{"title":"A movie in the operating theater: Guided story narration as a pragmatic language screening tool during awake craniotomy","authors":"Nishanth Sampath , Sunil Kapilavayi Raghavendra , Vishwaraj Ratha , Gomathi Sivakumar , Vijay Sankaran , Suresh Bapu K.R.","doi":"10.1016/j.cnp.2026.01.002","DOIUrl":"10.1016/j.cnp.2026.01.002","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 36-37"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cnp.2025.12.008
Yuichiro Shirota , Juuri Otsuka , Masashi Hamada
Objective
To investigate precision, accuracy, and reliability of a threshold hunting method to estimate resting motor threshold (RMT) using parameter estimation by sequential testing and maximum likelihood estimation (PEST-MLE).
Methods
In 53 healthy participants, single pulse transcranial magnetic stimulation was delivered to estimate RMT with cutoff values of 0.05 mV and 0.2 mV. RMT was inferred from 30-trial PEST-MLE algorithm for at maximum two days with two estimation sessions per day, comprising Sessions 1 to 4. Precision and accuracy were assessed within each session. Repeatability was assessed using intraclass correlation coefficient (ICC), reproducibility coefficient (RC), and standard error of measurement (SEM).
Results
For both 0.05 mV and 0.2 mV, 18 trials were needed to have good accuracy. ICC greater than 0.8 was achieved for within-day comparison but the ICC of between-day comparison was lower. RC and SEM were around 10 % and 5 %, respectively.
Conclusions
At 18th trial the estimations were converged in terms of precision and accuracy, and good reliability was achieved at that stage.
Significance
RMT estimation with the PEST-MLE is a rapid and reliable approach that can be implemented for future clinical and scientific studies.
{"title":"Precision, accuracy, and reliability of a threshold hunting method for transcranial magnetic stimulation","authors":"Yuichiro Shirota , Juuri Otsuka , Masashi Hamada","doi":"10.1016/j.cnp.2025.12.008","DOIUrl":"10.1016/j.cnp.2025.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate precision, accuracy, and reliability of a threshold hunting method to estimate resting motor threshold (RMT) using parameter estimation by sequential testing and maximum likelihood estimation (PEST-MLE).</div></div><div><h3>Methods</h3><div>In 53 healthy participants, single pulse transcranial magnetic stimulation was delivered to estimate RMT with cutoff values of 0.05 mV and 0.2 mV. RMT was inferred from 30-trial PEST-MLE algorithm for at maximum two days with two estimation sessions per day, comprising Sessions 1 to 4. Precision and accuracy were assessed within each session. Repeatability was assessed using intraclass correlation coefficient (ICC), reproducibility coefficient (RC), and standard error of measurement (SEM).</div></div><div><h3>Results</h3><div>For both 0.05 mV and 0.2 mV, 18 trials were needed to have good accuracy. ICC greater than 0.8 was achieved for within-day comparison but the ICC of between-day comparison was lower. RC and SEM were around 10 % and 5 %, respectively.</div></div><div><h3>Conclusions</h3><div>At 18th trial the estimations were converged in terms of precision and accuracy, and good reliability was achieved at that stage.</div></div><div><h3>Significance</h3><div>RMT estimation with the PEST-MLE is a rapid and reliable approach that can be implemented for future clinical and scientific studies.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 24-31"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cnp.2025.12.007
Brin E. Freund , Khalil S. Husari , José L. Fernández-Torre , Philippe Gélisse , Peter W. Kaplan
{"title":"Response to CNP-D-25–204 “Triphasic waves: To treat or not to treat?”: Do not overlook COVID-19 and Creutzfeldt-Jakob disease","authors":"Brin E. Freund , Khalil S. Husari , José L. Fernández-Torre , Philippe Gélisse , Peter W. Kaplan","doi":"10.1016/j.cnp.2025.12.007","DOIUrl":"10.1016/j.cnp.2025.12.007","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 34-35"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cnp.2025.12.009
Leyla Das Pektezel , Mehmet Yasir Pektezel
{"title":"A comment on “Electrodiagnostic criteria for neuromuscular transmission disorders suggested by a European consensus group”","authors":"Leyla Das Pektezel , Mehmet Yasir Pektezel","doi":"10.1016/j.cnp.2025.12.009","DOIUrl":"10.1016/j.cnp.2025.12.009","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 32-33"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.cnp.2025.12.005
Leonardo Affronte , Stefania Maffei , Mara Malerba , Giada Giovannini , Paolo Manganotti , Antonietta Coppola , Leonilda Bilo , Anna Elisabetta Vaudano , Marina Trivisano , Nicola Specchio , Stefano Meletti
Objective
Poor documentation of seizures can be a major challenge in epilepsy. Objective seizure counting with mobile devices might improve this challenge and the patient management. We investigate whether ultra long-term subcutaneous EEG improves seizure documentation and disease monitoring in adults and adolescents with developmental and epileptic encephalopathies (DEEs).
Methods
Ultra long-term subcutaneous EEG Monitoring In Rare Epilepsies and DEE (EMIRE) is a multi-centre prospective interventional study with an expected duration of 6 months. 33 Adolescents and adult participants will be implanted with 24/7 EEG SubQ and collect 2-channel EEG data up to 6 months. Data will be reviewed by experts on a weekly basis and a summary sent to the treating clinician.
Results
(1) safety and tolerability of subcutaneous EEG in this special patient population; (2) seizure detection sensitivity and specificity with respect to patients’ seizure-diaries and ‘ground truth’; (3) whether and how home monitoring can affect the clinical management of the patients.
Conclusions
This project will investigate home and remote patient monitoring systems, offering an accuracy that is unthinkable today.
Significance
This trial of home monitoring is intended to be of clinical utility to the patient by allowing objective assessment of therapeutic interventions and their effectiveness.
Plain language summary.
We present a clinical trial protocol for a prospective cohort study in people with severe epilepsies across Italy. The study aims to assess whether an EEG implant placed under the skin (1) is more accurate than patient-reported seizure diary, (2) is feasible and acceptable to patients and clinicians, (3) affect the clinical management of the patients, (4) reduces the impact of epilepsy.
{"title":"Ultra long-term EEG monitoring for developmental and epileptic encephalopathies: protocol for a prospective study using subscalp EEG","authors":"Leonardo Affronte , Stefania Maffei , Mara Malerba , Giada Giovannini , Paolo Manganotti , Antonietta Coppola , Leonilda Bilo , Anna Elisabetta Vaudano , Marina Trivisano , Nicola Specchio , Stefano Meletti","doi":"10.1016/j.cnp.2025.12.005","DOIUrl":"10.1016/j.cnp.2025.12.005","url":null,"abstract":"<div><h3>Objective</h3><div>Poor documentation of seizures can be a major challenge in epilepsy. Objective seizure counting with mobile devices might improve this challenge and the patient management. We investigate whether ultra long-term subcutaneous EEG improves seizure documentation and disease monitoring in adults and adolescents with developmental and epileptic encephalopathies (DEEs).</div></div><div><h3>Methods</h3><div>Ultra long-term subcutaneous EEG Monitoring In Rare Epilepsies and DEE (EMIRE) is a multi-centre prospective interventional study with an expected duration of 6 months. 33 Adolescents and adult participants will be implanted with 24/7 EEG SubQ and collect 2-channel EEG data up to 6 months. Data will be reviewed by experts on a weekly basis and a summary sent to the treating clinician.</div></div><div><h3>Results</h3><div>(1) safety and tolerability of subcutaneous EEG in this special patient population; (2) seizure detection sensitivity and specificity with respect to patients’ seizure-diaries and ‘ground truth’; (3) whether and how home monitoring can affect the clinical management of the patients.</div></div><div><h3>Conclusions</h3><div>This project will investigate home and remote patient monitoring systems, offering an accuracy that is unthinkable today.</div></div><div><h3>Significance</h3><div>This trial of home monitoring is intended to be of clinical utility to the patient by allowing objective assessment of therapeutic interventions and their effectiveness.</div><div>Plain language summary.</div><div>We present a clinical trial protocol for a prospective cohort study in people with severe epilepsies across Italy. The study aims to assess whether an EEG implant placed under the skin (1) is more accurate than patient-reported seizure diary, (2) is feasible and acceptable to patients and clinicians, (3) affect the clinical management of the patients, (4) reduces the impact of epilepsy.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 16-23"},"PeriodicalIF":2.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.cnp.2025.12.006
Jiaojiao Guo , Ziyi Wang , Nicole van Klink , Eline Schaft , Dongqing Sun , Sandra van der Salm , Maryse van ’t Klooster , Maeike Zijlmans
{"title":"Multi-montage visualization of interictal epileptic events in high-density intraoperative electrocorticography","authors":"Jiaojiao Guo , Ziyi Wang , Nicole van Klink , Eline Schaft , Dongqing Sun , Sandra van der Salm , Maryse van ’t Klooster , Maeike Zijlmans","doi":"10.1016/j.cnp.2025.12.006","DOIUrl":"10.1016/j.cnp.2025.12.006","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 13-15"},"PeriodicalIF":2.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.cnp.2025.12.004
A. Naidoo , KE. Jones
Objectives
To examine how stimulus amplitude and width influence subthreshold superexcitability of peripheral axons and to provide evidence-based recommendations for minimizing inadvertent compound muscle action potential (CMAP) generation during intraoperative corticobulbar monitoring.
Methods
Fifteen healthy participants received median nerve stimulation under nine conditions combining three amplitudes (80 %, 85 %, and 90 % of threshold) and three pulse widths (0.1 ms, 0.5 ms, 1.0 ms). Trains of 1–7 subthreshold pulses (2 ms interpulse interval) were delivered 10 times per condition. CMAPs were recorded from the abductor pollicis brevis (APB), and the probability of a response exceeding 100 µV (baseline-to-negative-peak) was calculated. Persistent sodium current was estimated using the latent addition test (LAh).
Results
Higher pulse amplitudes and wider pulse widths significantly increased CMAP probability, with a significant interaction (F(4,56) = 4.853, p = 0.002, partial η2 = 0.257). All pairwise comparisons were significant (p ≤ 0.023). When controlling for rheobase, LAh was positively correlated with response probability (rpartial(12) = 0.539, p = 0.047).
Conclusions & significance
Subthreshold trains activate motor axons in a predictable manner depending on amplitude, width, and train length. These findings challenge current IONM assumptions and highlight the need for threshold-referenced, standardized protocols.
目的探讨刺激幅度和宽度如何影响外周轴突的阈下超兴奋性，并为术中皮质球监测中减少无意复合肌动作电位（CMAP）的产生提供循证建议。方法15名健康受试者分别在阈值的80%、85%和90%三个幅度和0.1 ms、0.5 ms、1.0 ms三个脉宽的9种条件下接受正中神经刺激。每个条件下传递1-7个亚阈值脉冲序列（脉冲间隔2 ms） 10次。从短掌外展肌（APB）记录cmap，并计算反应超过100µV（基线到负峰）的概率。使用潜在添加试验（LAh）估计持久钠电流。结果较高的脉冲振幅和较宽的脉冲宽度显著提高了CMAP的发生概率，且存在显著的交互作用（F(4,56) = 4.853, p = 0.002，偏η2 = 0.257）。两两比较均显著（p≤0.023）。在控制流变酶的情况下，LAh与应答概率呈正相关（rpartial(12) = 0.539, p = 0.047）。阈下序列以可预测的方式激活运动轴突，这取决于振幅、宽度和序列长度。这些发现挑战了当前IONM的假设，并强调了阈值参考、标准化协议的必要性。
{"title":"Temporal summation of subthreshold stimuli in human motor axons: Implications for intraoperative neuromonitoring","authors":"A. Naidoo , KE. Jones","doi":"10.1016/j.cnp.2025.12.004","DOIUrl":"10.1016/j.cnp.2025.12.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine how stimulus amplitude and width influence subthreshold superexcitability of peripheral axons and to provide evidence-based recommendations for minimizing inadvertent compound muscle action potential (CMAP) generation during intraoperative corticobulbar monitoring.</div></div><div><h3>Methods</h3><div>Fifteen healthy participants received median nerve stimulation under nine conditions combining three amplitudes (80 %, 85 %, and 90 % of threshold) and three pulse widths (0.1 ms, 0.5 ms, 1.0 ms). Trains of 1–7 subthreshold pulses (2 ms interpulse interval) were delivered 10 times per condition. CMAPs were recorded from the abductor pollicis brevis (APB), and the probability of a response exceeding 100 µV (baseline-to-negative-peak) was calculated. Persistent sodium current was estimated using the latent addition test (LAh).</div></div><div><h3>Results</h3><div>Higher pulse amplitudes and wider pulse widths significantly increased CMAP probability, with a significant interaction (F(4,56) = 4.853, p = 0.002, partial η<sup>2</sup> = 0.257). All pairwise comparisons were significant (p ≤ 0.023). When controlling for rheobase, LAh was positively correlated with response probability (r<sub>partial</sub>(12) = 0.539, p = 0.047).</div></div><div><h3>Conclusions & significance</h3><div>Subthreshold trains activate motor axons in a predictable manner depending on amplitude, width, and train length. These findings challenge current IONM assumptions and highlight the need for threshold-referenced, standardized protocols.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 5-12"},"PeriodicalIF":2.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/j.cnp.2025.12.003
Moisés León-Ruiz, Julián Benito-León, Carlos Castañeda-Cabrero
{"title":"Response to “Triphasic waves: To treat or not to treat?”: Do not overlook COVID-19 and Creutzfeldt-Jakob disease","authors":"Moisés León-Ruiz, Julián Benito-León, Carlos Castañeda-Cabrero","doi":"10.1016/j.cnp.2025.12.003","DOIUrl":"10.1016/j.cnp.2025.12.003","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 1-2"},"PeriodicalIF":2.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.03.003
Johannes von Fraunberg , Hongyu Lu , Haodi Yang , Nura Marquetand , Christoph Braun , Lukas Rüttiger , Stephan Wolpert , Marlies Knipper , Markus Siegel , Hubert Löwenheim , Justus Marquetand
Objective
Measuring facial muscle activity is crucial in the diagnosis of facial palsy. This study investigated whether contactless Magnetomyography (MMG) using optically pumped magnetometers (OPM) is feasible for visualizing facial muscle activity.
Methods
An anatomically shaped mask featuring eleven OPM was arranged on one side of the face of five healthy subjects. MMG was recorded while they performed different facial expressions. The root mean square of each OPM signal was calculated for each expression and subject and allocated to the individual face. Moreover, the maximum average muscle activity and the signal-to-noise ratio (SNR) were determined.
Results
The subjects’ facial muscle activity could be measured individually per facial expression. Mean RMS was 0.6pT (SD 0.4pT), resulting in a mean SNR of 2.2 (SD 1.2).
Conclusions
Imaging facial activity via MMG using OPM is possible, although the sensor positioning (sensor geometry and distance to the muscle) is decisive. However, the signal amplitude of the facial muscles is low and the interindividual anatomical variability renders the measurement setup challenging.
Significance
As the imaging of facial MMG is feasible, this study paves the way for future studies using OPM for the diagnosis, monitoring, and rehabilitation of facial muscle and facial nerve disorders.
{"title":"Facial magnetomyography using an array of optically pumped magnetometers","authors":"Johannes von Fraunberg , Hongyu Lu , Haodi Yang , Nura Marquetand , Christoph Braun , Lukas Rüttiger , Stephan Wolpert , Marlies Knipper , Markus Siegel , Hubert Löwenheim , Justus Marquetand","doi":"10.1016/j.cnp.2025.03.003","DOIUrl":"10.1016/j.cnp.2025.03.003","url":null,"abstract":"<div><h3>Objective</h3><div>Measuring facial muscle activity is crucial in the diagnosis of facial palsy. This study investigated whether contactless Magnetomyography (MMG) using optically pumped magnetometers (OPM) is feasible for visualizing facial muscle activity.</div></div><div><h3>Methods</h3><div>An anatomically shaped mask featuring eleven OPM was arranged on one side of the face of five healthy subjects. MMG was recorded while they performed different facial expressions. The root mean square of each OPM signal was calculated for each expression and subject and allocated to the individual face. Moreover, the maximum average muscle activity and the signal-to-noise ratio (SNR) were determined.</div></div><div><h3>Results</h3><div>The subjects’ facial muscle activity could be measured individually per facial expression. Mean RMS was 0.6pT (SD 0.4pT), resulting in a mean SNR of 2.2 (SD 1.2).</div></div><div><h3>Conclusions</h3><div>Imaging facial activity via MMG using OPM is possible, although the sensor positioning (sensor geometry and distance to the muscle) is decisive. However, the signal amplitude of the facial muscles is low and the interindividual anatomical variability renders the measurement setup challenging.</div></div><div><h3>Significance</h3><div>As the imaging of facial MMG is feasible, this study paves the way for future studies using OPM for the diagnosis, monitoring, and rehabilitation of facial muscle and facial nerve disorders.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 134-140"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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