Clinical Neurophysiology Practice最新文献_第2页

Temporal summation of subthreshold stimuli in human motor axons: Implications for intraoperative neuromonitoring 人类运动轴突阈下刺激的时间汇总：术中神经监测的意义

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-12-16 DOI: 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 (r_partial(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。

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引用次数: 0

Response to “Triphasic waves: To treat or not to treat?”: Do not overlook COVID-19 and Creutzfeldt-Jakob disease 对《三相波：治疗还是不治疗？》：不要忽视COVID-19和克雅氏病

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-12-08 DOI: 10.1016/j.cnp.2025.12.003

Moisés León-Ruiz, Julián Benito-León, Carlos Castañeda-Cabrero

引用次数: 0

Selective loss of ulnar somatosensory evoked potentials revealing a focal cervical cord plaque in multiple sclerosis 多发性硬化症患者尺侧体感诱发电位选择性丧失显示局灶性颈髓斑块

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-12-08 DOI: 10.1016/j.cnp.2025.12.002

Julian Cheron , Bernard Dachy

引用次数: 0

Facial magnetomyography using an array of optically pumped magnetometers 使用光泵磁强计阵列的面部磁切面术

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 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.

目的测量面肌活动对面瘫的诊断具有重要意义。本研究探讨了使用光泵磁强计（OPM）的非接触式磁强图（MMG）是否可行，以显示面部肌肉活动。方法在5名健康受试者的面部一侧放置具有11个OPM的解剖形状的面罩。当他们表现出不同的面部表情时，MMG被记录下来。对每个表情和受试者计算每个OPM信号的均方根，并将其分配给单个人脸。测定最大平均肌肉活动和信噪比（SNR）。结果受试者的面部肌肉活动可以通过每个面部表情单独测量。平均RMS为0.6pT (SD为0.4pT)，平均信噪比为2.2 （SD为1.2）。结论虽然传感器的定位（传感器的几何形状和与肌肉的距离）是决定性的，但使用OPM通过MMG成像面部活动是可能的。然而，面部肌肉的信号幅度很低，个体间的解剖差异使得测量设置具有挑战性。意义由于面部MMG的成像是可行的，本研究为未来研究利用OPM进行面部肌肉和面神经疾病的诊断、监测和康复铺平了道路。

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引用次数: 0

Electrodiagnostic criteria for neuromuscular transmission disorders suggested by a European consensus group 欧洲共识小组提出的神经肌肉传递障碍的电诊断标准

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.02.011

H. Tankisi , K. Pugdahl , B. Johnsen , J.P. Camdessanché , M. de Carvalho , P. Fawcett , A. Labarre-Vila , R. Liguori , W. Nix , I. Schofield , A. Fuglsang-Frederiksen

Objective

Electrodiagnostic testing plays an important role in diagnosing disorders of neuromuscular transmission (NMT), especially in seronegative myasthenia gravis. However, electrodiagnostic criteria for the diagnosis are sparse. This study aimed at inferring evidence-based recommendations for the electrodiagnostic examination of NMT disorders.

Methods

A total of 164 cases with a consensus diagnosis of NMT disorder obtained by peer review by eight experienced neurophysiologists were analysed for differences in examination strategy, the sensitivity of different tests, and inferring minimal criteria. The diagnostic performance of the suggested criteria was validated on 24 MG patients and 50 patients with neuropathy (17), myopathy (15), or fatigue (18).

Results

We recommend as minimal electrodiagnostic criteria for NMT disorders, either (a) 2 abnormal repetitive nerve stimulation (RNS), (b) 1 abnormal RNS and 1 abnormal single fiber electromyography (SFEMG) or (c) 2 abnormal SFEMG. These showed a good diagnostic performance with a sensitivity of 87.5 % and a specificity of 100 %.

Conclusion

Recommendations with high diagnostic sensitivity and specificity for the minimum number of RNS and SFEMG studies to diagnose NMT disorders developed by an international consensus group are suggested.

Significance

The suggested electrodiagnostic recommendations for diagnosing NMT disorders are reliable and suitable for use at different centres.

目的电诊断在诊断神经肌肉传递障碍（NMT），特别是血清阴性重症肌无力中具有重要意义。然而，诊断的电诊断标准是稀疏的。本研究旨在推断NMT疾病电诊断检查的循证建议。方法对经8位经验丰富的神经生理学家同行评议的164例一致诊断为NMT障碍的病例进行分析，分析其检查策略、不同检查方法的敏感性以及推断最小标准的差异。建议的诊断标准在24名MG患者和50名神经病变（17名）、肌病（15名）或疲劳（18名）患者中得到了验证。结果我们推荐NMT障碍的最低电诊断标准为：(a) 2个异常的重复神经刺激（RNS）， (b) 1个异常的重复神经刺激（RNS）和1个异常的单纤维肌电图（SFEMG）或(c) 2个异常的SFEMG。结果表明，该方法具有良好的诊断性能，敏感性为87.5%，特异性为100%。结论国际共识小组提出了诊断NMT疾病的高诊断敏感性和特异性的RNS和SFEMG研究的最少数量的建议。建议的诊断NMT疾病的电诊断建议是可靠的，适合在不同的中心使用。

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引用次数: 0

Asymptomatic tarsal tunnel syndrome in rheumatoid arthritis: An electrophysiological perspective with Insights into clinical and Laboratory correlates 类风湿关节炎的无症状跗骨隧道综合征：电生理观点与临床和实验室相关的见解

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.07.003

Hosna Elshony , Mohamed H. Aly , Abdelgaffar Mohammed , Abdulrahman M. Hassan , Abdulrahman A. Alshehri , Mohamed Hedak , Rakan Almuhanna , Abdulaziz Al-Ghamdi , Rasha Elsaadawy

Objective

To evaluate the prevalence of asymptomatic tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients and its association with disease activity, inflammation, and electrophysiological changes.

Methods

Forty RA patients and 40 age- and sex-matched controls underwent nerve conduction studies assessing medial plantar, lateral plantar, and posterior tibial nerves. Disease activity (DAS28, RASS), inflammatory markers (ESR, CRP), and autoantibodies (RF, anti-CCP) were recorded. Comparisons used t-tests; correlations assessed associations.

Results

RA patients showed significantly prolonged sensory latencies and reduced amplitudes and nerve conduction velocities, especially in medial and lateral plantar nerves. Sensory latencies had 100% sensitivity for subclinical TTS; motor parameters demonstrated high specificity. Higher DAS28, longer disease duration, elevated ESR/CRP, joint deformities, and seropositivity predicted TTS.

Conclusions

Subclinical TTS is highly prevalent in RA and linked to systemic inflammation, disease severity, and structural damage.

Significance

Routine electrophysiological screening may enable early detection and intervention, preserving nerve function and improving long-term mobility and quality of life in RA patients.

Trial Registration

The study was approved by the SFHM Institutional Review Board and registered under HAP-02-K-052 in August 2024.

目的探讨无症状跗骨隧道综合征（TTS）在类风湿关节炎（RA）患者中的患病率及其与疾病活动度、炎症和电生理变化的关系。方法40例RA患者和40例年龄和性别匹配的对照组接受了神经传导研究，评估了足底内侧神经、足底外侧神经和胫后神经。记录疾病活动性（DAS28、RASS）、炎症标志物（ESR、CRP）和自身抗体（RF、抗ccp）。比较采用t检验；相关性评估关联。结果ra患者感觉潜伏期明显延长，振幅和神经传导速度明显降低，尤以内侧和外侧足底神经明显。感觉潜伏期对亚临床TTS的敏感性为100%；电机参数具有高特异性。较高的DAS28、较长的病程、升高的ESR/CRP、关节畸形和血清阳性预测TTS。结论亚临床TTS在RA中非常普遍，并与全身性炎症、疾病严重程度和结构损伤有关。常规电生理筛查可以早期发现和干预，保护神经功能，改善RA患者的长期活动能力和生活质量。试验注册该研究已获得SFHM机构审查委员会的批准，并于2024年8月根据HAP-02-K-052注册。

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引用次数: 0

Novel approaches to EEG and MEG in motor neurone disease: IFCN Handbook Chapter 运动神经元疾病EEG和MEG的新方法：IFCN手册章节

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.07.001

Stefan Dukic , Rosanne Govaarts , Arjan Hillebrand , Marianne de Visser , Margitta Seeck , Roisin McMackin

Motor neurone diseases (MNDs) are increasingly being acknowledged as network disorders, with cortical dysfunction and degeneration extending beyond the motor cortex. Measures of this broader cortical pathophysiology are providing promising candidates in the search for diagnostic and prognostic biomarkers of the MNDs. Electroencephalography (EEG) and magnetoencephalography (MEG) offer a direct view of neural network activity by detecting changes in electromagnetic fields of the brain. Measurements based on EEG/MEG have often been overlooked in the search for MND biomarkers, largely due to their limited spatial resolution and the perceived challenges associated with noise in these signals. However, with recent developments in sensor technology and source reconstruction algorithms, alongside substantial improvement in pipelines that address noise, EEG/MEG-based measures can now be readily employed for spatiotemporally-precise, economical and non-invasive characterisation of cortical network pathophysiology in MNDs. Here, we provide an overview of how EEG/MEG signals have been employed to quantify neural network function in MND. We outline the advantages and limitations of these measurements, discuss the most clinically promising EEG/MEG studies of MNDs to date, and highlight future directions warranted to harness the full potential of these technologies for understanding and assessing MNDs.

运动神经元疾病（mnd）越来越多地被认为是一种网络疾病，其皮层功能障碍和退化延伸到运动皮层以外。这种更广泛的皮层病理生理学的测量为寻找mnd的诊断和预后生物标志物提供了有希望的候选物。脑电图（EEG）和脑磁图（MEG）通过检测大脑电磁场的变化提供了对神经网络活动的直接观察。在寻找MND生物标志物的过程中，基于EEG/MEG的测量常常被忽视，这主要是由于它们有限的空间分辨率和与这些信号中的噪声相关的感知挑战。然而，随着传感器技术和声源重建算法的最新发展，以及解决噪声的管道的实质性改进，基于EEG/ meg的测量现在可以很容易地用于大脑皮层网络病理生理的时空精确、经济和非侵入性表征。在这里，我们概述了如何使用EEG/MEG信号来量化MND中的神经网络功能。我们概述了这些测量的优点和局限性，讨论了迄今为止最有临床前景的脑电/脑磁图研究，并强调了未来的方向，保证利用这些技术的全部潜力来理解和评估脑磁图。

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引用次数: 0

Evaluating diaphragm motor response variability in electric and magnetic phrenic nerve stimulations during passive expiration 评估被动呼气时膈神经电和磁刺激下膈肌运动的反应变异性

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.11.003

Ivan Chakalov , Swen Hülsmann , Perianen Ramasawmy , Lukas Diedrich , Mathias Bähr , Leif Saager , Konrad Meissner , Onnen Moerer , Caspar Stephani , Andrea Antal

Objective

This study assessed variability in cervical electrical (CEPNS) and magnetic (CMPNS) phrenic nerve stimulation alongside transcranial magnetic stimulation (diTMS) of the diaphragm, focusing on motor response latency and amplitude at individually calculated suprathreshold intensities.

Methods

Diaphragm motor responses were elicited via CEPNS and CMPNS (measuring compound muscle action potentials, CMAPs) and diTMS (measuring diaphragm motor evoked potentials, diMEPs). Latency and amplitude were recorded. Statistical analyses compared methods, evaluated variability using coefficients of variation (CV), and explored associations with height and central motor conduction time.

Results

Among 25 participants (mean age 25 ± 4 years), CMPNS evoked CMAPs in 21 subjects, CEPNS in 16, with 12 responding to both. No significant latency or amplitude differences emerged between CEPNS and CMPNS responders. TMS evoked diMEPs in 24 participants. Latency was more consistent than amplitude across all methods; CMPNS exhibited the lowest amplitude variability. Height moderately correlated positively with CMAP latency and negatively with central motor conduction time.

Conclusions

Individually adapted suprathreshold CEPNS and CMPNS assessed phrenic nerve conduction with varying success rates. Latency was a more reliable measure than amplitude. CMPNS and diTMS surpassed CEPNS in response reliability, positioning magnetic stimulations as preferable for assessing phrenic nerve conduction. CEPNS might not be suitable for examining motor response amplitudes when not applied at supramaximal intensity. Height-related anatomical factors influencing conduction merit further study.

Significance

Latency of diaphragm motor responses elicited at individually estimated stimulation intensities offers a more consistent biomarker over amplitude for assessing phrenic nerve function.

目的：本研究评估膈神经经颅磁刺激（diTMS）与宫颈电刺激（CEPNS）和磁刺激（CMPNS）的可变性，重点关注运动反应潜伏期和阈上强度单独计算的振幅。方法通过CEPNS、CMPNS（测量复合肌动作电位，CMAPs）和diTMS（测量膈肌运动诱发电位，diMEPs）诱发膈肌运动反应。记录潜伏期和振幅。统计分析比较了各种方法，使用变异系数（CV）评估了变异率，并探讨了与身高和中枢运动传导时间的关系。结果25例参与者（平均年龄25±4岁）中，CMPNS诱发cmap的21例，CEPNS诱发cmap的16例，其中12例均有反应。CEPNS和CMPNS应答者之间没有明显的潜伏期或幅度差异。经颅磁刺激诱发24例diMEPs。在所有方法中，潜伏期比振幅更一致；CMPNS表现出最低幅度的变异性。身高与CMAP潜伏期呈正相关，与中枢运动传导时间呈负相关。结论单独应用阈上CEPNS和CMPNS评估膈神经传导成功率不同。潜伏期比振幅更可靠。CMPNS和diTMS在反应可靠性上优于CEPNS，定位磁刺激作为评估膈神经传导的首选。当不以最大强度应用时，CEPNS可能不适合检查运动反应幅度。与高度相关的影响传导的解剖学因素值得进一步研究。在单独估计的刺激强度下引起的膈肌运动反应的潜伏期为评估膈神经功能提供了一个更一致的生物标志物。

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引用次数: 0

Favorable outcomes of epilepsy with gait-induced seizures after resection of the unilateral supplementary motor area 切除单侧辅助运动区后伴有步态性癫痫发作的良好结果

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.10.004

Satoshi Kodama , Naoto Kunii , Yuichiro Shirota , Takusei Chou , Mizuho Kawai , Seijiro Shimada , Meiko Maeda , Hiroyuki Ishiura , Masashi Hamada , Masako Ikemura , Yuko Saito , Naoki Akamatsu , Taira Uehara , Nobuhito Saito , Tatsushi Toda

Background

Gait-induced seizures are a rare manifestation of reflex epilepsy. Pathophysiology of this phenomenon has not been fully understood.

Case presentation

A 28-year-old woman presented with a long history of “falls” following paroxysmal bilateral leg stiffness triggered by walking. Scalp electroencephalogram (EEG) revealed low-amplitude rhythmic beta activity, maximal at the Cz electrode, during these events. Magnetoencephalography demonstrated repetitive sharp waves source-localized to the right primary motor cortex. Multiple anti-seizure medications failed to improve her symptoms; however, the clinical manifestation was consistent with epilepsy with gait-induced seizures. Intracranial subdural EEG recording was performed and confirmed ictal activity originating from the right supplementary motor area. Resection of this area resulted in complete resolution of her symptoms.

Discussion

This is the first reported case of successful resective surgery for epilepsy with gait-induced seizure. Brain networks involving cortical regions responsible for the initiation or execution of walking presumably played a key role in the generation of gait-induced seizures. Careful assessment using non-invasive neurophysiological studies facilitated accurate diagnosis, successful intracranial recordings, and effective resective surgery.

背景：步态诱发癫痫是反射性癫痫的一种罕见表现。这一现象的病理生理学尚未完全了解。病例介绍：一名28岁女性，因行走引起阵发性双侧腿僵硬，长期出现“跌倒”病史。在这些事件中，头皮脑电图（EEG）显示低振幅节律性β活动，在Cz电极处最大。脑磁图显示重复的尖波源定位于右侧初级运动皮层。多种抗癫痫药物未能改善她的症状；但临床表现符合癫痫伴步态性发作。进行颅内硬脑膜下脑电图记录，证实脑电图活动起源于右侧辅助运动区。切除该区域使她的症状完全消失。讨论：这是首例成功切除癫痫伴步态性癫痫发作的病例。涉及皮层区域的大脑网络负责开始或执行行走，可能在步态诱发癫痫发作的产生中发挥了关键作用。使用非侵入性神经生理学研究的仔细评估有助于准确诊断，成功的颅内记录和有效的切除手术。

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引用次数: 0

COMPRESSIVE DATA STORAGE FOR LONG-TERM EEG: VALIDATION BY VISUAL ANALYSIS 长期脑电图压缩数据存储：视觉分析验证

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.07.005

Giridhar P. Kalamangalam , Subeikshanan Venkatesan , Maria-Jose Bruzzone , Yue Wang , Carolina B. Maciel , Sotiris Mitropanopoulos , Jean Cibula , Kajal Patel , Abbas Babajani-Feremi

Objectives

Long-term EEG monitoring (LTM) in acute neurology generates massive data volumes. We investigated whether data-analytic techniques could reduce LTM data size yet conserve their visual diagnostic features.

Methods

LTM exemplars from 50 patients underwent singular value decomposition (SVD). High-variance SVD components were transformed using discrete cosine transform (DCT), and significant elements run-length encoded. Two regimes were tested: (I) SVD and DCT compression ratio (CR) of 1.7 and 12, and (II) CR of 3.7 and 5.7; each achieved an overall CR of ≈20. Compressed data were reconstructed alongside uncompressed originals, to create a total of 200 recordings that were scored by two blinded reviewers. Scores of original and reconstructed data were statistically analyzed.

Results

Score differences between original recordings were smaller than comparisons involving reconstructions using the first regime but did not differ significantly from reconstructions using the second regime.

Conclusions

Raw LTM EEG has sufficient redundancy to undergo extreme (20-fold) data compression without compromising visual diagnostic information. A balanced mix of SVD and DCT appears to be a suitable data-analytic pipeline for achieving such compression.

Significance

Dimension reduction is a significant goal in managing big biomedical data. Our results suggest a pathway for archival of meaningful representations of entire LTM datasets. The latent space suggests new lines of data-scientific inquiry of the EEG in acute neurological illness.

目的急性神经内科长期脑电图监测（LTM）产生海量数据。我们研究了数据分析技术是否可以减少LTM数据大小，同时保留其视觉诊断特征。方法对50例患者的sltm样本进行奇异值分解（SVD）。采用离散余弦变换（DCT）对高方差SVD分量进行变换，并对重要元素进行游程编码。测试两种方案：(I) SVD和DCT压缩比（CR）分别为1.7和12，（II） CR分别为3.7和5.7；每个细胞的总CR≈20。压缩后的数据与未压缩的原始数据一起重建，共创建200个录音，由两位盲法评论者评分。对原始数据和重建数据的评分进行统计分析。结果原始记录之间的评分差异小于使用第一种制度重建的比较，但与使用第二种制度重建的比较没有显著差异。结论原始LTM脑电图具有足够的冗余，可以在不影响视觉诊断信息的情况下进行极端（20倍）的数据压缩。SVD和DCT的平衡混合似乎是实现这种压缩的合适数据分析管道。降维是生物医学大数据管理的重要目标。我们的研究结果为整个LTM数据集的有意义表示的存档提供了一条途径。这一潜在的空间为脑电图在急性神经系统疾病中的数据科学探究提供了新的思路。

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引用次数: 0