Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.09.002
Greta Gustafsson , Martin Ulander , Cornelia Lauermann , Johanna Thegerström , Kathe Dahlbom , Anders Broström , Eva Svanborg , Magnus Vrethem
Objective
To evaluate possible age-specific differences in the diagnostic yield of sleep-deprived, and melatonin-induced pediatric sleep EEGs. The multicenter study was performed prospectively.
Methods
Children referred to sleep EEG (n = 169), were stratified into three age groups (2–5; 6–11; 12–17 years) and randomized to sleep induction by melatonin or partial sleep deprivation. Epileptiform activity, sleep, adverse effects, and technical recording quality were compared between study arms and age categories.
Results
Epileptiform activity occurred in 36% of the children, without significant differences between melatonin and sleep-deprived EEGs. In 6–11-year-old children, epileptiform abnormalities occurred in 49%, significantly higher than in the other age groups independent of the sleep-inducing method. Sleep, but not the sleep induction method, was significantly associated with the presence of epileptiform activity (OR 9.16). The occurrence of sleep was significantly higher (97%) after melatonin induction compared to sleep deprivation (86%) without age differences. No serious adverse effects were registered.
Conclusions
There were no differences concerning the occurrence of epileptiform activity in EEG after melatonin induction or sleep deprivation in children of any age category. Melatonin increased the likelihood of sleep.
Significance
Melatonin as a premedication for sleep EEG should be considered safe and efficient in terms of diagnostic yield.
{"title":"Comparison between sleep-deprived, and melatonin-induced sleep electroencephalography in children of different ages: a randomized controlled trial","authors":"Greta Gustafsson , Martin Ulander , Cornelia Lauermann , Johanna Thegerström , Kathe Dahlbom , Anders Broström , Eva Svanborg , Magnus Vrethem","doi":"10.1016/j.cnp.2025.09.002","DOIUrl":"10.1016/j.cnp.2025.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate possible age-specific differences in the diagnostic yield of sleep-deprived, and melatonin-induced pediatric sleep EEGs. The multicenter study was performed prospectively.</div></div><div><h3>Methods</h3><div>Children referred to sleep EEG (n = 169), were stratified into three age groups (2–5; 6–11; 12–17 years) and randomized to sleep induction by melatonin or partial sleep deprivation. Epileptiform activity, sleep, adverse effects, and technical recording quality were compared between study arms and age categories.</div></div><div><h3>Results</h3><div>Epileptiform activity occurred in 36% of the children, without significant differences between melatonin and sleep-deprived EEGs. In 6–11-year-old children, epileptiform abnormalities occurred in 49%, significantly higher than in the other age groups independent of the sleep-inducing method. Sleep, but not the sleep induction method, was significantly associated with the presence of epileptiform activity (OR 9.16). The occurrence of sleep was significantly higher (97%) after melatonin induction compared to sleep deprivation (86%) without age differences. No serious adverse effects were registered.</div></div><div><h3>Conclusions</h3><div>There were no differences concerning the occurrence of epileptiform activity in EEG after melatonin induction or sleep deprivation in children of any age category. Melatonin increased the likelihood of sleep.</div></div><div><h3>Significance</h3><div>Melatonin as a premedication for sleep EEG should be considered safe and efficient in terms of diagnostic yield.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 426-432"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218904","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 : 2024-01-01DOI: 10.1016/j.cnp.2023.10.003
Melanie Bergmann , Birgit Högl , Ambra Stefani
Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity.
Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology.
RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation.
Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.
{"title":"Clinical neurophysiology of REM parasomnias: Diagnostic aspects and insights into pathophysiology","authors":"Melanie Bergmann , Birgit Högl , Ambra Stefani","doi":"10.1016/j.cnp.2023.10.003","DOIUrl":"10.1016/j.cnp.2023.10.003","url":null,"abstract":"<div><p>Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity.</p><p>Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology.</p><p>RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation.</p><p>Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 53-62"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X24000027/pdfft?md5=284f181c314e115bc2779fb68c7c51dd&pid=1-s2.0-S2467981X24000027-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455170","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}
Pub Date : 2024-01-01DOI: 10.1016/j.cnp.2024.01.001
Tom Frenzel , Anne-Katrin Baum , Hardy Krause , Christoph Arens , Aiden Haghikia , Imke Galazky
Objective
Nerve conduction studies (NCS) in children remain technically challenging and depend on the cooperation of the child. Motor NCS are not compromised by analgosedation but data for sensory NCS are lacking. Here, we ask whether sensory NCS is influenced by analgosedation. We also compare the present data with NCS studies from the 1990s regarding anthropometric acceleration of the contemporary paediatric population.
Methods
Sensory NCS of the median nerve and sural nerve were performed in 182 healthy subjects aged 1 to 18 years during general anaesthesia and in 47 of them without analgosedation.
Results
Sensory NCS was not influenced by midazolam or propofol. The sensory nerve action potential (SNAP) amplitude and the nerve conduction velocity (NCV) of the sural nerve as well as the SNAP of the median nerve show no significant age dependence in age range 1–18 years. The sensory NCV of the median nerve increased age-dependent.
Conclusions
In clinical practice, analgosedation can be used for diagnostic NCS. Sensory NCS data show no relevant secular trend over the last 30 years. Differences due to technical inconsistency predominate.
Significance
Analgosedation can improve diagnostic quality of sensory NCS in children. Additionally, we provide sensory NCS values from a large pediatric cohort.
{"title":"Sensory nerve conduction studies in infants, children and teenagers – An update","authors":"Tom Frenzel , Anne-Katrin Baum , Hardy Krause , Christoph Arens , Aiden Haghikia , Imke Galazky","doi":"10.1016/j.cnp.2024.01.001","DOIUrl":"10.1016/j.cnp.2024.01.001","url":null,"abstract":"<div><h3>Objective</h3><p>Nerve conduction studies (NCS) in children remain technically challenging and depend on the cooperation of the child. Motor NCS are not compromised by analgosedation but data for sensory NCS are lacking. Here, we ask whether sensory NCS is influenced by analgosedation. We also compare the present data with NCS studies from the 1990s regarding anthropometric acceleration of the contemporary paediatric population.</p></div><div><h3>Methods</h3><p>Sensory NCS of the median nerve and sural nerve were performed in 182 healthy subjects aged 1 to 18 years during general anaesthesia and in 47 of them without analgosedation.</p></div><div><h3>Results</h3><p>Sensory NCS was not influenced by midazolam or propofol. The sensory nerve action potential (SNAP) amplitude and the nerve conduction velocity (NCV) of the sural nerve as well as the SNAP of the median nerve show no significant age dependence in age range 1–18 years. The sensory NCV of the median nerve increased age-dependent.</p></div><div><h3>Conclusions</h3><p>In clinical practice, analgosedation can be used for diagnostic NCS. Sensory NCS data show no relevant secular trend over the last 30 years. Differences due to technical inconsistency predominate.</p></div><div><h3>Significance</h3><p>Analgosedation can improve diagnostic quality of sensory NCS in children. Additionally, we provide sensory NCS values from a large pediatric cohort.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 63-68"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X24000015/pdfft?md5=61bf88b20b03d7d1f52c1913018a1aab&pid=1-s2.0-S2467981X24000015-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457901","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}
Pub Date : 2024-01-01DOI: 10.1016/j.cnp.2023.12.001
Magdalena Mroczek , Amedeo de Grado , Hossain Pia , Zahra Nochi , Hatice Tankisi
Objective
Insufficient sleep is linked to several health problems. Previous studies on the effects of sleep deprivation on cortical excitability using conventional transcranial magnetic stimulation (TMS) included a limited number of modalities, and few inter-stimulus intervals (ISIs) and showed conflicting results. This study aimed to investigate the effects of sleep deprivation on cortical excitability through threshold-tracking TMS, using a wide range of protocols at multiple ISIs.
Methods
Fifteen healthy subjects (mean age ± SD: 36 ± 3.34 years) were included. The following tests were performed before and after 24 h of sleep deprivation using semi-automated threshold-tacking TMS protocols: short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) at 11 ISIs between 1 and 30 ms, short interval intracortical facilitation (SICF) at 14 ISIs between 1 and 4.9 ms, long interval intracortical inhibition (LICI) at 6 ISIs between 50 and 300 ms, and short-latency afferent inhibition (SAI) at 12 ISIs between 16 and 30 ms.
Results
No significant differences were observed between pre- and post-sleep deprivation measurements for SICI, ICF, SICF, or LICI at any ISIs (p < 0.05). As for SAI, we found a difference at 28 ms (p = 0.007) and 30 ms (p = 0.04) but not at other ISIs.
Conclusions
Sleep deprivation does not affect cortical excitability except for SAI.
Significance
This study confirms some of the previous studies while contradicting others.
{"title":"Effects of sleep deprivation on cortical excitability: A threshold-tracking TMS study and review of the literature","authors":"Magdalena Mroczek , Amedeo de Grado , Hossain Pia , Zahra Nochi , Hatice Tankisi","doi":"10.1016/j.cnp.2023.12.001","DOIUrl":"10.1016/j.cnp.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>Insufficient sleep is linked to several health problems. Previous studies on the effects of sleep deprivation on cortical excitability using conventional transcranial magnetic stimulation (TMS) included a limited number of modalities, and few inter-stimulus intervals (ISIs) and showed conflicting results. This study aimed to investigate the effects of sleep deprivation on cortical excitability through threshold-tracking TMS, using a wide range of protocols at multiple ISIs.</p></div><div><h3>Methods</h3><p>Fifteen healthy subjects (mean age ± SD: 36 ± 3.34 years) were included. The following tests were performed before and after 24 h of sleep deprivation using semi-automated threshold-tacking TMS protocols: short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) at 11 ISIs between 1 and 30 ms, short interval intracortical facilitation (SICF) at 14 ISIs between 1 and 4.9 ms, long interval intracortical inhibition (LICI) at 6 ISIs between 50 and 300 ms, and short-latency afferent inhibition (SAI) at 12 ISIs between 16 and 30 ms.</p></div><div><h3>Results</h3><p>No significant differences were observed between pre- and post-sleep deprivation measurements for SICI, ICF, SICF, or LICI at any ISIs (p < 0.05). As for SAI, we found a difference at 28 ms (p = 0.007) and 30 ms (p = 0.04) but not at other ISIs.</p></div><div><h3>Conclusions</h3><p>Sleep deprivation does not affect cortical excitability except for SAI.</p></div><div><h3>Significance</h3><p>This study confirms some of the previous studies while contradicting others.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 13-20"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X23000318/pdfft?md5=e67a80b5f9c36abe3de95d1e36740be1&pid=1-s2.0-S2467981X23000318-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138992566","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}
Decreased cephalocaudal diaphragm movement may indicate respiratory dysfunction in amyotrophic lateral sclerosis (ALS). We aimed to evaluate diaphragm function in ALS using ultrasound speckle tracking, an image-analysis technology that follows similar pixel patterns.
Methods
We developed an offline application that tracks pixel patterns of recorded ultrasound video images using speckle-tracking methods. Ultrasonography of the diaphragm movement during spontaneous quiet respiration was performed on 19 ALS patients and 21 controls to measure the diaphragm moving distance (DMD) in the cephalocaudal direction during a single respiration. We compared respiratory function measures and analyzed the relationship between the clinical profiles and DMD.
Results
DMD was significantly lower in ALS patients than in the control group (0.6 ± 1.4 mm vs 2.2 ± 2.2 mm, p < 0.01) and positively correlated with phrenic nerve compound motor action potential amplitude (R = 0.63, p = 0.01). DMD was negatively correlated with the change in the ALS Functional Rating Scale-Revised scores per month after the exam (R = −0.61, p = 0.02), and those with a larger rate of decline had a significantly lower DMD (p = 0.03).
Conclusions
Diaphragm ultrasound speckle tracking enabled the detection of diaphragm dysfunction in ALS.
Significance
Diaphragm ultrasound speckle tracking may be useful for predicting prognosis.
目的头尾膈肌运动减少可能预示着肌萎缩侧索硬化症（ALS）患者的呼吸功能障碍。我们的目的是利用超声斑点追踪技术评估 ALS 的膈肌功能，该技术是一种图像分析技术，可跟踪类似的像素模式。方法我们开发了一种离线应用程序，可利用斑点追踪方法跟踪记录的超声视频图像的像素模式。我们对 19 名 ALS 患者和 21 名对照组患者进行了自发安静呼吸时横膈膜运动的超声波成像，以测量单次呼吸时横膈膜在头尾方向的移动距离 (DMD)。结果 ALS 患者的膈肌移动距离明显低于对照组（0.6 ± 1.4 mm vs 2.2 ± 2.2 mm，p < 0.01），且与膈神经复合运动动作电位振幅呈正相关（R = 0.63，p = 0.01）。DMD与检查后每月ALS功能评定量表-修订版评分的变化呈负相关（R = -0.61，p = 0.02），下降率较大者的DMD显著较低（p = 0.03）。结论膈肌超声斑点追踪技术可检测ALS患者的膈肌功能障碍。
{"title":"Decreased diaphragm moving distance measured by ultrasound speckle tracking reflects poor prognosis in amyotrophic lateral sclerosis","authors":"Shunsuke Watanabe , Kenji Sekiguchi , Hirotomo Suehiro , Masaaki Yoshikawa , Yoshikatsu Noda , Naohisa Kamiyama , Riki Matsumoto","doi":"10.1016/j.cnp.2024.10.002","DOIUrl":"10.1016/j.cnp.2024.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>Decreased cephalocaudal diaphragm movement may indicate respiratory dysfunction in amyotrophic lateral sclerosis (ALS). We aimed to evaluate diaphragm function in ALS using ultrasound speckle tracking, an image-analysis technology that follows similar pixel patterns.</div></div><div><h3>Methods</h3><div>We developed an offline application that tracks pixel patterns of recorded ultrasound video images using speckle-tracking methods. Ultrasonography of the diaphragm movement during spontaneous quiet respiration was performed on 19 ALS patients and 21 controls to measure the diaphragm moving distance (DMD) in the cephalocaudal direction during a single respiration. We compared respiratory function measures and analyzed the relationship between the clinical profiles and DMD.</div></div><div><h3>Results</h3><div>DMD was significantly lower in ALS patients than in the control group (0.6 ± 1.4 mm vs 2.2 ± 2.2 mm, <em>p</em> < 0.01) and positively correlated with phrenic nerve compound motor action potential amplitude (R = 0.63, <em>p</em> = 0.01). DMD was negatively correlated with the change in the ALS Functional Rating Scale-Revised scores per month after the exam (R = −0.61, <em>p</em> = 0.02), and those with a larger rate of decline had a significantly lower DMD (<em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>Diaphragm ultrasound speckle tracking enabled the detection of diaphragm dysfunction in ALS.</div></div><div><h3>Significance</h3><div>Diaphragm ultrasound speckle tracking may be useful for predicting prognosis.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 252-260"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561077","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}
It is generally believed that the decremental response in repetitive nerve stimulation (RNS) stabilizes at the fourth or fifth response. We have a preliminary impression that the decremental response approaches a plateau earlier in proximal muscles than in distal muscles. We investigated the speed of the completion of the decremental response in different muscles.
Methods
The “decrement completion ratio (DCR)” in the second or third response (DCR2 or DCR3) was defined as the ratio of the decremental percentage of the second or third response to that of the fourth response. Patients showing more than 10% decremental response both in the abductor pollicis (APB) and deltoid muscles were retrospectively extracted from our EMG database. The DCR2 and DCR3 were compared between two muscles in patients with myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS).
Results
Identified subjects consisted of 11patients with MG and 11 patients with ALS. Multiple regression analysis revealed that only the difference of muscle influenced on DCR2 and DCR3, with no contribution from the different disorder (MG or ALS) or the initial amplitude of the compound muscle action potential (CMAP). Both DCR2 and DCR3 were significantly higher in deltoid than in APB. In ALS, the normalized CMAP amplitude was not different between APB and deltoid whereas the decremental percentage was significantly higher in deltoid, suggesting a lower safety factor of the neuromuscular transmission in proximal muscles.
Conclusions
The decremental response completed more rapidly in deltoid than in APB which may be related to the lower safety factor also documented by this study.
Significance
Unexpected early completion of the decrement such as at the second response in RNS is not a technical error but may be an extreme of the rapid completion in deltoid, a proximal muscle.
{"title":"The speed of completion of the decremental responses on repetitive nerve stimulation","authors":"Yuki Ueta , Takamichi Kanbayashi , Yosuke Miyaji , Yuki Hatanaka , Keisuke Tachiyama , Kazusa Takahashi , Hiroo Terashi , Hitoshi Aizawa , Masahiro Sonoo","doi":"10.1016/j.cnp.2024.06.003","DOIUrl":"10.1016/j.cnp.2024.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>It is generally believed that the decremental response in repetitive nerve stimulation (RNS) stabilizes at the fourth or fifth response. We have a preliminary impression that the decremental response approaches a plateau earlier in proximal muscles than in distal muscles. We investigated the speed of the completion of the decremental response in different muscles.</p></div><div><h3>Methods</h3><p>The “decrement completion ratio (DCR)” in the second or third response (DCR2 or DCR3) was defined as the ratio of the decremental percentage of the second or third response to that of the fourth response. Patients showing more than 10% decremental response both in the abductor pollicis (APB) and deltoid muscles were retrospectively extracted from our EMG database. The DCR2 and DCR3 were compared between two muscles in patients with myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS).</p></div><div><h3>Results</h3><p>Identified subjects consisted of 11patients with MG and 11 patients with ALS. Multiple regression analysis revealed that only the difference of muscle influenced on DCR2 and DCR3, with no contribution from the different disorder (MG or ALS) or the initial amplitude of the compound muscle action potential (CMAP). Both DCR2 and DCR3 were significantly higher in deltoid than in APB. In ALS, the normalized CMAP amplitude was not different between APB and deltoid whereas the decremental percentage was significantly higher in deltoid, suggesting a lower safety factor of the neuromuscular transmission in proximal muscles.</p></div><div><h3>Conclusions</h3><p>The decremental response completed more rapidly in deltoid than in APB which may be related to the lower safety factor also documented by this study.</p></div><div><h3>Significance</h3><p>Unexpected early completion of the decrement such as at the second response in RNS is not a technical error but may be an extreme of the rapid completion in deltoid, a proximal muscle.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 211-216"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X24000192/pdfft?md5=0179049e31ad5c3015c4fdbd0d282190&pid=1-s2.0-S2467981X24000192-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141623880","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}
Pub Date : 2024-01-01DOI: 10.1016/j.cnp.2024.02.002
Bill Zhang , Irina Podkorytova , Ryan Hays , Ghazala Perven , Mark Agostini , Jay Harvey , Rodrigo Zepeda , Sasha Alick-Lindstrom , Marisara Dieppa , Alex Doyle , Rohit Das , Bradley Lega , Kan Ding
Objective
Epilepsy patients with mesial temporal sclerosis (MTS) on imaging who are drug-resistant usually undergo epilepsy surgery without previous invasive evaluation. However, up to one-third of patients are not seizure-free after surgery. Prior studies have identified risk factors for surgical failure, but it is unclear if they are associated with bilateral or discordant seizure onset.
Methods
In this retrospective case series, we identified 17 epilepsy patients who had MRI-confirmed MTS but received invasive stereo-EEG (SEEG) evaluation before definitive intervention. We analyzed their presurgical risk factors in relation to SEEG seizure onset localization and MRI/SEEG concordance.
Results
SEEG ictal onset was concordant with MTS localization (i.e. seizures started only from the hippocampus with MTS) in 5 out of 13 patients with unilateral MTS (UMTS) and in 3 out of 4 patients with bilateral MTS.
No statistically significant association regarding concordance of SEEG ictal onset and MTS location was found in patients with such risk factors as a history of non-mesial temporal aura, frequent focal to bilateral tonic-clonic seizures, prior viral brain infection, or family history of epilepsy. Nine out of 13 UMTS patients had resective surgery only, 5 out of 9 (56 %) have Engel class I outcome at most recent follow-up (median 46.5 months, range 22–91 months). In Engel class I cohort, the SEEG ictal onset was concordant with MTS location in 3 out of 5 patients, and 2 patients had ipsilateral temporal neocortical ictal onset.
Conclusions
Our findings suggest that patients with MTS might have discordant SEEG ictal onset (in 61.5% patients with UMTS in presented cohort), which may explain poor surgical outcome after destructive surgery in these cases.
Significance
Although no statistically significant association was found in this under-powered study, these findings could be potentially valuable for future meta-analyses.
{"title":"Stereo-electroencephalographic seizure localization in patients with mesial temporal sclerosis: A single center experience","authors":"Bill Zhang , Irina Podkorytova , Ryan Hays , Ghazala Perven , Mark Agostini , Jay Harvey , Rodrigo Zepeda , Sasha Alick-Lindstrom , Marisara Dieppa , Alex Doyle , Rohit Das , Bradley Lega , Kan Ding","doi":"10.1016/j.cnp.2024.02.002","DOIUrl":"https://doi.org/10.1016/j.cnp.2024.02.002","url":null,"abstract":"<div><h3>Objective</h3><p>Epilepsy patients with mesial temporal sclerosis (MTS) on imaging who are drug-resistant usually undergo epilepsy surgery without previous invasive evaluation. However, up to one-third of patients are not seizure-free after surgery. Prior studies have identified risk factors for surgical failure, but it is unclear if they are associated with bilateral or discordant seizure onset.</p></div><div><h3>Methods</h3><p>In this retrospective case series, we identified 17 epilepsy patients who had MRI-confirmed MTS but received invasive stereo-EEG (SEEG) evaluation before definitive intervention. We analyzed their presurgical risk factors in relation to SEEG seizure onset localization and MRI/SEEG concordance.</p></div><div><h3>Results</h3><p>SEEG ictal onset was concordant with MTS localization (i.e. seizures started only from the hippocampus with MTS) in 5 out of 13 patients with unilateral MTS (UMTS) and in 3 out of 4 patients with bilateral MTS.</p><p>No statistically significant association regarding concordance of SEEG ictal onset and MTS location was found in patients with such risk factors as a history of non-mesial temporal aura, frequent focal to bilateral tonic-clonic seizures, prior viral brain infection, or family history of epilepsy. Nine out of 13 UMTS patients had resective surgery only, 5 out of 9 (56 %) have Engel class I outcome at most recent follow-up (median 46.5 months, range 22–91 months). In Engel class I cohort, the SEEG ictal onset was concordant with MTS location in 3 out of 5 patients, and 2 patients had ipsilateral temporal neocortical ictal onset.</p></div><div><h3>Conclusions</h3><p>Our findings suggest that patients with MTS might have discordant SEEG ictal onset (in 61.5% patients with UMTS in presented cohort), which may explain poor surgical outcome after destructive surgery in these cases.</p></div><div><h3>Significance</h3><p>Although no statistically significant association was found in this under-powered study, these findings could be potentially valuable for future <em>meta</em>-analyses.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 106-111"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X24000106/pdfft?md5=a49a4443f8ef4720e1d0e21ef06d1ff5&pid=1-s2.0-S2467981X24000106-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140134380","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}
Pub Date : 2024-01-01DOI: 10.1016/j.cnp.2023.12.004
Hatice Tankisi , Viviana Versace , Annapoorna Kuppuswamy , Jonathan Cole
Though a common symptom, fatigue is difficult to define and investigate, occurs in a wide variety of neurological and systemic disorders, with differing pathological causes. It is also often accompanied by a psychological component. As a symptom of long-term COVID-19 it has gained more attention.
In this review, we begin by differentiating fatigue, a perception, from fatigability, quantifiable through biomarkers. Central and peripheral nervous system and muscle disorders associated with these are summarised. We provide a comprehensive and objective framework to help identify potential causes of fatigue and fatigability in a given disease condition. It also considers the effectiveness of neurophysiological tests as objective biomarkers for its assessment. Among these, twitch interpolation, motor cortex stimulation, electroencephalography and magnetencephalography, and readiness potentials will be described for the assessment of central fatigability, and surface and needle electromyography (EMG), single fibre EMG and nerve conduction studies for the assessment of peripheral fatigability.
The purpose of this review is to guide clinicians in how to approach fatigue, and fatigability, and to suggest that neurophysiological tests may allow an understanding of their origin and interactions. In this way, their differing types and origins, and hence their possible differing treatments, may also be defined more clearly.
{"title":"The role of clinical neurophysiology in the definition and assessment of fatigue and fatigability","authors":"Hatice Tankisi , Viviana Versace , Annapoorna Kuppuswamy , Jonathan Cole","doi":"10.1016/j.cnp.2023.12.004","DOIUrl":"10.1016/j.cnp.2023.12.004","url":null,"abstract":"<div><p>Though a common symptom, fatigue is difficult to define and investigate, occurs in a wide variety of neurological and systemic disorders, with differing pathological causes. It is also often accompanied by a psychological component. As a symptom of long-term COVID-19 it has gained more attention.</p><p>In this review, we begin by differentiating fatigue, a perception, from fatigability, quantifiable through biomarkers. Central and peripheral nervous system and muscle disorders associated with these are summarised. We provide a comprehensive and objective framework to help identify potential causes of fatigue and fatigability in a given disease condition. It also considers the effectiveness of neurophysiological tests as objective biomarkers for its assessment. Among these, twitch interpolation, motor cortex stimulation, electroencephalography and magnetencephalography, and readiness potentials will be described for the assessment of central fatigability, and surface and needle electromyography (EMG), single fibre EMG and nerve conduction studies for the assessment of peripheral fatigability.</p><p>The purpose of this review is to guide clinicians in how to approach fatigue, and fatigability, and to suggest that neurophysiological tests may allow an understanding of their origin and interactions. In this way, their differing types and origins, and hence their possible differing treatments, may also be defined more clearly.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 39-50"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X23000367/pdfft?md5=598322e61ca375a5dcff79f4baba5e5a&pid=1-s2.0-S2467981X23000367-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139015879","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}
Pub Date : 2024-01-01DOI: 10.1016/j.cnp.2023.12.005
Caterina Coviello , Silvia Lori , Giovanna Bertini , Simona Montano , Simonetta Gabbanini , Maria Bastianelli , Cesarina Cossu , Sara Cavaliere , Clara Lunardi , Carlo Dani
Objective
The present study aimed to explore first the impact of perinatal risk factors on flash-VEP waves and morphology in a group of preterm infants studied at term equivalent age (TEA). Second, to correlate VEP morphology with neurological outcome at 2 years corrected age (CA).
Methods
Infants with a gestational age (GA) at birth <32 weeks, without major brain injury, were enrolled. Multivariate regression analyses were performed, and the models were run separately for each dependent variable N2, P2, N3 latencies and P2 amplitude. Logistic regression was applied to study N4 component (present/absent) and VEP morphology (regular/irregular). The predictors were GA, bronchopulmonary dysplasia (BPD), postmenstrual age at VEP registration, cumulative morphine and fentanyl dose, and painful procedures. Lastly, linear regression models were performed to assess the relation between the Bayley-III cognitive and motor scores at 2 years CA and VEP morphology, in relation to GA, BPD, painful procedures and cumulative morphine dose.
Results
Eighty infants were enrolled. Morphine was the predictor of N2 (R2 = 0.09, p = 0.006), P2 (R2 = 0.11, p = 0.002), and N3 (R2 = 0.13, p = 0.003) latencies. Younger GA was associated with lower amplitude (R2 = 0.05, p = 0.029). None of the independent variables predicted the presence of N4 component, nor VEP morphology in the logistic analysis. VEP morphology was not associated with cognitive and motor scores at 2 years.
Conclusions
Morphine treatment and prematurity were risk factors for altered VEPs parameters at TEA. In our cohort VEP morphology did not predict neurological outcome.
Significance
Morphine administration should be evaluated according to potential risks and benefits, and dosage individually accustomed, according to pain and comfort scores, considering the possible risk for neurodevelopmental impairment.
{"title":"Morphine exposure and prematurity affect flash visual evoked potentials in preterm infants","authors":"Caterina Coviello , Silvia Lori , Giovanna Bertini , Simona Montano , Simonetta Gabbanini , Maria Bastianelli , Cesarina Cossu , Sara Cavaliere , Clara Lunardi , Carlo Dani","doi":"10.1016/j.cnp.2023.12.005","DOIUrl":"10.1016/j.cnp.2023.12.005","url":null,"abstract":"<div><h3>Objective</h3><p>The present study aimed to explore first the impact of perinatal risk factors on flash-VEP waves and morphology in a group of preterm infants studied at term equivalent age (TEA). Second, to correlate VEP morphology with neurological outcome at 2 years corrected age (CA).</p></div><div><h3>Methods</h3><p>Infants with a gestational age (GA) at birth <32 weeks, without major brain injury, were enrolled. Multivariate regression analyses were performed, and the models were run separately for each dependent variable N2, P2, N3 latencies and P2 amplitude. Logistic regression was applied to study N4 component (present/absent) and VEP morphology (regular/irregular). The predictors were GA, bronchopulmonary dysplasia (BPD), postmenstrual age at VEP registration, cumulative morphine and fentanyl dose, and painful procedures. Lastly, linear regression models were performed to assess the relation between the Bayley-III cognitive and motor scores at 2 years CA and VEP morphology, in relation to GA, BPD, painful procedures and cumulative morphine dose.</p></div><div><h3>Results</h3><p>Eighty infants were enrolled. Morphine was the predictor of N2 (R<sup>2</sup> = 0.09, <em>p</em> = 0.006), P2 (R<sup>2</sup> = 0.11, <em>p</em> = 0.002), and N3 (R<sup>2</sup> = 0.13, <em>p</em> = 0.003) latencies. Younger GA was associated with lower amplitude (R<sup>2</sup> = 0.05, <em>p</em> = 0.029). None of the independent variables predicted the presence of N4 component, nor VEP morphology in the logistic analysis. VEP morphology was not associated with cognitive and motor scores at 2 years.</p></div><div><h3>Conclusions</h3><p>Morphine treatment and prematurity were risk factors for altered VEPs parameters at TEA. In our cohort VEP morphology did not predict neurological outcome.</p></div><div><h3>Significance</h3><p>Morphine administration should be evaluated according to potential risks and benefits, and dosage individually accustomed, according to pain and comfort scores, considering the possible risk for neurodevelopmental impairment.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 85-93"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X24000040/pdfft?md5=19636996dbe6798a1a0be137990c1c31&pid=1-s2.0-S2467981X24000040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638835","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}
Pub Date : 2024-01-01DOI: 10.1016/j.cnp.2024.10.004
Kevin J. Felice
Background
Electromyographers are frequently confronted by anomalous innervations and some may challenge the interpretation of nerve conduction studies (NCS). Reports of 2 or more anomalous innervations in the same patient are rare. I describe the NCS in a patient referred for an evaluation of carpal tunnel syndrome (CTS) who was found to harbor a combined Martin-Gruber anastomosis (MGA) and complete Riché-Cannieu anastomosis (RCA).
Case presentation
This 31-year-old man was referred for electrodiagnostic studies following several months of intermittent right hand numbness and tingling. Clinical exam was normal. Median and ulnar motor NCS showed evidence of a combined MGA and complete RCA. Prolongation of the median sensory peak latency and median-2nd lumbrical motor distal latency provided the electrodiagnostic clues in support of CTS.
Discussion
In summary, this report describes the rare occurrence of a combined MGA and complete RCA in a patient with CTS, demonstrates how NCS can sort out this dual anomaly, and discusses the electrodiagnostic and cadaveric literature on the topic.
{"title":"Combined Martin-Gruber and complete Riché-Cannieu anastomoses disclosed during the electrodiagnostic evaluation of carpal tunnel syndrome","authors":"Kevin J. Felice","doi":"10.1016/j.cnp.2024.10.004","DOIUrl":"10.1016/j.cnp.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Electromyographers are frequently confronted by anomalous innervations and some may challenge the interpretation of nerve conduction studies (NCS). Reports of 2 or more anomalous innervations in the same patient are rare. I describe the NCS in a patient referred for an evaluation of carpal tunnel syndrome (CTS) who was found to harbor a combined Martin-Gruber anastomosis (MGA) and complete Riché-Cannieu anastomosis (RCA).</div></div><div><h3>Case presentation</h3><div>This 31-year-old man was referred for electrodiagnostic studies following several months of intermittent right hand numbness and tingling. Clinical exam was normal. Median and ulnar motor NCS showed evidence of a combined MGA and complete RCA. Prolongation of the median sensory peak latency and median-2nd lumbrical motor distal latency provided the electrodiagnostic clues in support of CTS.</div></div><div><h3>Discussion</h3><div>In summary, this report describes the rare occurrence of a combined MGA and complete RCA in a patient with CTS, demonstrates how NCS can sort out this dual anomaly, and discusses the electrodiagnostic and cadaveric literature on the topic.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"9 ","pages":"Pages 279-282"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142660395","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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