The Neurodiagnostic Journal最新文献

Chiari malformation types 1 and 1.5 can be treated with posterior fossa decompression, though surgical techniques vary considerably, with more aggressive approaches often considered for type 1.5. Given this variability, an objective intraoperative marker of adequate decompression would support more tailored surgery. While brainstem auditory evoked potentials (BAEPs) have been explored in pediatric populations, their utility in adults remains unstudied. We present a 26-year-old female with Chiari 1.5 and symptoms including migraines, visual disturbances, balance issues, and right-hand clumsiness. She underwent a BAEP-guided, minimally invasive decompression involving a C1 laminectomy, linear dural opening, and tonsillar cauterization. Intraoperative BAEP monitoring allowed for a targeted, less extensive decompression, resulting in significant clinical improvement. This case highlights the potential utility of BAEPs in adult Chiari decompression, suggesting a role for further investigation of this technique in optimizing outcomes while minimizing invasiveness.

Artificial intelligence-integrated electroencephalography (AI-EEG) has demonstrated promise in the early detection of nonconvulsive status epilepticus (NCSE), particularly in emergency and intensive care settings with limited access to trained EEG technologists. This review includes 20 studies, of which 12 were incorporated into a meta-analysis assessing the diagnostic accuracy of AI-EEG. The pooled sensitivity reached 95%, with a specificity of 83%. However, when the pretest probability of NCSE is 40%, false positives may occur in approximately one in seven patients. Commercial AI-EEG platforms have shown a reduction in unnecessary antiepileptic drug (AED) administration compared to clinical judgment alone. Four prospective cohort studies reported a 26% relative risk reduction (RR -0.26; 95% CI -0.50 to -0.02; p = .03) in unnecessary AED use. Additionally, AI-EEG shortened the median time to EEG acquisition in resource-limited settings-from 4.5 hours (IQR 3.2-6.8) to 2.1 hours (IQR 1.5-3.4). A sub-analysis from an industry-sponsored trial suggested potential benefits of AI-EEG in reducing morbidity and ICU length of stay, though evidence remains insufficient for definitive conclusions. Despite these advantages, rapid-deployment AI-EEG systems face challenges: lack of video integration makes it difficult to distinguish seizures from artifacts or behavioral events, and limited electrode coverage may miss central brain activity. Moreover, AI algorithms tend to overread sharp and spike activities compared to human interpretation. Further investigator-initiated studies are needed to evaluate the diagnostic yield of AI-EEG beyond its simplified setup, assess its true impact on patient outcomes, and determine its feasibility for large-scale clinical implementation. .

Intraoperative neurophysiological monitoring (IONM) has emerged as a pivotal technology in neurosurgery, significantly enhancing patient safety and surgical outcomes by providing real-time monitoring of neurological functions. Despite its recognized benefits, the adoption and development of IONM in regions like West Africa have been relatively slow, with Ghana pioneering its introduction and utilization. This report explores the evolution of IONM in Ghana, initiated by FOCOS Hospital, and examines its expansion across the region. The report highlights key developments, including the first use of IONM during complex spine surgeries such as scoliosis, kyphosis and kyphoscoliosis deformity correction and brain tumor surgeries. Challenges, such as the scarcity of trained professionals, limited access to essential equipment, and the high cost of implementation are discussed. The future outlook of IONM in Ghana and potentially other West African and by extension, other low- and middle-income countries looks promising with planned expansions in training and certification programs to meet the growing demand. This report underscores the transformative potential of IONM in improving surgical care and patient outcomes in Ghana, West Africa, and other low- and middle-income countries advocating for increased regional support and investment in this crucial healthcare technology.

Developmental and/or epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS), formerly electrical status epilepticus of sleep (ESES), is a rare childhood-onset epilepsy characterized by continuous spike waves seen in sleep with or without associated seizures. D/EE-SWAS affects children ages 2-12 years and shows characteristic pattern of continuous spike-and-wave discharges during non-rapid eye movement (NREM) sleep (CSWS) on electroencephalography (EEG) with a high density of spikes. Generalized D/EE-SWAS is found in patients with acquired symptoms of progressive neurocognitive and/or behavioral regression. D/EE-SWAS with focal discharges has been reported with focal deficits. We present a 3.5-year-old boy with focal D/EE-SWAS who changed dominant handedness. He was innately right-hand dominant with obvious preference for scribbling and feeding himself with his right hand per his mother, though developed focal seizures and D/EE-SWAS of the left hemisphere and became left-hand dominant for all activities. Following medical treatment, he again used his right hand with ambidextrous handwriting. We report the first case of change in handedness with focal D/EE-SWAS. We review the available diagnostics and treatments of Landau-Kleffner syndrome (LKS) and D/EE-SWAS.