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It is time to personalize rTMS targeting for the treatment of pain 现在是个性化经颅磁刺激靶向治疗疼痛的时候了
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2024.102950
Jean-Pascal Lefaucheur
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引用次数: 0
Long-interval afferent inhibition measurement using two different methods: Normative values, repeatability and reliability 使用两种不同方法测量长间隔传入抑制:标准值、重复性和可靠性
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2023.102940
Hürrem Evren Boran , Halil Can Alaydın , Hasan Kılınç , Hatice Tankişi , Ginte Samusyte , James Howells , Martin Koltzenburg , Bülent Cengiz

Background

The mechanism of Short-Latency Afferent Inhibition (SAI) is relatively well understood. In contrast, Long-Latency Afferent Inhibition (LAI) has not been as extensively studied as SAI, and its underlying mechanism remains unclear.

Objective/Hypothesis

This study had two primary objectives: first, to determine the optimal ISIs for LAI measured by amplitude changes (A-LAI) using high-resolution ISI ranges; and second, to compare measurements of LAI by threshold-tracking (T-LAI).

Methods

Twenty-eight healthy volunteers (12 males aged 24- 45 years) participated in the study. Paired peripheral electrical and transcranial magnetic stimulation (TMS) stimuli (TS1mv) were applied at varying (ISIs)- 100, 200, 250, 300, 350, 400, 450, 500, 550, 600, 700, 800, 900, 1000 ms.

Results

Both A-LAI and T-LAI showed that LAI decreased progressively from a peak at 200 or 250 ms to 1000 ms. Using the A-LAI method, pronounced inhibition was observed at three specific ISIs: 100 ms, 250 ms and 450 ms. When A-LAI values were converted to equivalent threshold changes, they did not differ significantly from T-LAI. Reliability at distinguishing individuals, as indicated by intraclass correlation coefficient (ICC) was greater for A-LAI, with a peak value of 0.82 at 250 ms.

Conclusion(s)

The study demonstrates that ISIs of 100 ms and 250 ms can be reliably used in amplitude measurement LAI. The study demonstrates that both LAI measurements record a similar decline of inhibition with increasing ISI.

背景短延时传入抑制(SAI)的机制相对来说比较清楚。本研究有两个主要目标:第一,利用高分辨率 ISI 范围确定通过振幅变化(A-LAI)测量 LAI 的最佳 ISI;第二,比较通过阈值跟踪(T-LAI)测量 LAI。结果A-LAI 和 T-LAI 均显示 LAI 从 200 或 250 毫秒的峰值逐渐下降到 1000 毫秒。使用 A-LAI 方法,在三个特定的 ISIs(100 ms、250 ms 和 450 ms)处观察到明显的抑制作用。将 A-LAI 值转换为等效阈值变化时,它们与 T-LAI 没有显著差异。根据类内相关系数(ICC),A-LAI 区分个体的可靠性更高,250 ms 时的峰值为 0.82。研究表明,随着 ISI 的增加,两种 LAI 测量都记录了类似的抑制下降。
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引用次数: 0
Higher cortical excitability to negative emotions involved in musculoskeletal pain in Parkinson's disease 帕金森病患者大脑皮层对涉及肌肉骨骼疼痛的负面情绪的兴奋性更高
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2023.102936
Ming Liu , Hanying Gu , Jingzhe Hu , Manhua Liu , Yajun Luo , Yuan Yuan , Jiayu Wu , Yan Zhou , Ru Juan , Xiaoyu Cheng , Sheng Zhuang , Yun Shen , Hong Jin , Jing Chen , Kai Li , Fen Wang , Chunfeng Liu , Chengjie Mao

Objective

Changes in brain structure and neurotransmitter systems are involved in pain in Parkinson's disease (PD), and emotional factors are closely related to pain. Our study applied electroencephalography (EEG) to investigate the role of emotion in PD patients with chronic musculoskeletal pain.

Methods

Forty-two PD patients with chronic musculoskeletal pain and 38 without were enrolled. EEG data were recorded under resting conditions, and while viewing pictures with neutral, positive, and negative content. We compared spectrum power, functional connectivity, and late positive potential (LPP), an event-related potential (ERP), between the groups.

Results

PD patients with pain tended to have higher scores for the Hamilton Rating Scale for Depression (HRSD). In the resting EEG, mean β-band amplitude was significantly higher in patients with pain than in those without. Logistic regression analysis showed that higher HRSD scores and higher mean β-band amplitude were associated with pain. ERP analysis revealed that the amplitudes of LPP difference waves (the absolute difference between positive and negative condition LPP and neutral condition LPP) at the central–parietal region were significantly reduced in patients with pain (P = 0.029). Spearman correlation analysis showed that the amplitudes of late (700–1000 ms) negative versus neutral condition LPP difference waves were negatively correlated with pain intensity, assessed by visual analogue scale, (r = −0.393, P = 0.010) and HRSD scores (r = −0.366, P = 0.017).

Conclusion

Dopaminergic and non-dopaminergic systems may be involved in musculoskeletal pain in PD by increasing β-band activity and weakening the connection of the θ-band at the central–parietal region. PD patients with musculoskeletal pain have higher cortical excitability to negative emotions. The changes in pain-related EEG may be used as electrophysiological markers and therapeutic targets in PD patients with chronic pain.

目的帕金森病(PD)患者的疼痛与大脑结构和神经递质系统的变化有关,而情绪因素与疼痛密切相关。我们的研究采用脑电图(EEG)来研究情绪在帕金森病慢性肌肉骨骼疼痛患者中的作用。我们记录了静息状态下以及观看中性、积极和消极内容图片时的脑电图数据。我们比较了两组患者的频谱功率、功能连通性和晚期正电位(LPP)(一种事件相关电位(ERP))。在静息脑电图中,疼痛患者的平均β波段振幅明显高于非疼痛患者。逻辑回归分析表明,HRSD评分越高,平均β波段振幅越大,则疼痛越严重。ERP分析显示,疼痛患者中央顶叶区的LPP差异波(正负状态LPP与中性状态LPP的绝对差值)振幅明显降低(P = 0.029)。斯皮尔曼相关分析表明,晚期(700-1000 毫秒)阴性与中性状态 LPP 差异波的振幅与视觉模拟量表评估的疼痛强度呈负相关(r = -0.393,P = 0.结论多巴胺能系统和非多巴胺能系统可能通过增加 β 波段活动和减弱中央顶叶区 θ 波段的连接参与了帕金森病肌肉骨骼疼痛。患有肌肉骨骼疼痛的帕金森病患者大脑皮层对负面情绪的兴奋性更高。疼痛相关脑电图的变化可作为慢性疼痛的帕金森病患者的电生理标记和治疗目标。
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引用次数: 0
Sensory symptoms relieved by navigated rTMS, targeted using lesion network mapping based on human brain connectome, in a patient after thalamic stroke 利用基于人脑连接组的病变网络图,通过导航经颅磁刺激缓解丘脑中风患者的感觉症状
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2024.102953
Mengdan Zhang , Xiaohui Xie , Yuqian Zhan , Yu Jiang , Tongjian Bai , Long Zhang , Kai Wang , Gong-Jun Ji , Yanghua Tian
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引用次数: 0
Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study 截肢者幻肢痛和残肢痛的代谢运动皮层活动模式不同:功能性近红外光谱研究
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2023.102939
Marcel Simis , Lucas Murrins Marques , Sara Pinto Barbosa , André Tadeu Sugawara , João Ricardo Sato , Kevin Pacheco-Barrios , Linamara Rizzo Battistella , Felipe Fregni
<div><h3>Background</h3><p>Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood.</p></div><div><h3>Objectives</h3><p>The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS).</p></div><div><h3>Methods</h3><p>Sixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education.</p></div><div><h3>Results</h3><p>We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks.</p></div><div><h3>Conclusion</h3><p>These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contrib
背景幻肢痛(Phantom pain limb,PLP)由于全球截肢患者人数众多以及人们对疼痛过程的认识不断加深而受到越来越多的关注,尽管人们对其机制尚未完全了解。方法从巴西圣保罗的康复项目中招募了 60 名参与者。研究人员从巴西圣保罗的康复项目中招募了 60 名参与者,其中包括年龄超过 18 岁的外伤性单侧下肢截肢患者,以及在截肢手术完全康复后至少 3 个月仍有 PLP 的患者。为了突出与疼痛测量变化相关的可能变量,对两种实验条件进行了单变量线性回归分析,得出了四个 fNIRS 变量(两个半球 x 两个实验条件)。随后,为了测试模型的地形特异性,进行了八次多元回归分析(两个疼痛量表 x 两个实验条件 x 两个半球),包括作为自变量的初级运动皮层(PMC)相关通道以及与前运动区、辅助区和躯体感觉皮层相关的其他五个通道。所有模型均控制了年龄、性别、种族和教育程度。结果我们发现i) 在执行运动和镜像任务时,大脑半球之间的代谢激活不对称(以截肢同侧为主);ii) 截肢同侧运动前区代谢反应的增加与 PLP 的增加有关(在两项实验任务中),而对侧运动前区代谢反应的增加与 RLP 的增加有关(仅在镜像运动任务中);ii)在运动镜像任务中,同侧运动前区代谢活动的增加与 PLP 的增加有关;iii)在运动镜像任务中,RLP 仅与对侧运动前区代谢活动的增加有关,而与同侧额叶下区代谢活动的减少有关,但在两项任务中,PLP 都与代谢活动的增加有关。结论这些结果表明,大脑代谢反应与两种不同类型的截肢后疼痛之间存在任务和区域特异性。在这两项任务中,截肢肢体同侧的代谢优势与较高水平的 PLP 相关,这表明由于潜在的半球间补偿机制,大脑皮层运动网络活动失衡。本研究有助于了解与截肢后疼痛相关的运动相关回路的基本地形模式。
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引用次数: 0
Impact of textured surfaces on the orthostatic balance of patients with multiple sclerosis 纹理表面对多发性硬化症患者正立平衡的影响
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2023.102941
Nathalie Bonardet , Benjamin Bardel , Jean-Pascal Lefaucheur , Marc Sorel , Alain Créange

Objective

To perform posturographic measurements with eyes open or closed using floor coverings with different textured surfaces to study postural control in patients with multiple sclerosis (MS).

Methods

Static posturographic recordings were performed with eyes open and eyes closed on a forceplate with no covering (control condition) or covered by a textured mat with small pimples (height 2 mm) or large pimples (height 7 mm). Several posturographic variables were measured, focusing on displacements of the center of pressure (CoP) including the average velocity (Vav), the total length (L) of all displacements, and the surface (S) of the confidence ellipse. The recordings made with the textured mats were compared to the control condition with eyes open or closed. Then, the differences between the recordings made with large vs. small pimples on the one hand, and with eyes closed vs. open were calculated to assess the impact of pimple height or eye closure on posturographic measurements. Clinical assessment was based on the Expanded Disability Status Scale (EDSS) and its functional system (FS) subscores, the Modified Fatigue Impact Scale (MFIS), the Unipodal Stance test (UST), and the Timed Up-and-Go test (TUG).

Results

Forty-six MS patients (mean EDSS score: 3.6) completed the study. Several posturographic variables, including Vav and L, deteriorated when measured on a textured mat, especially with large pimples and in eyes open condition. In contrast, no difference was found with small pimples and eyes closed, as compared to the control condition (no covering). The deleterious impact of pimple height on posturography correlated positively with the alteration of balance and gait clinically assessed by the UST and the TUG, and also with the MFIS physical and cerebral EDSS-FS subscores, and negatively with the cerebellar and brainstem subscores. On the other hand, the impact of eye closure on posturography was negatively correlated with the visual EDSS-FS subscore.

Discussion

Static posturographic measurements made with different textured surfaces and visual conditions can be considered as a sensitive tool to measure "proprioceptive reserves". Actually, when cerebellar, brainstem, or visual functions are impaired, the resources of the sensory (proprioceptive) system, if preserved, can be recruited at a higher level and compensate for dysfunctions of other postural controls to maintain a satisfactory balance. In addition, this procedure of static posturographic examination can provide objective measurements correlated with clinical testing of balance and gait and could usefully complement EDSS scoring to assess disability affecting postural control and the risk of falling in MS patients.

方法在没有覆盖物的受力板(对照组)上或覆盖有小疙瘩(高度为 2 毫米)或大疙瘩(高度为 7 毫米)的纹理垫子上进行睁眼和闭眼的静态体位图形记录。我们测量了几种姿势变量,重点是压力中心(CoP)的位移,包括平均速度(Vav)、所有位移的总长度(L)和置信椭圆的表面(S)。将使用纹理垫进行的记录与睁眼或闭眼的对照条件进行比较。然后,计算大痘痘与小痘痘、闭眼与睁眼所做记录之间的差异,以评估痘痘高度或闭眼对体位测量的影响。临床评估基于扩展残疾状况量表(EDSS)及其功能系统(FS)子量表、改良疲劳影响量表(MFIS)、单足站立测试(UST)和定时上走测试(TUG)。在有纹理的垫子上进行测量时,包括 Vav 和 L 在内的几项体位图形变量均出现恶化,尤其是在有大疙瘩和睁眼的情况下。相比之下,与对照组(无覆盖物)相比,小痘痘和闭眼时没有差异。痘痘高度对体位描记术的不利影响与 UST 和 TUG 临床评估的平衡和步态改变呈正相关,也与 MFIS 体力和大脑 EDSS-FS 子评分呈正相关,与小脑和脑干子评分呈负相关。另一方面,闭眼对体位法的影响与视觉 EDSS-FS 分值呈负相关。讨论在不同质地表面和视觉条件下进行的静态体位法测量可被视为测量 "本体感觉储备 "的敏感工具。事实上,当小脑、脑干或视觉功能受损时,如果感觉(本体感觉)系统资源得以保留,则可在更高水平上被调用,并补偿其他姿势控制功能障碍,以保持令人满意的平衡。此外,这种静态姿势图检查程序可提供与平衡和步态临床测试相关的客观测量结果,可有效补充 EDSS 评分,以评估影响姿势控制的残疾情况和多发性硬化症患者跌倒的风险。
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引用次数: 0
Efficacy and safety of transcranial direct current stimulation in the treatment of fibromyalgia: A systematic review and meta-analysis 经颅直流电刺激治疗纤维肌痛的有效性和安全性:系统回顾与荟萃分析
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2024.102944
Chun-Lan Yang , Yun Qu , Jia-Peng Huang , Ting-Ting Wang , Han Zhang , Yin Chen , Ying-Chao Tan

Objectives

To update a systematic review of the efficacy and safety of transcranial direct current stimulation (tDCS) for analgesia, for antidepressant effects, and to reduce the impact of fibromyalgia (FM), looking for optimal areas of stimulation.

Methods

We searched five databases to identify randomized controlled trials comparing active and sham tDCS for FM. The primary outcome was pain intensity, and secondary outcome measures included FM Impact Questionnaire (FIQ) and depression score. Meta-analysis was conducted using standardized mean difference (SMD). Subgroup analysis was performed to determine the effects of different regional stimulation, over the primary motor cortex (M1), dorsolateral prefrontal cortex (DLPFC), opercular-insular cortex (OIC), and occipital nerve (ON) regions. We analyzed the minimal clinically important difference (MCID) by the value of the mean difference (MD) for an 11-point scale for pain, the Beck Depressive Inventory-II (BDI-II), and the Fibromyalgia Impact Questionnaire (FIQ) score. We described the certainty of the evidence (COE) using the tool GRADE profile.

Results

Twenty studies were included in the analysis. Active tDCS had a positive effect on pain (SMD= -1.04; 95 % CI -1.38 to -0.69), depression (SMD= -0.46; 95 % CI -0.64 to -0.29), FIQ (SMD= -0.73; 95 % CI -1.09 to –0.36), COE is moderate. Only group M1 (SD=-1.57) and DLPFC (SD=-1.44) could achieve MCID for analgesia; For BDI-II, only group DLPFC (SD=-5.36) could achieve an MCID change. Adverse events were mild.

Conclusion

tDCS is a safe intervention that relieves pain intensity, reduces depression, and reduces the impact of FM on life. Achieving an MCID is related to the stimulation site and the target symptom.

目的对经颅直流电刺激(tDCS)镇痛、抗抑郁以及减轻纤维肌痛(FM)影响的疗效和安全性进行系统综述,寻找最佳刺激区域。主要结果为疼痛强度,次要结果包括FM影响问卷(FIQ)和抑郁评分。采用标准化平均差(SMD)进行了元分析。我们进行了分组分析,以确定不同区域刺激对初级运动皮层(M1)、背外侧前额叶皮层(DLPFC)、厣肌-岛叶皮层(OIC)和枕神经(ON)区域的影响。我们通过疼痛 11 分量表、贝克抑郁清单-II (BDI-II) 和纤维肌痛影响问卷 (FIQ) 评分的平均差 (MD) 值来分析最小临床重要差异 (MCID)。我们使用 GRADE 工具描述了证据的确定性(COE)。有源 tDCS 对疼痛(SMD=-1.04;95 % CI -1.38 to -0.69)、抑郁(SMD=-0.46;95 % CI -0.64 to -0.29)和 FIQ(SMD=-0.73;95 % CI -1.09 to -0.36)有积极影响,COE 为中等。只有 M1 组(SD=-1.57)和 DLPFC 组(SD=-1.44)的镇痛效果达到 MCID;对于 BDI-II,只有 DLPFC 组(SD=-5.36)的变化达到 MCID。结论TDCS是一种安全的干预措施,能缓解疼痛强度、减轻抑郁、减少FM对生活的影响。MCID的实现与刺激部位和目标症状有关。
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引用次数: 0
Can epilepsy affect normal EEG variants? A comparative study between subjects with and without epilepsy 癫痫会影响正常脑电图变异吗?癫痫患者与非癫痫患者的比较研究
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-02-01 DOI: 10.1016/j.neucli.2023.102935
Greta Macorig , Arielle Crespel , Annacarmen Nilo , Ngoc Phuong Loc Tang , Gian Luigi Gigli , Philippe Gélisse

Objectives

To compare the prevalence of benign EEG variants (BEVs) between epileptic and non-epileptic subjects.

Methods

A prospective, observational EEG study of 1,163 consecutive patients, using the 10–20 international system with systematically two additional anterior/inferior temporal electrodes. The video-EEG monitoring duration was between 24 h and eight days.

Results

We identified 917 (78.9%) epileptic patients (mean age: 33.42 ± 15.5 years; females: 53.4%) and 246 (21.2%) non-epileptic patients (mean age: 35.6 ± 18.75 years; females: 54.9%). Despite a shorter mean duration of the EEG recordings, the prevalence of BEVs was higher in non-epileptic vs. epileptic patients (73.2% vs. 57.8%, p = 0.000011). This statistical difference was confirmed for lambda waves (23.6% in the non-epilepsy group vs. 14.8% in the epilepsy group, p = 0.001), POSTs (50.8% vs. 32.5%, p < 0.000001), wicket spikes (20.3% vs. 13.6%, p = 0.009) in particular in NREM and REM sleep, and 14- and 6-Hz positive bursts (13% vs. 7.1% p = 0.003). Mu rhythm was observed at the same frequency in both groups (21.1% in the non-epilepsy group vs. 22.7% in the epilepsy group). There was no difference between the two groups for rarer rhythms, such as rhythmic mid-temporal theta burst of drowsiness, small sharp spikes, and midline theta rhythm.

Conclusions

There was no increase in any of the BEVs in the epilepsy group. On the contrary, BEVs were more frequent and diversified in the non-epilepsy group. Epilepsy may negatively affect the occurrence of the most common BEVs, with the exception of the mu rhythm, which is present in about one-fifth of the population with or without epilepsy.

目的比较癫痫患者和非癫痫患者良性脑电图变异(BEVs)的发生率。方法对 1,163 名连续患者进行前瞻性观察性脑电图研究,采用 10-20 国际系统,系统性地增加两个颞前/颞下电极。结果我们发现了 917 名(78.9%)癫痫患者(平均年龄:33.42 ± 15.5 岁;女性:53.4%)和 246 名(21.2%)非癫痫患者(平均年龄:35.6 ± 18.75 岁;女性:54.9%)。尽管脑电图记录的平均持续时间较短,但非癫痫患者与癫痫患者的 BEVs 发生率更高(73.2% 对 57.8%,p = 0.000011)。这一统计差异在以下方面得到了证实:λ波(非癫痫组 23.6% 对癫痫组 14.8%,p = 0.001)、POSTs(50.8% 对 32.5%,p < 0.000001)、wicket spikes(20.3% 对 13.6%,p = 0.009),尤其是在 NREM 和 REM 睡眠中,以及 14-Hz 和 6-Hz 阳性爆发(13% 对 7.1% p = 0.003)。两组观察到的 Mu 节律频率相同(非癫痫组为 21.1%,癫痫组为 22.7%)。两组在罕见节律方面没有差异,如嗜睡的θ中颞节律性爆发、小尖峰和中线θ节律。相反,非癫痫组的 BEVs 更为频繁和多样化。癫痫可能会对最常见的 BEVs 的出现产生负面影响,但 mu 节律除外。
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引用次数: 0
Suboptimal postnatal function of brainstem auditory pathway in late preterm infants who do not have major perinatal and postnatal complications 无重大围产期和产后并发症的晚早产儿脑干听觉通路的亚理想产后功能
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-11-18 DOI: 10.1016/j.neucli.2023.102919
Cui Wang, James K. Jiang, Rong Yin, Ze D. Jiang

Objectives

To examine postnatal functional status of the brainstem auditory pathway in late preterm infants and detect any postnatal auditory abnormality.

Methods

Thirty preterm infants born at 33–36 weeks gestation were studied three months after term. None had major perinatal and postnatal complications to minimize confounding effects. Brainstem auditory evoked responses were recorded with 21–91/s clicks.

Results

Compared with postnatal age-matched normal term infants, the late preterm infants did not manifest any major abnormalities in brainstem auditory evoked responses at conventionally used 21/s clicks. At higher click rates, however, the late preterm infants manifested a moderate prolongation in BAER wave V latency. All interpeak intervals tended to be prolonged at higher click rates. The I-V interval was significantly prolonged at 51/s and particularly at 91/s clicks. Both the I-III and III-V intervals were significantly prolonged at 91/s. The late preterm infants also manifested reduced amplitudes of BAER waves III and V at most click rates.

Conclusion

The central components of the brainstem auditory evoked responses were abnormal at higher click rates three months after term in the late preterm infants. Postnatal brainstem auditory function is suboptimal in late preterm infants without major complications. This suboptimal brainstem auditory function may not be clearly shown at term or an earlier stage, but can be shown later. Late preterm infants, although they may not have major complications, should be followed for later auditory development, providing valuable information for improving postnatal care.

目的探讨晚期早产儿脑干听觉通路的产后功能状态,发现新生儿的听觉异常。方法对30例妊娠33 ~ 36周的早产儿进行足月后随访研究。没有主要的围产期和产后并发症,以尽量减少混淆的影响。以21-91 /s的咔哒声记录脑干听觉诱发反应。结果与出生后年龄匹配的正常足月儿相比,晚早产儿的脑干听觉诱发反应未出现明显异常。然而,在较高的点击率下,晚期早产儿表现出BAER波V潜伏期的适度延长。在较高的点击率下,所有的高峰间隔都趋于延长。在51/s下,特别是在91/s下,I-V间隔明显延长。I-III期和III-V期均以91/s的速度显著延长。在大多数点击率下,晚期早产儿也表现出BAER波III和V的振幅降低。结论晚期早产儿在足月后3个月时,脑干听觉诱发反应中枢成分出现异常,且点击率较高。没有重大并发症的晚期早产儿,出生后脑干听觉功能是次优的。这种次优的脑干听觉功能可能不会在足月或早期阶段明显表现出来,但可以在以后表现出来。晚期早产儿虽然可能没有重大并发症,但应随访其后期听觉发育,为改善产后护理提供有价值的信息。
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引用次数: 0
The effects of anodal tDCS on pain reduction in people with knee osteoarthritis: A systematic review and meta-analysis 负极tDCS对膝关节骨关节炎患者疼痛减轻的影响:一项系统回顾和荟萃分析
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-11-18 DOI: 10.1016/j.neucli.2023.102921
Thusharika Dissanayaka , Piumi Nakandala , Kavinda Malwanage , Aron T. Hill , Deborah N. Ashthree , Melissa M. Lane , Nikolaj Travicia , Elizabeth Gamage , Wolfgang Marx , Shapour Jaberzadeh

Objectives

To synthesise the literature on the efficacy of primary motor cortex anodal transcranial direct current stimulation (M1-a-tDCS), as a standalone or priming technique, for pain reduction in people with knee osteoarthritis (KOA).

Methods

The systematic literature search was conducted in MEDLINE, CINAHL, Embase and CENTRAL according to PRISMA statement.

Results

Fourteen studies involving 740 people with KOA were included. In the meta-analysis, six studies compared a-tDCS alone with sham stimulation, and five studies compared a-tDCS combined with other methods with sham stimulation. We found positive effect of a-tDCS alone on pain in KOA (standard mean difference (SMD) −0.52; 95% CI, −0.78 to −0.25; P=0.001; I2 = 69%). Further, a-tDCS with other treatments showed positive effect (SMD −1.23; 95% CI, −1.59 to −0.88; P<0.001; I2 = 48%) on pain in people with KOA. This evidence showed low certainty due to a high risk of bias and imprecision.

Discussion and Conclusion

A-tDCS could be considered as standalone and an adjunct treatment for pain reduction in people with KOA. Future randomised studies should address quality issues, including small sample size, to enhance the overall certainty of the findings.

Significance

A-tDCS can be used as a standalone and adjunct treatment for KOA.

Study registration

PROSPERO number CRD42021255114

目的综合有关原发性运动皮质阳极经颅直流电刺激(M1-a-tDCS)作为单独或启动技术减轻膝关节骨关节炎(KOA)患者疼痛的疗效的文献。方法根据PRISMA声明在MEDLINE、CINAHL、Embase和CENTRAL进行系统文献检索。结果共纳入14项研究,涉及740例KOA患者。在meta分析中,6项研究比较了a-tDCS单独与假手术刺激,5项研究比较了a-tDCS联合其他方法与假手术刺激。我们发现单独使用a-tDCS对KOA患者疼痛有积极影响(标准平均差(SMD) - 0.52;95% CI,−0.78 ~−0.25;P = 0.001;i2 = 69%)。此外,a-tDCS联合其他处理显示出积极的效果(SMD - 1.23;95% CI,−1.59 ~−0.88;术中,0.001;I2 = 48%)对KOA患者疼痛的影响。由于高偏倚和不精确的风险,该证据的确定性较低。讨论与结论a - tdcs可作为KOA患者减轻疼痛的独立治疗和辅助治疗。未来的随机研究应该解决质量问题,包括小样本量,以提高研究结果的总体确定性。意义- tdcs可作为KOA的独立治疗和辅助治疗。研究注册号为CRD42021255114
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引用次数: 1
期刊
Neurophysiologie Clinique/Clinical Neurophysiology
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