seizure initiation; the Propagation Zone Network (PZN), involving regions with delayed and less intense epileptic activity; and Non-Involved networks (NI). Quantitative measures, such as the epileptogenicity index (EI), aid in delineating these networks, revealing that EZN can be focal or networked, with the latter being more prevalent.
The relationship between epilepsy-associated lesions and network organization is complex. Intrinsically epileptogenic lesions, like focal cortical dysplasia and periventricular nodular heterotopias, often generate epileptiform activities but may still involve broader epileptogenic networks. Non-intrinsically epileptogenic lesions, such as cavernomas and post-stroke lesions, typically lack inherent neuronal activity but can facilitate the development of extensive epileptogenic networks.
Understanding the intricacies of these networks is crucial for optimizing surgical interventions. Recognizing that lesions may represent just one node within a broader epileptogenic network underscores the importance of comprehensive SEEG evaluations to achieve better surgical outcomes.
{"title":"The epileptogenic network concept: Applications in the SEEG exploration of lesional focal epilepsies","authors":"Fabrice Bartolomei","doi":"10.1016/j.neucli.2024.103023","DOIUrl":"10.1016/j.neucli.2024.103023","url":null,"abstract":"<div><div>The advent of advanced brain imaging techniques has significantly enhanced the understanding and treatment of focal epilepsies, with identifiable brain lesions present in 80 % of cases. Despite this, surgical outcomes remain varied, often influenced by lesion type and location. Traditional lesion-centric approaches may overlook the complex organization of the epileptogenic zone (EZ), which often extends beyond the visible lesion, emphasizing the need for comprehensive presurgical evaluations like stereo-electroencephalography (SEEG) in some cases. This article delves into the concept of epileptogenic networks, moving beyond the notion of a lesional epileptic focus. Through SEEG, three primary network types have been identified: the Epileptogenic Zone Network (EZN), characterized by regions with heightened epileptogenicity and seizure initiation; the Propagation Zone Network (PZN), involving regions with delayed and less intense epileptic activity; and Non-Involved networks (NI). Quantitative measures, such as the epileptogenicity index (EI), aid in delineating these networks, revealing that EZN can be focal or networked, with the latter being more prevalent.</div><div>The relationship between epilepsy-associated lesions and network organization is complex. Intrinsically epileptogenic lesions, like focal cortical dysplasia and periventricular nodular heterotopias, often generate epileptiform activities but may still involve broader epileptogenic networks. Non-intrinsically epileptogenic lesions, such as cavernomas and post-stroke lesions, typically lack inherent neuronal activity but can facilitate the development of extensive epileptogenic networks.</div><div>Understanding the intricacies of these networks is crucial for optimizing surgical interventions. Recognizing that lesions may represent just one node within a broader epileptogenic network underscores the importance of comprehensive SEEG evaluations to achieve better surgical outcomes.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103023"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.neucli.2024.103018
Miguel Lopes , Michael Swash , Mamede de Carvalho
Objectives
The “split-hand syndrome” is a common clinical sign in amyotrophic lateral sclerosis (ALS), being characterized by more severe atrophy of the hand muscles on the radial side of the hand compared to the ulnar side. We aimed to investigate possible physiological differences between relevant hand muscles using low-intensity F-wave stimulation to assess spinal motoneuron excitability.
Methods
We recruited 36 healthy volunteers. F-waves were recorded from the abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM), using 20 supramaximal stimuli followed by 20 stimuli at a low-intensity required to obtain M-waves with 10 % amplitude of maximal CMAP. We evaluated the following F-wave parameters: F-M latency, chronodispersion, persistence, amplitude, F/CMAP amplitude ratio and number of F-wave repeaters (with low-intensity). In 10 subjects, low-intensity stimulation F-waves were compared after 20 and 50 stimuli in each muscle.
Results
Low-intensity stimulation resulted in lower F-wave amplitude and persistence and higher F/CMAP amplitude ratios. There were no significant differences in F-wave latencies and chronodispersion. When comparing the three muscles, we found higher F-wave persistence and F/CMAP amplitude ratios when recording over the ADM and APB compared to the FDI. We also found a higher number of F-wave repeaters in the ADM with low-intensity stimulation. Results from 20 to 50 low-intensity stimuli were similar.
Discussion
A small number of low-intensity stimuli is appropriate to study F-wave latencies and chronodispersion. We found differences in some physiological properties of the ADM spinal motoneuron pool compared to other hand muscles.
研究目的分裂手综合征 "是肌萎缩性脊髓侧索硬化症（ALS）的一种常见临床表现，其特征是手部桡侧肌肉的萎缩程度比尺侧更严重。我们的目的是利用低强度 F 波刺激来评估脊髓运动神经元的兴奋性，从而研究相关手部肌肉之间可能存在的生理差异：我们招募了 36 名健康志愿者。方法：我们招募了 36 名健康志愿者，使用 20 次超大强度刺激，然后再使用 20 次低强度刺激，以获得振幅为最大 CMAP 的 10% 的 M 波，记录了来自拇趾外展肌（APB）、第一背侧骨间肌（FDI）和拇趾外展肌（ADM）的 F 波。我们评估了以下 F 波参数：F-M潜伏期、时间分散性、持续性、振幅、F/CMAP振幅比和F波重复次数（低强度）。在 10 名受试者中，对每块肌肉进行 20 次和 50 次刺激后的低强度刺激 F 波进行了比较：结果：低强度刺激导致较低的 F 波振幅和持续性，以及较高的 F/CMAP 振幅比。F 波潜伏期和时间分散性无明显差异。在比较三块肌肉时，我们发现在 ADM 和 APB 上记录的 F 波持续时间和 F/CMAP 振幅比高于 FDI。我们还发现，在低强度刺激下，ADM 的 F 波重复次数较多。20 至 50 次低强度刺激的结果相似：讨论：少量低强度刺激适用于研究 F 波潜伏期和时序分散。我们发现，与其他手部肌肉相比，ADM脊髓运动神经元池的某些生理特性存在差异。
{"title":"F-waves responses derived from low-intensity electrical stimulation: A method to explore split-hand pathogenesis","authors":"Miguel Lopes , Michael Swash , Mamede de Carvalho","doi":"10.1016/j.neucli.2024.103018","DOIUrl":"10.1016/j.neucli.2024.103018","url":null,"abstract":"<div><h3>Objectives</h3><div>The “split-hand syndrome” is a common clinical sign in amyotrophic lateral sclerosis (ALS), being characterized by more severe atrophy of the hand muscles on the radial side of the hand compared to the ulnar side. We aimed to investigate possible physiological differences between relevant hand muscles using low-intensity F-wave stimulation to assess spinal motoneuron excitability.</div></div><div><h3>Methods</h3><div>We recruited 36 healthy volunteers. F-waves were recorded from the abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM), using 20 supramaximal stimuli followed by 20 stimuli at a low-intensity required to obtain M-waves with 10 % amplitude of maximal CMAP. We evaluated the following F-wave parameters: F-M latency, chronodispersion, persistence, amplitude, F/CMAP amplitude ratio and number of F-wave repeaters (with low-intensity). In 10 subjects, low-intensity stimulation F-waves were compared after 20 and 50 stimuli in each muscle.</div></div><div><h3>Results</h3><div>Low-intensity stimulation resulted in lower F-wave amplitude and persistence and higher F/CMAP amplitude ratios. There were no significant differences in F-wave latencies and chronodispersion. When comparing the three muscles, we found higher F-wave persistence and F/CMAP amplitude ratios when recording over the ADM and APB compared to the FDI. We also found a higher number of F-wave repeaters in the ADM with low-intensity stimulation. Results from 20 to 50 low-intensity stimuli were similar.</div></div><div><h3>Discussion</h3><div>A small number of low-intensity stimuli is appropriate to study F-wave latencies and chronodispersion. We found differences in some physiological properties of the ADM spinal motoneuron pool compared to other hand muscles.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103018"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Motor evoked potential (MEP) monitoring is a reliable method for real-time assessment of corticospinal tract integrity. However, the potential benefits of MEP monitoring during degenerative spine surgery remain controversial. This study aims to determine the role of MEP monitoring during surgery for cervical spondylotic myelopathy (CSM) in prediction of prognosis.
Methods
Transcranial electrical stimulation was performed to elicit MEPs during dorsal decompression for the treatment of CSM. MEP-threshold levels were assessed separately at the beginning and end of the surgery in upper extremity muscles corresponding to nerve roots at the level of/distal to the decompression site. Clinical outcome was measured using the modified Japanese Orthopedic Association score (mJOA).
Results
The study included 47 patients. 31 patients (66 %) showed improvements in neurological function at discharge. A measurable improvement in the majority of tested muscles, or in at least one muscle group, in a given patient highly correlated with mJOA score increase at discharge (p < 0.001) with an odds ratio of 10.3 (CI:2.6–34.4) and 11.4 (CI:2.8–41.3), respectively. Conversely, MEP deterioration was not associated with worse clinical outcome, nor was it predictive of failure to recover.
Conclusion
MEP improvement during CSM surgery seems to be highly predictive of early postoperative neurological recovery and could indicate subclinically enhanced signal conduction. This highlights the potential of MEP monitoring as an intraoperative, real-time predictive tool for clinical recovery after decompression in patients with CSM.
{"title":"Transcranial MEPs predict clinical outcome during minimally invasive dorsal decompression for cervical spondylotic myelopathy","authors":"Fares Komboz , Fabian Kück , Silvia Hernández-Durán , Ingo Fiss , Xenia Hautmann , Dorothee Mielke (Prof.) , Veit Rohde (Prof.) , Tammam Abboud","doi":"10.1016/j.neucli.2024.103022","DOIUrl":"10.1016/j.neucli.2024.103022","url":null,"abstract":"<div><h3>Objectives</h3><div>Motor evoked potential (MEP) monitoring is a reliable method for real-time assessment of corticospinal tract integrity. However, the potential benefits of MEP monitoring during degenerative spine surgery remain controversial. This study aims to determine the role of MEP monitoring during surgery for cervical spondylotic myelopathy (CSM) in prediction of prognosis.</div></div><div><h3>Methods</h3><div>Transcranial electrical stimulation was performed to elicit MEPs during dorsal decompression for the treatment of CSM. MEP-threshold levels were assessed separately at the beginning and end of the surgery in upper extremity muscles corresponding to nerve roots at the level of/distal to the decompression site. Clinical outcome was measured using the modified Japanese Orthopedic Association score (mJOA).</div></div><div><h3>Results</h3><div>The study included 47 patients. 31 patients (66 %) showed improvements in neurological function at discharge. A measurable improvement in the majority of tested muscles, or in at least one muscle group, in a given patient highly correlated with mJOA score increase at discharge (<em>p</em> < 0.001) with an odds ratio of 10.3 (CI:2.6–34.4) and 11.4 (CI:2.8–41.3), respectively. Conversely, MEP deterioration was not associated with worse clinical outcome, nor was it predictive of failure to recover.</div></div><div><h3>Conclusion</h3><div>MEP improvement during CSM surgery seems to be highly predictive of early postoperative neurological recovery and could indicate subclinically enhanced signal conduction. This highlights the potential of MEP monitoring as an intraoperative, real-time predictive tool for clinical recovery after decompression in patients with CSM.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103022"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142587277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-26DOI: 10.1016/j.neucli.2024.103024
Michael W.K. Fong , Lawrence J. Hirsch
{"title":"Twenty years of SIRPIDs: What have we learned?","authors":"Michael W.K. Fong , Lawrence J. Hirsch","doi":"10.1016/j.neucli.2024.103024","DOIUrl":"10.1016/j.neucli.2024.103024","url":null,"abstract":"","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103024"},"PeriodicalIF":2.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.neucli.2024.103020
Mariana Lopes Martins , Melyssa Kellyane Cavalcanti Galdino , Daniel Soares Ferreira Silva , Eliza Carolina Dantas Valença , Mariana Braz dos Santos , Jessica Figueiredo de Medeiros , Daniel Gomes da Silva Machado , Marine Raquel Diniz da Rosa
Objectives
To evaluate the short and long-term effects of anodal tDCS (a-tDCS) targeting the left temporoparietal area (LTA) on tinnitus severity, annoyance, and loudness.
Methods
This is a double-blind, randomized, sham-controlled, and parallel-group clinical trial. A total of 42 individuals with tinnitus were randomized to a-tDCS (n = 24) or sham tDCS (n = 18). The a-tDCS group received tDCS over the LTA during five consecutive day sessions (2 mA, 20 min). The sham group received a placebo current with the same characteristics as the a-tDCS group. Participants were assessed at baseline, after the fifth session, and at the 30-day follow-up, using hearing assessments and symptom questionnaires.
Results
There was no effect of comparison between groups or interaction effect (time x group) in all hearing assessments and symptom questionnaires. There was only a main effect of time for Tinnitus Handicap Inventory - THI [F(1.642, 45.988) = 5.128; p = 0.014; η2 = 0.155]. Bonferroni post hoc showed that there was a significant difference in THI in the sham group between pre and post-treatment [CI (0.107, 14.643; p = 0.046)]. However, there was no difference between pre-treatment and follow-up THI, or between post-treatment and follow-up THI. There was no treatment effect on tinnitus severity (assessed by Tinnitus Functional Inventory - TFI), tinnitus annoyance or loudness (assessed by Visual Analogue Scale - VAS), or tinnitus pitch, loudness or minimum masking level (assessed by tinnitometry).
Conclusion
Five consecutive sessions of a-tDCS targeting LTA do not improve tinnitus severity, annoyance, and loudness. Future studies should investigate if other tDCS protocols are effective or a combination of tDCS with other forms of treatment.
目的评估以左侧颞顶区（LTA）为靶点的阳极tDCS（a-tDCS）对耳鸣严重程度、烦恼和响度的短期和长期影响：这是一项双盲、随机、假对照和平行组临床试验。共有 42 名耳鸣患者被随机分配到 a-tDCS 组（24 人）或假 tDCS 组（18 人）。a-tDCS组连续五天在LTA上接受tDCS治疗（2毫安，20分钟）。假电流组接受与 a-tDCS 组相同的安慰剂电流。在基线、第五次治疗后和 30 天随访时，使用听力评估和症状问卷对参与者进行评估：结果：在所有听力评估和症状问卷调查中，组间比较或交互效应（时间 x 组）均无影响。只有耳鸣障碍量表（THI）存在时间主效应[F（1.642，45.988）=5.128；p=0.014；η2=0.155]。Bonferroni post hoc 显示，假治疗组的 THI 在治疗前和治疗后有显著差异 [CI (0.107, 14.643; p = 0.046)]。但是，治疗前和治疗后的 THI 之间以及治疗后和治疗后的 THI 之间没有差异。治疗对耳鸣严重程度（通过耳鸣功能量表评估）、耳鸣烦扰度或响度（通过视觉模拟量表评估）、耳鸣音高、响度或最低掩蔽水平（通过耳鸣测量法评估）均无影响：结论：以 LTA 为目标的连续五次 a-tDCS 治疗并不能改善耳鸣的严重程度、烦扰度和响度。未来的研究应探讨其他 tDCS 方案是否有效，或将 tDCS 与其他治疗方式相结合。
{"title":"Effect of transcranial direct current stimulation on tinnitus modulation: A randomized, double-blind, and placebo-controlled clinical trial","authors":"Mariana Lopes Martins , Melyssa Kellyane Cavalcanti Galdino , Daniel Soares Ferreira Silva , Eliza Carolina Dantas Valença , Mariana Braz dos Santos , Jessica Figueiredo de Medeiros , Daniel Gomes da Silva Machado , Marine Raquel Diniz da Rosa","doi":"10.1016/j.neucli.2024.103020","DOIUrl":"10.1016/j.neucli.2024.103020","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the short and long-term effects of anodal tDCS (a-tDCS) targeting the left temporoparietal area (LTA) on tinnitus severity, annoyance, and loudness.</div></div><div><h3>Methods</h3><div>This is a double-blind, randomized, sham-controlled, and parallel-group clinical trial. A total of 42 individuals with tinnitus were randomized to a-tDCS (<em>n</em> = 24) or sham tDCS (<em>n</em> = 18). The a-tDCS group received tDCS over the LTA during five consecutive day sessions (2 mA, 20 min). The sham group received a placebo current with the same characteristics as the a-tDCS group. Participants were assessed at baseline, after the fifth session, and at the 30-day follow-up, using hearing assessments and symptom questionnaires.</div></div><div><h3>Results</h3><div>There was no effect of comparison between groups or interaction effect (time x group) in all hearing assessments and symptom questionnaires. There was only a main effect of time for Tinnitus Handicap Inventory - THI [F(1.642, 45.988) = 5.128; <em>p</em> = 0.014; η<sup>2</sup> = 0.155]. Bonferroni post hoc showed that there was a significant difference in THI in the sham group between pre and post-treatment [CI (0.107, 14.643; <em>p</em> = 0.046)]. However, there was no difference between pre-treatment and follow-up THI, or between post-treatment and follow-up THI. There was no treatment effect on tinnitus severity (assessed by Tinnitus Functional Inventory - TFI), tinnitus annoyance or loudness (assessed by Visual Analogue Scale - VAS), or tinnitus pitch, loudness or minimum masking level (assessed by tinnitometry).</div></div><div><h3>Conclusion</h3><div>Five consecutive sessions of a-tDCS targeting LTA do not improve tinnitus severity, annoyance, and loudness. Future studies should investigate if other tDCS protocols are effective or a combination of tDCS with other forms of treatment.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103020"},"PeriodicalIF":2.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.neucli.2024.103021
Hamid Karimi-Rouzbahani , Simon Vogrin , Miao Cao , Chris Plummer , Aileen McGonigal
Surgical resection for epilepsy often fails due to incomplete Epileptogenic Zone Network (EZN) localization from scalp electroencephalography (EEG), stereo-EEG (SEEG), and Magnetic Resonance Imaging (MRI). Subjective interpretation based on interictal, or ictal recordings limits conventional EZN localization. This study employs multimodal analysis using high-density-EEG (HDEEG), Magnetoencephalography (MEG), functional-MRI (fMRI), and SEEG to overcome these limitations in a patient with drug-resistant MRI-negative focal epilepsy. A 17-year-old with drug-resistant epilepsy underwent evaluation. HDEEG, MEG, fMRI, and SEEG were used, with a novel HDEEG-cap facilitating simultaneous EEG-MEG and EEG-fMRI recordings. Electrical and magnetic source imaging were performed, and fMRI data were analysed for homogenous regions. SEEG analysis involved spike detection, spike timing analysis, ictal fast activity quantification, and Granger-based connectivity analysis. Non-invasive sessions revealed consistent interictal source imaging results identifying the EZN in the right anterior cingulate cortex. EEG-fMRI highlighted broader activation in the right cingulate cortex. SEEG analysis localized spikes and fast activity in the right anterior and posterior cingulate gyri. Multi-modal analysis suggested the EZN in the right frontal lobe, primarily involving the anterior and mid-cingulate cortices. Multi-modal non-invasive analyses can optimise SEEG implantation and surgical decision-making. Invasive analyses corroborated non-invasive findings, emphasising the importance of individual-case quantitative analysis across modalities in complex epilepsy cases.
{"title":"Multimodal and quantitative analysis of the epileptogenic zone network in the pre-surgical evaluation of drug-resistant focal epilepsy","authors":"Hamid Karimi-Rouzbahani , Simon Vogrin , Miao Cao , Chris Plummer , Aileen McGonigal","doi":"10.1016/j.neucli.2024.103021","DOIUrl":"10.1016/j.neucli.2024.103021","url":null,"abstract":"<div><div>Surgical resection for epilepsy often fails due to incomplete Epileptogenic Zone Network (EZN) localization from scalp electroencephalography (EEG), stereo-EEG (SEEG), and Magnetic Resonance Imaging (MRI). Subjective interpretation based on interictal, or ictal recordings limits conventional EZN localization. This study employs multimodal analysis using high-density-EEG (HDEEG), Magnetoencephalography (MEG), functional-MRI (fMRI), and SEEG to overcome these limitations in a patient with drug-resistant MRI-negative focal epilepsy. A 17-year-old with drug-resistant epilepsy underwent evaluation. HDEEG, MEG, fMRI, and SEEG were used, with a novel HDEEG-cap facilitating simultaneous EEG-MEG and EEG-fMRI recordings. Electrical and magnetic source imaging were performed, and fMRI data were analysed for homogenous regions. SEEG analysis involved spike detection, spike timing analysis, ictal fast activity quantification, and Granger-based connectivity analysis. Non-invasive sessions revealed consistent interictal source imaging results identifying the EZN in the right anterior cingulate cortex. EEG-fMRI highlighted broader activation in the right cingulate cortex. SEEG analysis localized spikes and fast activity in the right anterior and posterior cingulate gyri. Multi-modal analysis suggested the EZN in the right frontal lobe, primarily involving the anterior and mid-cingulate cortices. Multi-modal non-invasive analyses can optimise SEEG implantation and surgical decision-making. Invasive analyses corroborated non-invasive findings, emphasising the importance of individual-case quantitative analysis across modalities in complex epilepsy cases.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103021"},"PeriodicalIF":2.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.neucli.2024.103012
Thibaut Mussigmann , Benjamin Bardel , Silvia Casarotto , Suhan Senova , Mario Rosanova , François Vialatte , Jean-Pascal Lefaucheur
<div><h3>Background</h3><p>Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) at high frequency (HF) is an effective treatment of neuropathic pain. The classical HF-rTMS protocol (CHF-rTMS) includes a daily session for one week as an induction phase of treatment followed by more spaced sessions. Another type of protocol without an induction phase and based solely on spaced sessions of HF-rTMS (SHF-rTMS) has also been shown to produce neuropathic pain relief. However, CHF-rTMS and SHF-rTMS of M1 have never been compared regarding their analgesic potential. Another type of rTMS paradigm, called accelerated intermittent theta burst stimulation (ACC-iTBS), has recently been proposed for the treatment of depression, the other clinical condition for which HF-rTMS is proposed as an effective therapeutic strategy. ACC-iTBS combines a high number of pulses delivered in short sessions grouped into a few days of stimulation. This type of protocol has never been applied to M1 for the treatment of pain.</p></div><div><h3>Methods/Design</h3><p>The objective of this single-centre randomized study is to compare the efficacy of three different rTMS protocols for the treatment of chronic neuropathic pain: CHF-rTMS, SHF-rTMS, and ACC-iTBS. The CHF-rTMS will consists of 10 stimulation sessions, including 5 daily sessions of 10Hz-rTMS (3,000 pulses per session) over one week, then one session per week for 5 weeks, for a total of 30,000 pulses delivered in 10 stimulation days. The SHF-rTMS protocol will only include 4 sessions of 20Hz-rTMS (1,600 pulses per session), one every 15 days, for a total of 6,400 pulses delivered in 4 stimulation days. The ACC-iTBS protocol will comprise 5 sessions of iTBS (600 pulses per session) completed in half a day for 2 consecutive days, repeated 5 weeks later, for a total of 30,000 pulses delivered in 4 stimulation days. Thus, CHF-rTMS and ACC-iTBS protocols will share a higher total number of TMS pulses (30,000 pulses) compared to SHF-rTMS protocol (6,400 pulses), while CHF-rTMS protocol will include a higher number of stimulation days (10 days) compared to ACC-iTBS and SHF-rTMS protocols (4 days). In all protocols, the M1 target will be defined in the same way and stimulated at the same intensity using a navigated rTMS (nTMS) procedure. The evaluation will be based on clinical outcomes with various scales and questionnaires assessed every week, from two weeks before the 7-week period of therapeutic stimulation until 4 weeks after. Additionally, three sets of neurophysiological outcomes (resting-state electroencephalography (EEG), nTMS-EEG recordings, and short intracortical inhibition measurement with threshold tracking method) will be assessed the week before and after the 7-week period of therapeutic stimulation.</p></div><div><h3>Discussion</h3><p>This study will make it possible to compare the analgesic efficacy of the CHF-rTMS and SHF-rTMS protocols and to appraise that of the ACC-iTBS protoco
{"title":"Classical, spaced, or accelerated transcranial magnetic stimulation of motor cortex for treating neuropathic pain: A 3-arm parallel non-inferiority study","authors":"Thibaut Mussigmann , Benjamin Bardel , Silvia Casarotto , Suhan Senova , Mario Rosanova , François Vialatte , Jean-Pascal Lefaucheur","doi":"10.1016/j.neucli.2024.103012","DOIUrl":"10.1016/j.neucli.2024.103012","url":null,"abstract":"<div><h3>Background</h3><p>Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) at high frequency (HF) is an effective treatment of neuropathic pain. The classical HF-rTMS protocol (CHF-rTMS) includes a daily session for one week as an induction phase of treatment followed by more spaced sessions. Another type of protocol without an induction phase and based solely on spaced sessions of HF-rTMS (SHF-rTMS) has also been shown to produce neuropathic pain relief. However, CHF-rTMS and SHF-rTMS of M1 have never been compared regarding their analgesic potential. Another type of rTMS paradigm, called accelerated intermittent theta burst stimulation (ACC-iTBS), has recently been proposed for the treatment of depression, the other clinical condition for which HF-rTMS is proposed as an effective therapeutic strategy. ACC-iTBS combines a high number of pulses delivered in short sessions grouped into a few days of stimulation. This type of protocol has never been applied to M1 for the treatment of pain.</p></div><div><h3>Methods/Design</h3><p>The objective of this single-centre randomized study is to compare the efficacy of three different rTMS protocols for the treatment of chronic neuropathic pain: CHF-rTMS, SHF-rTMS, and ACC-iTBS. The CHF-rTMS will consists of 10 stimulation sessions, including 5 daily sessions of 10Hz-rTMS (3,000 pulses per session) over one week, then one session per week for 5 weeks, for a total of 30,000 pulses delivered in 10 stimulation days. The SHF-rTMS protocol will only include 4 sessions of 20Hz-rTMS (1,600 pulses per session), one every 15 days, for a total of 6,400 pulses delivered in 4 stimulation days. The ACC-iTBS protocol will comprise 5 sessions of iTBS (600 pulses per session) completed in half a day for 2 consecutive days, repeated 5 weeks later, for a total of 30,000 pulses delivered in 4 stimulation days. Thus, CHF-rTMS and ACC-iTBS protocols will share a higher total number of TMS pulses (30,000 pulses) compared to SHF-rTMS protocol (6,400 pulses), while CHF-rTMS protocol will include a higher number of stimulation days (10 days) compared to ACC-iTBS and SHF-rTMS protocols (4 days). In all protocols, the M1 target will be defined in the same way and stimulated at the same intensity using a navigated rTMS (nTMS) procedure. The evaluation will be based on clinical outcomes with various scales and questionnaires assessed every week, from two weeks before the 7-week period of therapeutic stimulation until 4 weeks after. Additionally, three sets of neurophysiological outcomes (resting-state electroencephalography (EEG), nTMS-EEG recordings, and short intracortical inhibition measurement with threshold tracking method) will be assessed the week before and after the 7-week period of therapeutic stimulation.</p></div><div><h3>Discussion</h3><p>This study will make it possible to compare the analgesic efficacy of the CHF-rTMS and SHF-rTMS protocols and to appraise that of the ACC-iTBS protoco","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103012"},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1016/j.neucli.2024.103007
S. Dionisio , I. Althubaiti , M. Aldosari , F Alsallom , N. Alomar , F. Babtain , A. Alkhotani , S. Baeesa , A. Najjar , A. Sabbagh , Z. Althani , F. Alotaibi , K. Alqadi
Epilepsy surgery and intracranial monitoring have a long history in the Kingdom of Saudi Arabia, spanning over 30 years. Stereo-EEG however, is a more recent offering. In this short communication, we discuss how Stereo-EEG has grown in the context of the Kingdom's healthcare model and the Vision 2030 model. We discuss the various positives of this technique and methodology as well as the various challenges that the hospitals offering Stereo-EEG have faced.
{"title":"Stereo electroencephalography in the kingdom of Saudi Arabia","authors":"S. Dionisio , I. Althubaiti , M. Aldosari , F Alsallom , N. Alomar , F. Babtain , A. Alkhotani , S. Baeesa , A. Najjar , A. Sabbagh , Z. Althani , F. Alotaibi , K. Alqadi","doi":"10.1016/j.neucli.2024.103007","DOIUrl":"10.1016/j.neucli.2024.103007","url":null,"abstract":"<div><p>Epilepsy surgery and intracranial monitoring have a long history in the Kingdom of Saudi Arabia, spanning over 30 years. Stereo-EEG however, is a more recent offering. In this short communication, we discuss how Stereo-EEG has grown in the context of the Kingdom's healthcare model and the Vision 2030 model. We discuss the various positives of this technique and methodology as well as the various challenges that the hospitals offering Stereo-EEG have faced.</p></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103007"},"PeriodicalIF":2.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.neucli.2024.103010
Yan Wang , Jiajia Yang , Wei Wang , Xin Zhou, Xuefeng Wang, Jing Luo, Feng Li
Objectives
To explore the factors associated with poor prognosis in critically ill patients with Electroencephalogram (EEG) patterns exhibiting stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs), and to construct a prognostic prediction model.
Methods
This study included a total of 53 critically ill patients with EEG patterns exhibiting SIRPIDs who were admitted to the First Affiliated Hospital of Chongqing Medical University from May 2023 to March 2024. Patients were divided into two groups based on their Modified Rankin Scale (mRS) scores at discharge: good prognosis group (0–3 points) and poor prognosis group (4–6 points). Retrospective analyses were performed on the clinical and EEG parameters of patients in both groups. Logistic regression analysis was applied to identify the risk factors related to poor prognosis in critically ill patients with EEG patterns exhibiting SIRPIDs; a risk prediction model for poor prognosis was constructed, along with an individualized predictive nomogram model, and the predictive performance and consistency of the model were evaluated.
Results
Multivariate logistic regression analysis revealed that APACHE II score (OR=1.217, 95 %CI=1.030∼1.438), slow frequency bands or no obvious brain electrical activity (OR=8.720, 95 %CI=1.220∼62.313), and no sleep waveforms (OR=9.813, 95 %CI=1.371∼70.223) were independent risk factors for poor prognosis in patients. A regression model established based on multivariate logistic regression analysis had an area under the curve of 0.902. The model's accuracy was 90.60 %, with a sensitivity of 92.86 % and a specificity of 89.70 %. The nomogram model, after internal validation, showed a concordance index of 0.904.
Conclusions
A high APACHE II score, EEG patterns with slow frequency bands or no obvious brain electrical activity, and no sleep waveforms were independent risk factors for poor prognosis in patients with SIRPIDs. The nomogram model constructed based on these factors had a favorably high level of accuracy in predicting the risk of poor prognosis and held certain reference and application value for clinical neurofunctional assessment and prognostic determination.
{"title":"A novel nomogram for predicting the prognosis of critically ill patients with EEG patterns exhibiting stimulus-induced rhythmic, periodic, or ictal discharges","authors":"Yan Wang , Jiajia Yang , Wei Wang , Xin Zhou, Xuefeng Wang, Jing Luo, Feng Li","doi":"10.1016/j.neucli.2024.103010","DOIUrl":"10.1016/j.neucli.2024.103010","url":null,"abstract":"<div><h3>Objectives</h3><p>To explore the factors associated with poor prognosis in critically ill patients with Electroencephalogram (EEG) patterns exhibiting stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs), and to construct a prognostic prediction model.</p></div><div><h3>Methods</h3><p>This study included a total of 53 critically ill patients with EEG patterns exhibiting SIRPIDs who were admitted to the First Affiliated Hospital of Chongqing Medical University from May 2023 to March 2024. Patients were divided into two groups based on their Modified Rankin Scale (mRS) scores at discharge: good prognosis group (0–3 points) and poor prognosis group (4–6 points). Retrospective analyses were performed on the clinical and EEG parameters of patients in both groups. Logistic regression analysis was applied to identify the risk factors related to poor prognosis in critically ill patients with EEG patterns exhibiting SIRPIDs; a risk prediction model for poor prognosis was constructed, along with an individualized predictive nomogram model, and the predictive performance and consistency of the model were evaluated.</p></div><div><h3>Results</h3><p>Multivariate logistic regression analysis revealed that APACHE II score (OR=1.217, 95 %CI=1.030∼1.438), slow frequency bands or no obvious brain electrical activity (OR=8.720, 95 %CI=1.220∼62.313), and no sleep waveforms (OR=9.813, 95 %CI=1.371∼70.223) were independent risk factors for poor prognosis in patients. A regression model established based on multivariate logistic regression analysis had an area under the curve of 0.902. The model's accuracy was 90.60 %, with a sensitivity of 92.86 % and a specificity of 89.70 %. The nomogram model, after internal validation, showed a concordance index of 0.904.</p></div><div><h3>Conclusions</h3><p>A high APACHE II score, EEG patterns with slow frequency bands or no obvious brain electrical activity, and no sleep waveforms were independent risk factors for poor prognosis in patients with SIRPIDs. The nomogram model constructed based on these factors had a favorably high level of accuracy in predicting the risk of poor prognosis and held certain reference and application value for clinical neurofunctional assessment and prognostic determination.</p></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103010"},"PeriodicalIF":2.7,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.neucli.2024.103011
Francis Houde , Russell Butler , Etienne St-Onge , Marylie Martel , Véronique Thivierge , Maxime Descoteaux , Kevin Whittingstall , Guillaume Leonard
Objective
Explore how anatomical measurements and field modeling can be leveraged to improve investigations of transcranial magnetic stimulation (TMS) effects on both motor and non-motor TMS targets.
Methods
TMS motor effects (targeting the primary motor cortex [M1]) were evaluated using the resting motor threshold (rMT), while TMS non-motor effects (targeting the superior temporal gyrus [STG]) were assessed using a pain memory task. Anatomical measurements included scalp-cortex distance (SCD) and cortical thickness (CT), whereas field modeling encompassed the magnitude of the electric field (E) induced by TMS.
Results
Anatomical measurements and field modeling values differed significantly between M1 and STG. For TMS motor effects, rMT was correlated with SCD, CT, and E values at M1 (p < 0.05). No correlations were found between these metrics for the STG and TMS non-motor effects (pain memory; all p-values > 0.05).
Conclusion
Although anatomical measurements and field modeling are closely related to TMS motor effects, their relationship to non-motor effects – such as pain memory – appear to be much more tenuous and complex, highlighting the need for further advancement in our use of TMS and virtual lesion paradigms.
{"title":"Anatomical measurements and field modeling to assess transcranial magnetic stimulation motor and non-motor effects","authors":"Francis Houde , Russell Butler , Etienne St-Onge , Marylie Martel , Véronique Thivierge , Maxime Descoteaux , Kevin Whittingstall , Guillaume Leonard","doi":"10.1016/j.neucli.2024.103011","DOIUrl":"10.1016/j.neucli.2024.103011","url":null,"abstract":"<div><h3>Objective</h3><p>Explore how anatomical measurements and field modeling can be leveraged to improve investigations of transcranial magnetic stimulation (TMS) effects on both motor and non-motor TMS targets.</p></div><div><h3>Methods</h3><p>TMS motor effects (targeting the primary motor cortex [M1]) were evaluated using the resting motor threshold (rMT), while TMS non-motor effects (targeting the superior temporal gyrus [STG]) were assessed using a pain memory task. Anatomical measurements included scalp-cortex distance (SCD) and cortical thickness (CT), whereas field modeling encompassed the magnitude of the electric field (E) induced by TMS.</p></div><div><h3>Results</h3><p>Anatomical measurements and field modeling values differed significantly between M1 and STG. For TMS motor effects, rMT was correlated with SCD, CT, and E values at M1 (<em>p</em> < 0.05). No correlations were found between these metrics for the STG and TMS non-motor effects (pain memory; all p-values > 0.05).</p></div><div><h3>Conclusion</h3><p>Although anatomical measurements and field modeling are closely related to TMS motor effects, their relationship to non-motor effects – such as pain memory – appear to be much more tenuous and complex, highlighting the need for further advancement in our use of TMS and virtual lesion paradigms.</p></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"54 6","pages":"Article 103011"},"PeriodicalIF":2.7,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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