Clinical Neurophysiology Practice最新文献

英文中文

Bringing nerve excitability out of the research laboratory into the clinic 将神经兴奋性从实验室带到临床

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.10.001

Karl Ng

引用次数: 0

The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study 术中神经生理监测在脊柱动静脉畸形手术治疗中的应用:一项历史对照研究

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.01.004

Sooyoung Kim , Haelim Kim , Jun-Soon Kim , Seung-Jae Hyun , Ki-Jeong Kim , Kyung Seok Park

Objective

This study sought to investigate the utility of intraoperative neurophysiological monitoring (IONM) in the surgical treatment for spinal arteriovenous malformations (SAVMs).

Methods

We retrospectively reviewed the data of 39 patients who underwent surgical treatment for SAVMs. Twenty-eight patients who received multimodal IONM (transcranial electrical motor-evoked potentials [MEPs], somatosensory-evoked potentials, continuous electromyography, and bulbocavernosus reflex [BCR]) between 2011 and 2020 were compared to 11 historical controls between 2003 and 2011. The rates of postoperative neurological deficits (PNDs), neurophysiological warnings, and their characteristics were analyzed.

Results

PNDs were developed in 10.7% and 54.5% of patients in the IONM and historical control (non-IONM) groups, respectively (p = 0.008). Moreover, not applying IONM was the only significant risk factor for the development of PNDs in the logistic regression analysis (odds ratio 10.0, p = 0.007). In the IONM group, a total of three electrophysiological warnings were observed, and two of these were true positives; one patient complained of leg motor weakness after surgery with loss of the abductor halluces MEPs. The other patient experienced disappearance of the BCR during surgery and newly developed urinary retention. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of IONM warnings for detecting PNDs were 66.7%, 96.0%, 66.7%, and 96.0%, respectively.

Conclusions

The neurological outcome of the IONM group was significantly better than that of the historical control group in the surgical treatments for SAVMs.

Significance

Multimodal IONM could be a useful tool to detect neurological damage with relatively high accuracy in this type of surgery.

目的探讨术中神经生理监测(IONM)在脊柱动静脉畸形(SAVMs)手术治疗中的应用价值。方法回顾性分析39例接受手术治疗的SAVMs患者的资料。2011年至2020年间接受多模态IONM(经颅电运动诱发电位，体感诱发电位，连续肌电图和球海绵体反射[BCR])治疗的28例患者与2003年至2011年11例历史对照进行比较。分析术后神经功能缺损(PNDs)发生率、神经生理警示及其特点。结果IONM组和历史对照组(非IONM组)发生spnd的比例分别为10.7%和54.5% (p = 0.008)。此外，在logistic回归分析中，未应用IONM是pnd发生的唯一显著危险因素(优势比10.0,p = 0.007)。在IONM组中，共观察到三次电生理警告，其中两次为真阳性;一名患者在手术后抱怨腿部运动无力并失去外展肌幻觉。另一名患者在手术中出现BCR消失和新出现的尿潴留。总体而言，IONM预警检测pnd的敏感性、特异性、阳性预测值和阴性预测值分别为66.7%、96.0%、66.7%和96.0%。结论IONM组手术治疗savm的神经功能预后明显优于历史对照组。意义:在这类手术中，多模态离子离子显微镜可作为检测神经损伤的有效工具，具有较高的准确性。

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引用次数: 3

Eye-opening in brain death: A case report and review of the literature 脑死亡的大开眼界:一例报告和文献回顾

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.03.006

Martina Focardi , Barbara Gualco , Maenia Scarpino , Manuela Bonizzoli , Beatrice Defraia , Riccardo Carrai , Giovanni Lanzo , Silvia Raddi , Ilenia Bianchi , Antonello Grippo

Background

According to Italian law, brain death is diagnosed when the patient is in a coma, showing the absence of respiratory drive under specific clinical conditions, and without any brain stem reflexes. On the other hand, presence of spinal reflexes, when correctly identified, does not hamper the diagnosis.

Case report

We present a case of eyelid elevation two seconds after thoracic pain stimulation in a patient who otherwise fulfilled all clinical and instrumental brain-death criteria due to a residual preserved function of the superior cervical ganglion.

Conclusion

Although the observed reflex is to be considered extracerebral, and therefore it should not hamper the diagnosis of BD, the authors propose implementing cerebral flow evaluation, considered “prudential”, as a preliminary assessment before determining BD.

根据意大利法律，当病人处于昏迷状态，表现出在特定临床条件下缺乏呼吸驱动，并且没有任何脑干反射时，就会被诊断为脑死亡。另一方面，脊髓反射的存在，当正确识别时，并不妨碍诊断。病例报告:我们报告了一例胸部疼痛刺激后两秒眼睑升高的病例，该患者由于颈上神经节功能保留而符合所有临床和器质性脑死亡标准。结论虽然观察到的反射被认为是脑外反射，因此不应妨碍BD的诊断，但作者建议在确定BD之前进行“审慎”的脑流量评估。

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引用次数: 2

Sural-sparing pattern: A study against electrodiagnostic subtypes of Guillain–Barre syndrome 存活模式:一项针对格林-巴利综合征电诊断亚型的研究

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.09.001

Nath Pasutharnchat , Varis Ratanasirisawad , Manasawan Santananukarn , Chamaiporn Taychargumpoo , Jakkrit Amornvit , Chaipat Chunharas

Objective

To study sural-sparing pattern in Guillain–Barre syndrome (GBS) and compare it among GBS’s electrodiagnostic subtypes, classified by two recent criteria.

Methods

This study retrospectively reviewed clinical data and electrodiagnostic studies (EDXs) of 88 GBS patients diagnosed in a tertiary care hospital (2010–2019).

Results

Overall, 79/88 (89.8%) and 36/45 (80%) patients had bilateral sensory nerve conduction studies (NCS) in the first EDX and follow-up EDX, respectively. Sural-sparing occurred in all subtypes (50% overall occurrence rate), most commonly in demyelination. There was no statistically significant difference in sural-sparing occurrence rates between demyelinating and axonal GBS; however, sural-sparing in axonal GBS tended to show a lower number of abnormal upper-limb sensory nerve action potentials (SNAPs) than demyelinating GBS. Shifting between sural-sparing and no sural-sparing occurred in approximately-one-fourth of patients receiving serial studies. Follow-up EDX additionally discovered 20% of all sural-sparing. Unilateral EDX could have omitted up to 30% of sural-sparing.

Conclusions

Sural-sparing is less obviously manifested in axonal than demyelinating GBS, with respect to the number of affected upper-limb SNAPs. Extended sensory NCS is worth in detecting sural-sparing as a supportive electrodiagnostic GBS feature.

Significance

This report showed one different character of sural-sparing (number of affected upper-limb SNAPs) between demyelinating and axonal GBS.

目的研究格林-巴利综合征(GBS)的存活模式，并比较两种最新诊断标准对GBS电诊断亚型的影响。方法回顾性分析了2010-2019年在三级医院诊断的88例GBS患者的临床资料和电诊断研究(EDXs)。结果总体而言，79/88例(89.8%)和36/45例(80%)患者在首次和后续的EDX中分别进行了双侧感觉神经传导检查(NCS)。所有亚型均有存活(总发生率为50%)，最常见于脱髓鞘。脱髓鞘性和轴突性GBS的存活率差异无统计学意义;然而，与脱髓鞘性GBS相比，轴突性GBS的肢体保留倾向于显示更少的上肢感觉神经动作电位(snap)异常。在接受系列研究的患者中，大约四分之一的患者发生了生存保护和无生存保护之间的转变。随访EDX发现20%的存活率有所降低。单侧EDX可以省去多达30%的存活率。结论就上肢关节损伤的数量而言，轴突性GBS的存活程度不如脱髓鞘性GBS明显。扩展感觉NCS作为一种支持性电诊断GBS特征，在检测存活余量方面是有价值的。意义:本报告显示脱髓鞘性和轴突性GBS之间存在一个不同的特征(受影响的上肢SNAPs数量)。

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引用次数: 1

Acknowledgement to Reviewers 审稿人致谢

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.10.003

引用次数: 0

Towards more reliable TMS studies – How fast can we probe cortical excitability? 迈向更可靠的经颅磁刺激研究——我们能多快探测到皮层的兴奋性?

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2021.11.004

Maria Nazarova , Anastasia Asmolova

引用次数: 3

Tradução e Adaptação para a Língua Portuguesa – Brasil do Glossário Revisado dos Termos Mais Comumente Usados por Eletroencefalografistas Clínicos e Proposta Atualizada do Formato do Laudo de EEG (IFCN Revisão 2017) 翻译和改编葡萄牙语-巴西脑电图医师最常用术语的修订词汇表和脑电图报告格式的更新建议(IFCN修订2017)

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2021.12.003

Ana Paula Gonçalves , Carlos Eduardo Silvado , Isabella D'Andrea Meira , José Augusto Bragatti , Luís Otávio Caboclo , Mirian Bittar Guaranha , Priscila Oliveira da Conceição , Pedro Alessandro Leite de Oliveira , Taíssa Ferrari Marinho

引用次数: 1

Myoclonus generators in sialidosis 唾液中毒的肌阵挛产生者

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.05.004

Felipe Vial , Patrick McGurrin , Sanaz Attaripour , Alesandra d'Azzo , Cynthia J. Tifft , Camilo Toro , Mark Hallett

Objective

Sialidosis is an inborn error of metabolism. There is evidence that the myoclonic movements observed in this disorder have a cortical origin, but this mechanism does not fully explain the bilaterally synchronous myoclonus activity frequently observed in many patients. We present evidence of a subcortical basis for synchronous myoclonic phenomena.

Methods

Electromyographic investigations were undertaken in two molecularly and biochemically confirmed patients with sialidosis type-1.

Results

The EMG recordings showed clear episodes of bilaterally synchronous myoclonic activity in contralateral homologous muscles. We also observed a high muscular-muscular coherence with near-zero time-lag between these muscles.

Conclusion

The absence of coherence phase lag between the right-and-left homologous muscles during synchronous events indicates that a unilateral cortical source cannot fully explain the myoclonic activity. There must exist a subcortical mechanism for bilateral synchronization accounting for this phenomenon.

Significance

Understanding this mechanism may illuminate cortical-subcortical relationships in myoclonus.

目的脂肪肝是一种先天性代谢异常。有证据表明，在这种疾病中观察到的肌阵挛运动有皮层起源，但这一机制并不能完全解释在许多患者中经常观察到的双侧同步肌阵挛活动。我们提出的证据表明，皮层下基础的同步肌阵挛现象。方法对2例经分子及生化证实的1型唾液中毒患者进行肌电图检查。结果肌电图显示对侧同源肌有明显的双侧同步肌阵挛活动。我们还观察到高度的肌肉-肌肉一致性，这些肌肉之间的时间滞后接近于零。结论在同步事件中，左右同源肌肉之间不存在相干相位滞后，表明单侧皮质源不能完全解释肌阵挛活动。一定存在一种皮层下的双侧同步机制来解释这种现象。了解这一机制有助于阐明肌阵挛的皮层-皮层下关系。

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引用次数: 0

The value of intraoperative neurophysiological monitoring during positioning in pediatric scoliosis correction: A case report 小儿脊柱侧凸矫正术中定位时神经生理监测的价值:1例报告

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.11.001

M. Cavinato , F. Vittoria , F. Piccione , S. Masiero , M. Carbone

Introduction

Prone position during posterior spine surgery can represent a potentially risky procedure for the nervous system. Infrequent injuries due to prone positioning consist of subtle spinal cord infarction or myelopathy that can be promptly detected by intraoperative neurophysiological monitoring (IONM), if applied in this phase of surgery. Here, we report a case that stresses the value of IONM even in detecting spinal positioning-related neurological complications during kyphoscoliosis correction.

Case presentation

A 3-year-old child with a severe thoracic kyphoscoliosis with the angle in the tract T5-T6 underwent an early treatment of scoliosis with growing rods. Before instrumentation or the reduction maneuver, lower limb somatosensory and motor responses disappeared. The patient was repositioned with neck and chest in a more protective position and neuromonitoring signals returned to baseline. The surgery could be completed and the patient had no postoperative neurologic or vascular deficits.

Conclusion

Our findings suggest the importance of extending neuromonitoring in the early phases of anesthesia induction and patient positioning during corrective spinal deformity surgery.

脊柱后路手术时俯卧位可能对神经系统有潜在风险。由于俯卧位引起的罕见损伤包括轻微的脊髓梗死或脊髓病，如果在手术的这一阶段应用，可以通过术中神经生理监测(IONM)及时发现。在这里，我们报告了一个病例，强调了IONM在脊柱后凸矫正过程中检测脊柱定位相关神经系统并发症的价值。病例介绍:一名患有严重胸椎后凸性脊柱侧凸的3岁儿童，脊柱侧凸的角度在T5-T6椎道，他接受了脊柱侧凸生长棒的早期治疗。在置入或复位操作前，下肢体感和运动反应消失。将患者重新定位，使颈部和胸部处于更具保护性的位置，神经监测信号恢复到基线。手术可以完成，患者术后无神经或血管缺损。结论本研究提示在脊柱畸形矫正手术中麻醉诱导和患者体位的早期阶段扩大神经监测的重要性。

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引用次数: 0

Neurology resident EEG training in Europe 欧洲神经内科住院医师脑电图培训

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2022-01-01 DOI: 10.1016/j.cnp.2022.08.001

Fábio A. Nascimento , Jay R. Gavvala , Hatice Tankisi , Sándor Beniczky

Objective

To detail current European EEG education practices and compare European and U.S. EEG teaching systems.

Methods

A 19-question online survey focused on EEG clinical practices and residency training was emailed to all 47 European Academy of Neurology Societies.

Results

Thirty-two (68 %) out of the 47 Societies completed the survey. In half of countries, general neurologists are either among the providers or the only providers who typically read EEGs. The number of weeks devoted to EEG learning required to graduate ranged from none to 26, and it was expected to be continuous in one country. In most countries (n = 17/32), trainees read >40 EEGs per EEG rotation, and the most commonly interpreted studies are routine and prolonged routine EEGs. Rotations involve clinic/outpatient (90 %), epilepsy monitoring unit/inpatient (60 %), or both (50 %). Roughly half of countries do not use objective measures to assess EEG competency. The most reported educational methods are teaching during EEG rotation and yearly didactics, and the most reported education barriers are insufficient didactics and insufficient EEG exposure.

Conclusions

We suggest neurology educators in Europe, especially in those countries where EEGs are read by general neurologists, consider ensuring that residency EEG learning is mandatory and establishing objective measures in teaching and evaluating competency.

Significance

Similar to the U.S., neurology resident EEG training in Europe is highly variable.

目的详细介绍欧洲脑电图教育实践，比较欧美脑电图教学体系。方法通过电子邮件向47个欧洲神经病学学会发送一份关于脑电图临床实践和住院医师培训的19个问题的在线调查。结果47个学会中有32个(68% %)完成了调查。在一半的国家，普通神经科医生要么是通常阅读脑电图的提供者之一，要么是唯一的提供者。毕业所需的脑电图学习周数从零到26周不等，预计在一个国家将是连续的。在大多数国家(n = 17/32)，受训人员每轮脑电图读取 >40脑电图，最常见的解释研究是常规脑电图和延长常规脑电图。轮转涉及诊所/门诊(90% %)，癫痫监测单位/住院(60% %)，或两者兼而有之(50% %)。大约一半的国家没有使用客观的方法来评估脑电图能力。报道最多的教育方法是脑电图轮转教学和年度教学，报道最多的教育障碍是教学不足和脑电图暴露不足。结论我们建议欧洲的神经病学教育工作者，特别是那些由普通神经科医生阅读脑电图的国家，考虑确保住院脑电图学习是强制性的，并在教学和评估能力方面建立客观的措施。意义与美国相似，欧洲的神经内科住院医师脑电图训练具有高度的差异性。

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