Clinical Neurophysiology Practice最新文献

Stimulation selectivity in transcranial motor evoked potentials for monitoring during surgery for supratentorial lesions 幕上病变手术中监测经颅运动诱发电位的刺激选择性

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-01-30 DOI: 10.1016/j.cnp.2026.01.006

Tammam Abboud , Jan-Bernd Wemhoff , Fares Komboz , Angelina Nazarenus , Tatiana Chacon , Dorothee Mielke , Veit Rohde

Objective

To identify the most selective electrode configuration for monitoring of transcranial motor evoked potentials (TcMEP) during supratentorial tumor surgery and determine the stimulation threshold at which bilateral corticospinal tract (CST) activation occurs at deeper white matter levels.

Methods

Fifty-six patients undergoing resection of supratentorial tumors without preoperative motor deficits were prospectively included. TcMEPs were elicited under general anesthesia using three electrode configurations: C1 ↔ C2, C3 ↔ C4, and C3/4 → Cz. Motor thresholds (MT) were recorded bilaterally from the abductor pollicis brevis (APB), and the selectivity ratio (ipsilateral/contralateral MT) was calculated. Electrode combinations were compared using paired t-tests. Linear regression assessed the influence of age, sex, height, and weight.

Results

The C3/4 → Cz montage demonstrated the highest selectivity ratio (median 248%, range: 140–364%), significantly greater than C1 ↔ C2 and C3 ↔ C4 (p < 0.001). Bilateral CST activation with C3/4 → Cz began at 140% of the contralateral MT. Age correlated with lower MTs; sex, height, and weight had no significant effect.

Conclusions

C3/4 → Cz is the most selective configuration for eliciting contralateral TcMEP and requires higher stimulation intensity before activating bilateral CST fibers at deeper levels.

Significance

This study supports using C3/4 → Cz to optimize TcMEP selectivity and reduce the risk of false-negative monitoring due to deep white matter stimulation.

目的确定幕上肿瘤手术中经颅运动诱发电位（TcMEP）监测的最选择性电极配置，并确定双侧皮质脊髓束（CST）在更深白质水平激活的刺激阈值。方法前瞻性分析56例术前无运动障碍的幕上肿瘤切除术患者。tcmep在全身麻醉下用三种电极配置引起：C1↔C2， C3↔C4和C3/4→Cz。记录双侧短拇外展肌（APB）的运动阈值（MT），并计算选择性比（同侧/对侧MT）。电极组合采用配对t检验进行比较。线性回归评估了年龄、性别、身高和体重的影响。结果C3/4→Cz蒙太奇表现出最高的选择比（中位数248%，范围：140-364%），显著高于C1↔C2和C3↔C4 （p < 0.001）。C3/4→Cz的双侧CST激活始于对侧MT的140%。年龄与较低的MT相关；性别、身高和体重没有显著影响。结论sc3 /4→Cz是激发对侧TcMEP最具选择性的配置，在激活双侧CST纤维之前需要较高的刺激强度。意义本研究支持C3/4→Cz优化TcMEP选择性，降低深部白质刺激导致的假阴性监测风险。

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引用次数: 0

A movie in the operating theater: Guided story narration as a pragmatic language screening tool during awake craniotomy 手术室电影：引导故事叙事作为清醒开颅术中语用筛选工具

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-01-10 DOI: 10.1016/j.cnp.2026.01.002

Nishanth Sampath , Sunil Kapilavayi Raghavendra , Vishwaraj Ratha , Gomathi Sivakumar , Vijay Sankaran , Suresh Bapu K.R.

引用次数: 0

Estimating paediatric normative values for nerve studies using clustering techniques 使用聚类技术估计神经研究的儿科规范值

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-02-28 DOI: 10.1016/j.cnp.2026.02.006

G.K. Cooray , D. Motan , K. Howse , L. Nastasi , J. Deeb

Objective:

To estimate normative values from mixed clinical paediatric electroneurography data using an unsupervised clustering approach.

Methods:

Electroneurography studies from paediatric patients (2009–2024) were analysed for common motor and sensory nerves. Motor parameters included distal motor latency, CMAP amplitude, duration, area, and conduction velocity; sensory parameters included SNAP amplitude and conduction velocity. Data were grouped into age windows, and within each, t-distributed stochastic neighbour embedding (t-SNE) was applied to identify the normative distribution. The mean, 5th, and 95th centiles were derived and modelled using exponential fits.

Results:

Normative values were estimated for ages 0–18 years. Motor amplitudes increased with age, and conduction velocities rose rapidly until 3–4 years before plateauing. Distal motor latency showed a brief early dip followed by an increase. Sensory amplitudes peaked between 1 and 8 years, while sensory conduction velocities increased sharply in the first year, then gradually declined.

Conclusion:

Unsupervised clustering can derive normative paediatric electroneurography values from heterogeneous clinical data, yielding trends consistent with published references.

Significance:

This data-driven approach is practical, generalisable, and enables identification of likely healthy individuals using multivariate electrophysiological parameters.

目的：利用无监督聚类方法估计混合临床儿科神经电图数据的规范性值。方法：分析2009-2024年儿科患者常见运动神经和感觉神经的神经电图研究。运动参数包括远端运动潜伏期、CMAP振幅、持续时间、面积和传导速度；感官参数包括SNAP振幅和传导速度。数据按年龄窗分组，在每个年龄窗内，应用t分布随机邻居嵌入（t-SNE）来确定规范分布。平均值、第5百分位和第95百分位采用指数拟合方法推导和建模。结果：0-18岁的正常值估计。运动振幅随年龄增长而增加，传导速度迅速上升，直到3-4年才达到稳定期。远端运动潜伏期表现为短暂的早期下降，随后增加。感觉振幅在1 - 8岁之间达到峰值，而感觉传导速度在第一年急剧增加，然后逐渐下降。结论：无监督聚类可以从异质临床数据中得出规范的儿科神经电图值，得出与已发表文献一致的趋势。意义：这种数据驱动的方法是实用的，可推广的，并且可以使用多变量电生理参数识别可能健康的个体。

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引用次数: 0

Multi-montage visualization of interictal epileptic events in high-density intraoperative electrocorticography 高密度术中皮质电图中癫痫发作间期事件的多蒙太奇可视化

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2025-12-20 DOI: 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

引用次数: 0

Ultra long-term EEG monitoring for developmental and epileptic encephalopathies: protocol for a prospective study using subscalp EEG 发育性和癫痫性脑病的超长期脑电图监测：一项使用头皮下脑电图的前瞻性研究方案

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2025-12-20 DOI: 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.

目的癫痫发作的不良记录可能是癫痫的主要挑战。目的：利用移动设备进行癫痫发作计数可以改善这一挑战和患者管理。我们研究超长时间皮下脑电图是否能改善成人和青少年发育性和癫痫性脑病（dee）的癫痫发作记录和疾病监测。方法超长时间皮下脑电图监测在罕见癫痫和DEE （EMIRE）是一项多中心前瞻性介入研究，预计持续时间6个月。33名青少年和成人参与者将被植入24/7 EEG SubQ，并收集长达6个月的双通道EEG数据。数据将由专家每周审查一次，并将总结发送给治疗临床医生。结果(1)皮下脑电图在这一特殊患者群体中的安全性和耐受性；(2)癫痫发作检测的敏感性和特异性相对于患者的癫痫发作日记和“基础真相”；(3)家庭监护是否以及如何影响患者的临床管理。该项目将调查家庭和远程患者监测系统，提供当今难以想象的准确性。这项家庭监测试验旨在通过客观评估治疗干预措施及其有效性，为患者提供临床应用。简单的语言总结。我们提出了一项意大利严重癫痫患者前瞻性队列研究的临床试验方案。该研究旨在评估皮下植入脑电图（EEG）是否(1)比患者报告的癫痫日记更准确，(2)对患者和临床医生来说是否可行和可接受，(3)影响患者的临床管理，(4)减少癫痫的影响。

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引用次数: 0

ACF-SAP: A machine learning framework for predicting obstructive sleep apnea severity using anthropometric and clinical features ACF-SAP：利用人体测量学和临床特征预测阻塞性睡眠呼吸暂停严重程度的机器学习框架

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-01-10 DOI: 10.1016/j.cnp.2025.12.001

Abduladhim Ashtaiwi , Mohamed Eltwayeb

Objective:

This study aims to develop and evaluate ACF-SAP, a machine learning (ML) framework for predicting obstructive sleep apnea (OSA) severity using non-invasive, routinely collected clinical features.

Methods:

The proposed approach leverages common anthropometric and clinical variables, including sex, body mass index (BMI), height, weight, neck circumference, and nocturia. The methodology integrates machine-learning–based feature selection to identify the most informative predictors, followed by unsupervised clustering to generate data-driven sleep severity labels. These labeled data are then used to train and evaluate the ACF-SAP framework.

Results:

ACF-SAP, implemented with ensemble classifiers, achieved a classification accuracy of 0.84, with strong F1-scores and balanced sensitivity across OSA severity levels.

Conclusions:

The ACF-SAP model supports early identification of patients at high risk for OSA and may serve as a first-line screening tool to prioritize referrals for polysomnography (PSG).

Significance:

This work presents a scalable, low-cost screening framework that can improve triage efficiency and facilitate timely diagnosis, particularly in resource-constrained healthcare environments.

目的：本研究旨在开发和评估ACF-SAP，这是一个机器学习（ML）框架，用于预测阻塞性睡眠呼吸暂停（OSA）的严重程度，使用无创的，常规收集的临床特征。方法：提出的方法利用常见的人体测量和临床变量，包括性别、体重指数（BMI）、身高、体重、颈围和夜尿症。该方法集成了基于机器学习的特征选择，以识别最具信息量的预测因子，然后是无监督聚类，以生成数据驱动的睡眠严重程度标签。然后使用这些标记的数据来训练和评估ACF-SAP框架。结果：采用集成分类器实现的ACF-SAP的分类精度为0.84，具有较强的f1评分和跨OSA严重程度的平衡敏感性。结论：ACF-SAP模型支持OSA高危患者的早期识别，可作为优先转诊多导睡眠图（PSG）的一线筛查工具。意义：这项工作提出了一个可扩展的、低成本的筛查框架，可以提高分诊效率，促进及时诊断，特别是在资源有限的医疗环境中。

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引用次数: 0

Applications of pelvic neurophysiology testing in clinical practice 盆腔神经生理检测在临床中的应用

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-02-09 DOI: 10.1016/j.cnp.2026.01.008

Jalesh N. Panicker , Sara Simeoni , Sarah Wright , Claire Hentzen , Prasad Malladi

Pelvic neurophysiology testing uniquely provides an evaluation of the sacral S2, 3 and 4 segmental somatic innervation. Since the tests are involved and some are invasive, a clear clinical question is essential in order to tailor the tests appropriately. Results should always be interpreted in conjunction with the clinical presentation and other investigation findings. The tests provide objective quantitative evidence for nerve injury and there are specific indications where these tests become of paramount importance such as the evaluation of suspected cauda equina syndrome, suspected MSA, chronic urinary retention, pelvic pain, sexual dysfunction and situations where MRI findings are inconclusive. Neurophysiology testing is a useful adjunct to clinical examination, and adds value to the diagnostic workup of patients presenting with neuro-urological disorders.

盆腔神经生理学测试独特地提供了骶S2, 3和4节段体神经支配的评估。由于这些检查涉及到患者，而且有些是侵入性的，因此明确的临床问题是必要的，以便适当地调整检查。结果应始终结合临床表现和其他调查结果来解释。这些测试为神经损伤提供了客观的定量证据，并且在某些特定适应症中，这些测试变得至关重要，例如评估疑似马尾综合征、疑似MSA、慢性尿潴留、盆腔疼痛、性功能障碍和MRI结果不确定的情况。神经生理学测试是临床检查的一种有用的辅助手段，并为神经-泌尿系统疾病患者的诊断工作增加了价值。

引用次数: 0

Effective connectivity between homologous cortices mediated by the corpus callosum: An axono-cortical evoked potentials study 胼胝体介导的同源皮层之间的有效连接：轴突-皮层诱发电位研究

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-02-10 DOI: 10.1016/j.cnp.2026.02.002

Takumi Mitsuhashi, Yasushi Iimura, Hiroharu Suzuki, Tetsuya Ueda, Kazuki Nishioka, Kazuki Nomura, Madoka Nakajima, Hidenori Sugano, Akihide Kondo

Objective

To demonstrate the role of the corpus callosum in interhemispheric effective connectivity and investigate the distribution of the connectivity originating from it using axono-cortical evoked potentials.

Methods

A 14-year-old girl with drug-resistant focal epilepsy underwent total callosotomy. Intraoperatively, we placed four subdural strip electrode contacts on the corpus callosum and eight on each hemisphere. We applied single-pulse electrical stimulation to eight pairs of contacts placed on the corpus callosum and cerebral cortex, recording axono-cortical, cortico-axonal, and cortico-cortical evoked potentials. Propagation latencies and anatomical distributions were determined based on the first negative deflection within 10–50 ms.

Results

Stimulation of the rostral to the anterior midbody elicited responses in bilateral anterior premotor cortices. The anterior to posterior midbody stimulation elicited responses in more posterior premotor cortices. The sum of latencies from the corpus callosum to each hemisphere (23.5 + 21.75 = 45.25 ms) approximated the interhemispheric neural propagation latency (44.5 ms). No significant responses were observed within the corpus callosum.

Conclusion

The corpus callosum mediated effective connectivity between homologous cortices aligned along the anterior–posterior axis, consistent with known structural connectivity.

Significance

This study provides the first direct neurophysiological evidence of the contribution of the corpus callosum to interhemispheric effective connectivity, highlighting its structural–functional correspondence and limitations in generating local field potentials.

目的利用轴突-皮层诱发电位研究胼胝体在脑半球有效连接中的作用，并探讨胼胝体在脑半球有效连接中的分布。方法对14岁顽固性局灶性癫痫患者行全胼胝体切开术。术中，我们在胼胝体上放置了4个硬膜下条状电极接触点，每个半球各放置了8个电极接触点。我们对放置在胼胝体和大脑皮层上的8对触点施加单脉冲电刺激，记录轴突-皮层、皮质-轴突和皮质-皮层的诱发电位。在10-50 ms内，根据第一次负偏转确定传播潜伏期和解剖分布。结果刺激吻侧至前中体在双侧前运动前皮质中引起反应。前前后后的中体刺激在更多的后侧运动前皮质中引起反应。从胼胝体到每个半球的潜伏期之和（23.5 + 21.75 = 45.25 ms）近似于半球间神经传播潜伏期（44.5 ms）。在胼胝体内未观察到明显的反应。结论胼胝体介导了沿前后轴排列的同源皮层之间的有效连通性，与已知的结构连通性一致。本研究首次提供了直接的神经生理学证据，证明胼胝体对半球间有效连接的贡献，突出了其结构-功能的对应关系和在产生局部场电位方面的局限性。

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引用次数: 0

Disentangling Event-Related Potential and Oscillatory Sources using Time- and Frequency-Domain Source Imaging 使用时域和频域源成像解纠缠事件相关的电位和振荡源

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-02-01 DOI: 10.1016/j.cnp.2026.01.007

Emma Depuydt , Miet De Letter , Pieter van Mierlo

Objective

To determine whether event-related potentials (ERPs) and neural oscillations arise from common or distinct neural sources by combining two EEG source localization methods.

Methods

We applied eLORETA and DICS, which localize activity in the time and frequency domains respectively, to both simulated and real EEG data. Simulations assessed the spatial accuracy and specificity of each method. Real data analyses were used to examine the correspondence between ERP-related activity and oscillatory dynamics in relevant frequency bands.

Results

For the P300, eLORETA and DICS yielded overlapping source localizations, indicating a shared neural origin. Although alpha desynchronization temporally aligned with the P300, its sources were spatially distinct. In the case of the auditory N1, both methods revealed bilateral activation, with higher spatial precision observed using eLORETA. For the N400, DICS revealed sources that overlapped with eLORETA’s localization, suggesting a distributed semantic network engaged through amplitude asymmetry mechanisms.

Conclusions

ERP components may result from both shared and distinct oscillatory sources, varying by frequency band and cognitive function. The complementary use of eLORETA and DICS enhances interpretability of source dynamics.

Significance

This study underscores the value of integrating time- and frequency-domain source imaging to deepen our mechanistic understanding of stimulus-locked brain responses.

目的结合两种脑电图源定位方法，确定事件相关电位（ERPs）和神经振荡是来自共同的还是不同的神经源。方法应用eLORETA和DICS对模拟和真实脑电数据分别进行时域和频域定位。模拟评估了每种方法的空间精度和特异性。使用真实数据分析来检查erp相关活动与相关频段的振荡动力学之间的对应关系。结果对于P300， eLORETA和DICS产生重叠的源定位，表明共享的神经起源。虽然α去同步在时间上与P300一致，但其来源在空间上是不同的。在听觉N1的情况下，两种方法都显示双侧激活，使用eLORETA观察到更高的空间精度。对于N400， DICS揭示了与eLORETA定位重叠的来源，表明通过幅度不对称机制参与分布式语义网络。结论serp成分可能来自共同或不同的振荡源，并因频段和认知功能的不同而不同。eLORETA和DICS的互补使用增强了源动态的可解释性。这项研究强调了整合时域和频域源成像的价值，以加深我们对刺激锁定大脑反应的机制理解。

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引用次数: 0

Prognostic value of auditory evoked potentials in disorders of consciousness: a systematic literature review 听觉诱发电位在意识障碍中的预后价值：系统的文献回顾

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-01-30 DOI: 10.1016/j.cnp.2026.01.005

Panithi Khusakul , Ioan Valnarov-Boulter , Aden Noronha , Wanapas Wachiradejkul , Tim M. Young , Blake Hale

Objective

Decisions regarding withdrawal of life support in disorders of consciousness (DoC) are challenged by prognostic uncertainty. Auditory evoked potentials (AEPs) are widely used, yet no recent systematic review has focused exclusively on their prognostic value. Given evidence that some withdrawal decisions are based on inaccurate prognoses, this study aimed to evaluate the prognostic utility of AEPs in DoC using recent evidence.

Methods

Comprehensive literature searches of PubMed, Scopus, and Web of Science Core Collection identified studies published between 2013 and 2023 assessing AEPs for prognostication in DoC. Three authors independently screened studies using predefined criteria. Eligible studies were original English-language research evaluating prognostic outcomes in adults (≥18 years) with DoC. Reviews and secondary literature were excluded. Risk of bias was assessed using the QUADAS-2 tool.

Results

Of 2249 records screened, 24 studies met inclusion criteria, encompassing 1562 patients. Mismatch negativity (MMN), the most frequently studied AEP, reliably predicted both favourable and unfavourable outcomes. P300 demonstrated potential for predicting recovery, though findings were inconsistent. Although less studied, the absence of N100 predicted poor functional outcomes, including reduced autonomy. Absence of brainstem or middle-latency AEPs predicted negative outcomes with high specificity but low sensitivity.

Conclusion

MMN, P300, and N100 demonstrate meaningful prognostic value in DoC. Despite methodological heterogeneity, current evidence supports AEPs as useful clinical prognostic tools. Standardised, blinded protocols are needed to improve reliability.

Significance

Integrating AEPs into multimodal prognostic frameworks may enhance outcome prediction. Advances in electrode coverage, machine learning, and automated detection paradigms offer promising future directions.

目的意识障碍（DoC）患者撤销生命支持的决定受到预后不确定性的挑战。听觉诱发电位（AEPs）被广泛使用，但最近还没有专门针对其预后价值的系统综述。鉴于有证据表明一些停药决定是基于不准确的预后，本研究旨在利用最新证据评估aep在DoC中的预后效用。方法对PubMed、Scopus和Web of Science核心合集进行综合文献检索，确定2013年至2023年间发表的评估AEPs对DoC预测的研究。三位作者使用预定义的标准独立筛选研究。符合条件的研究是评估成人（≥18岁）DoC预后结果的原始英语研究。排除综述和二手文献。使用QUADAS-2工具评估偏倚风险。结果在筛选的2249份记录中，24项研究符合纳入标准，包括1562名患者。错配负性（MMN）是最常被研究的AEP，可靠地预测了有利和不利的结果。P300显示了预测恢复的潜力，尽管结果不一致。尽管研究较少，但缺乏N100预示着不良的功能结果，包括自主性降低。脑干缺失或中潜伏期AEPs预测阴性结果具有高特异性但低敏感性。结论mmn、P300、N100对DoC有重要的预后价值。尽管方法存在异质性，但目前的证据支持aep作为有用的临床预后工具。需要标准化的盲法协议来提高可靠性。意义：将AEPs整合到多模式预后框架中可以增强预后预测。电极覆盖、机器学习和自动检测范式的进步提供了有希望的未来方向。

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引用次数: 0