Pub Date : 2026-01-01Epub Date: 2025-12-08DOI: 10.1016/j.cnp.2025.12.003
Moisés León-Ruiz, Julián Benito-León, Carlos Castañeda-Cabrero
{"title":"Response to “Triphasic waves: To treat or not to treat?”: Do not overlook COVID-19 and Creutzfeldt-Jakob disease","authors":"Moisés León-Ruiz, Julián Benito-León, Carlos Castañeda-Cabrero","doi":"10.1016/j.cnp.2025.12.003","DOIUrl":"10.1016/j.cnp.2025.12.003","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-06DOI: 10.1016/j.cnp.2026.02.001
Sampsa Lohi , Petro Julkunen , Reetta Kälviäinen , Esa Mervaala
Objective
We present ‘Epicurrents’, an open-source JavaScript library for processing and displaying neurophysiological signal data in a web browser.
Methods
The library follows a modular architecture to enable support for multiple clinical neurophysiology modalities. It supports open standards such as the European Data Format (EDF) and Digital Imaging and Communications in Medicine (DICOM), with optional Python and Open Neural Network Exchange (ONNX) integrations for scientific signal processing. The application presented in this article is platform agnostic, requires no installation, and is usable both online and offline as a progressive web application.
Results
The library has been tested in real-world educational and research projects and is used by the European Academy of Neurology for hands-on EEG-education in their congresses. While JavaScript’s memory management poses limitations for processing large recordings, architectural workarounds such as shared memory buffers and asynchronous processing have resulted in improved performance.
Conclusions
The application presented here is not intended nor certified for clinical diagnostics, but its accessibility and extensibility make it a promising tool for neurophysiology education and research.
Significance
Epicurrents is the first modular JavaScript library for clinical neurophysiology education and illustrates how web technologies can also enhance collaborative scientific research in the field of clinical neurophysiology.
{"title":"An open-source JavaScript clinical neurophysiology library for education and clinical research","authors":"Sampsa Lohi , Petro Julkunen , Reetta Kälviäinen , Esa Mervaala","doi":"10.1016/j.cnp.2026.02.001","DOIUrl":"10.1016/j.cnp.2026.02.001","url":null,"abstract":"<div><h3>Objective</h3><div>We present ‘Epicurrents’, an open-source JavaScript library for processing and displaying neurophysiological signal data in a web browser.</div></div><div><h3>Methods</h3><div>The library follows a modular architecture to enable support for multiple clinical neurophysiology modalities. It supports open standards such as the European Data Format (EDF) and Digital Imaging and Communications in Medicine (DICOM), with optional Python and Open Neural Network Exchange (ONNX) integrations for scientific signal processing. The application presented in this article is platform agnostic, requires no installation, and is usable both online and offline as a progressive web application.</div></div><div><h3>Results</h3><div>The library has been tested in real-world educational and research projects and is used by the European Academy of Neurology for hands-on EEG-education in their congresses. While JavaScript’s memory management poses limitations for processing large recordings, architectural workarounds such as shared memory buffers and asynchronous processing have resulted in improved performance.</div></div><div><h3>Conclusions</h3><div>The application presented here is not intended nor certified for clinical diagnostics, but its accessibility and extensibility make it a promising tool for neurophysiology education and research.</div></div><div><h3>Significance</h3><div>Epicurrents is the first modular JavaScript library for clinical neurophysiology education and illustrates how web technologies can also enhance collaborative scientific research in the field of clinical neurophysiology.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 115-125"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-03-01DOI: 10.1016/j.cnp.2026.02.007
Ana Calzada-Reyes , Lidice Galán-García , Trinidad Virués-Alba , Lidia Charroó-Ruiz , Laura Perez-Mayo , Maria Luisa Bringas-Vega , Jorge Bosch-Bayard , Yanely Acosta-Ymas , Eduardo Aubert-Vázquez , Mayrim Vega-Hernández , Joel Gutiérrez-Gil , Antonio Caballero-Moreno , Annette Valdés-Virués , Mitchell Valdés-Sosa , Peng Ren , Dezhong Yao , Luo Cheng , Roberto Rodriguez-Labrada , Pedro Valdés-Sosa
Objective
This study compared EEG findings in COVID-19 survivors, close contacts, and a normative database using visual EEG inspection, quantitative EEG (QEEG), and source density analysis.
Methods
Resting-state EEG, QEEG, and VARETA inverse solution were analyzed in 173 participants (87 COVID-19 cases, 86 close contacts) alongside the Cuban EEG normative database. Clinical evaluations included neurological exams and neuropsychiatric assessments.
Results
COVID-19 survivors showed significant EEG abnormalities, including background abnormalities, focal abnormalities and diffuse slow activity. QEEG revealed excess theta, alpha, and beta activity in COVID-19 and symptomatic groups, while close contacts had elevated alpha and beta. EEG source analysis identified functional impairments in key brain regions: COVID-19 patients had abnormalities in the supramarginal and angular gyri, while close contacts showed abnormalities in the supramarginal, postcentral, and superior temporal gyri. Symptomatic individuals exhibited superior temporal gyrus abnormalities, whereas asymptomatic cases had impairments in the supramarginal, angular, and postcentral gyri.
Conclusions
Long-term COVID-19 impacts brain function, with QEEG and VARETA revealing region-specific vulnerabilities linked to viral exposure. These tools help assess neurological dysfunction in post-COVID cases.
Significance
This approach is crucial for understanding the COVID-19 long-term effects on brain function and guiding potential therapeutic interventions.
{"title":"EEG Signatures of COVID-19 Survival compared to close contacts and the Cuban EEG normative database","authors":"Ana Calzada-Reyes , Lidice Galán-García , Trinidad Virués-Alba , Lidia Charroó-Ruiz , Laura Perez-Mayo , Maria Luisa Bringas-Vega , Jorge Bosch-Bayard , Yanely Acosta-Ymas , Eduardo Aubert-Vázquez , Mayrim Vega-Hernández , Joel Gutiérrez-Gil , Antonio Caballero-Moreno , Annette Valdés-Virués , Mitchell Valdés-Sosa , Peng Ren , Dezhong Yao , Luo Cheng , Roberto Rodriguez-Labrada , Pedro Valdés-Sosa","doi":"10.1016/j.cnp.2026.02.007","DOIUrl":"10.1016/j.cnp.2026.02.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared EEG findings in COVID-19 survivors, close contacts, and a normative database using visual EEG inspection, quantitative EEG (QEEG), and source density analysis.</div></div><div><h3>Methods</h3><div>Resting-state EEG, QEEG, and VARETA inverse solution were analyzed in 173 participants (87 COVID-19 cases, 86 close contacts) alongside the Cuban EEG normative database. Clinical evaluations included neurological exams and neuropsychiatric assessments.</div></div><div><h3>Results</h3><div>COVID-19 survivors showed significant EEG abnormalities, including background abnormalities, focal abnormalities and diffuse slow activity. QEEG revealed excess theta, alpha, and beta activity in COVID-19 and symptomatic groups, while close contacts had elevated alpha and beta. EEG source analysis identified functional impairments in key brain regions: COVID-19 patients had abnormalities in the supramarginal and angular gyri, while close contacts showed abnormalities in the supramarginal, postcentral, and superior temporal gyri. Symptomatic individuals exhibited superior temporal gyrus abnormalities, whereas asymptomatic cases had impairments in the supramarginal, angular, and postcentral gyri.</div></div><div><h3>Conclusions</h3><div>Long-term COVID-19 impacts brain function, with QEEG and VARETA revealing region-specific vulnerabilities linked to viral exposure. These tools help assess neurological dysfunction in post-COVID cases.</div></div><div><h3>Significance</h3><div>This approach is crucial for understanding the COVID-19 long-term effects on brain function and guiding potential therapeutic interventions.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 174-186"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147385307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-03-03DOI: 10.1016/j.cnp.2026.02.009
José Castro
{"title":"Evaluating diaphragm motor response variability in electric and magnetic phrenic nerve stimulations during passive expiration","authors":"José Castro","doi":"10.1016/j.cnp.2026.02.009","DOIUrl":"10.1016/j.cnp.2026.02.009","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 172-173"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147385308","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}
Discrimination between EMG activity such as fibrillation potentials/positive sharp waves (Fib/PSW), end plate spikes (EPS), fasciculation potentials (FP), and contaminating voluntary motor unit potentials (MUP) is mandatory for EMG diagnosis. Discharge rhythm is the key for discrimination. We devised a new parameter, Random Index (RI), which quantifies the rhythm and takes a value from 0 to 1, smaller for regular trains of discharges. This study evaluated the utility of RI as well as modified versions of the regularity indices proposed in past reports.
Methods
EMG records of patients with amyotrophic lateral sclerosis were retrospectively reviewed. EPS were collected also from a healthy volunteer. The EMG activity was classified by an expert. RI and other regularity indices as well as the median instantaneous firing rate (IFRm) were calculated.
Results
Analyzed sequences were 73 Fib/PSW, 27 EPS, 24 FP, and 36 MUP. The four types were clearly separated over the 2-dimensional plots of regularity indices vs. IFRm. Especially, Fib/PSW and EPS were far separated in these plots. RI achieved significantly better discrimination between Fib/PSW and MUP than other indices.
Conclusion
RI is a robust tool for discriminating EMG activity.
Significance
RI and other regularity indices would be useful for educational purpose.
{"title":"Discrimination of spontaneous activity in needle EMG based on the quantitative assessment of the discharge rhythm using “Random Index”","authors":"Taiji Mukai , Takamichi Kanbayashi , Masahito Kobayashi , Masamichi Peter Okano , Keisuke Tachiyama , Yosuke Miyaji , Yuki Hatanaka , Shunsuke Kobayashi , Masahiro Sonoo","doi":"10.1016/j.cnp.2026.01.003","DOIUrl":"10.1016/j.cnp.2026.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>Discrimination between EMG activity such as fibrillation potentials/positive sharp waves (Fib/PSW), end plate spikes (EPS), fasciculation potentials (FP), and contaminating voluntary motor unit potentials (MUP) is mandatory for EMG diagnosis. Discharge rhythm is the key for discrimination. We devised a new parameter, Random Index (RI), which quantifies the rhythm and takes a value from 0 to 1, smaller for regular trains of discharges. This study evaluated the utility of RI as well as modified versions of the regularity indices proposed in past reports.</div></div><div><h3>Methods</h3><div>EMG records of patients with amyotrophic lateral sclerosis were retrospectively reviewed. EPS were collected also from a healthy volunteer. The EMG activity was classified by an expert. RI and other regularity indices as well as the median instantaneous firing rate (IFRm) were calculated.</div></div><div><h3>Results</h3><div>Analyzed sequences were 73 Fib/PSW, 27 EPS, 24 FP, and 36 MUP. The four types were clearly separated over the 2-dimensional plots of regularity indices vs. IFRm. Especially, Fib/PSW and EPS were far separated in these plots. RI achieved significantly better discrimination between Fib/PSW and MUP than other indices.</div></div><div><h3>Conclusion</h3><div>RI is a robust tool for discriminating EMG activity.</div></div><div><h3>Significance</h3><div>RI and other regularity indices would be useful for educational purpose.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 65-71"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-24DOI: 10.1016/j.cnp.2025.12.008
Yuichiro Shirota , Juuri Otsuka , Masashi Hamada
Objective
To investigate precision, accuracy, and reliability of a threshold hunting method to estimate resting motor threshold (RMT) using parameter estimation by sequential testing and maximum likelihood estimation (PEST-MLE).
Methods
In 53 healthy participants, single pulse transcranial magnetic stimulation was delivered to estimate RMT with cutoff values of 0.05 mV and 0.2 mV. RMT was inferred from 30-trial PEST-MLE algorithm for at maximum two days with two estimation sessions per day, comprising Sessions 1 to 4. Precision and accuracy were assessed within each session. Repeatability was assessed using intraclass correlation coefficient (ICC), reproducibility coefficient (RC), and standard error of measurement (SEM).
Results
For both 0.05 mV and 0.2 mV, 18 trials were needed to have good accuracy. ICC greater than 0.8 was achieved for within-day comparison but the ICC of between-day comparison was lower. RC and SEM were around 10 % and 5 %, respectively.
Conclusions
At 18th trial the estimations were converged in terms of precision and accuracy, and good reliability was achieved at that stage.
Significance
RMT estimation with the PEST-MLE is a rapid and reliable approach that can be implemented for future clinical and scientific studies.
{"title":"Precision, accuracy, and reliability of a threshold hunting method for transcranial magnetic stimulation","authors":"Yuichiro Shirota , Juuri Otsuka , Masashi Hamada","doi":"10.1016/j.cnp.2025.12.008","DOIUrl":"10.1016/j.cnp.2025.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate precision, accuracy, and reliability of a threshold hunting method to estimate resting motor threshold (RMT) using parameter estimation by sequential testing and maximum likelihood estimation (PEST-MLE).</div></div><div><h3>Methods</h3><div>In 53 healthy participants, single pulse transcranial magnetic stimulation was delivered to estimate RMT with cutoff values of 0.05 mV and 0.2 mV. RMT was inferred from 30-trial PEST-MLE algorithm for at maximum two days with two estimation sessions per day, comprising Sessions 1 to 4. Precision and accuracy were assessed within each session. Repeatability was assessed using intraclass correlation coefficient (ICC), reproducibility coefficient (RC), and standard error of measurement (SEM).</div></div><div><h3>Results</h3><div>For both 0.05 mV and 0.2 mV, 18 trials were needed to have good accuracy. ICC greater than 0.8 was achieved for within-day comparison but the ICC of between-day comparison was lower. RC and SEM were around 10 % and 5 %, respectively.</div></div><div><h3>Conclusions</h3><div>At 18th trial the estimations were converged in terms of precision and accuracy, and good reliability was achieved at that stage.</div></div><div><h3>Significance</h3><div>RMT estimation with the PEST-MLE is a rapid and reliable approach that can be implemented for future clinical and scientific studies.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 24-31"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-19DOI: 10.1016/j.cnp.2026.02.003
William T. Creel, Colleen A. Brenner, Richard E Hartman
Objective
Entropy analysis of electroencephalographic (EEG) data provides insight into the complexity of neural activity. This study primarily examined whether cannabis use frequency is associated with alterations in multiscale entropy (MSE) in the prefrontal cortex (PFC) and mapped baseline MSE differences across cortical regions.
Methods
Resting-state EEG was collected from 57 adults: non-users (n = 18), low-frequency users (≤ 1x/week; n = 24), and frequent users (≥ 2x/week; n = 15). MSE values were binned into fine, medium, coarse, and very-coarse scale ranges. Linear mixed-effects models assessed group × scale bin interactions in the PFC and regional differences among lobes, irrespective of cannabis use.
Results
Entropy increased with coarser scales in all groups, but the slope was significantly flatter in frequent users. From the medium bin onward, their PFC scale–entropy slope was ∼ 0.12 bits lower than in non-users, widening to ∼ 0.16 bits at very-coarse scales (FDR-corrected q < 0.012). Across all participants, the PFC exhibited lower MSE than parietal, occipital, and temporal lobes, with regional gaps expanding at coarser scales.
Conclusions
The PFC exhibits intrinsically reduced signal complexity compared with other cortical regions, with further attenuation in frequent cannabis users.
Significance
MSE captures regional cortical dynamics in resting EEG and detects cannabis-related reductions in prefrontal signal complexity at longer temporal scales.
{"title":"Regional and cannabis-related differences in prefrontal multiscale entropy of resting-state EEG","authors":"William T. Creel, Colleen A. Brenner, Richard E Hartman","doi":"10.1016/j.cnp.2026.02.003","DOIUrl":"10.1016/j.cnp.2026.02.003","url":null,"abstract":"<div><h3>Objective</h3><div>Entropy analysis of electroencephalographic (EEG) data provides insight into the complexity of neural activity. This study primarily examined whether cannabis use frequency is associated with alterations in multiscale entropy (MSE) in the prefrontal cortex (PFC) and mapped baseline MSE differences across cortical regions.</div></div><div><h3>Methods</h3><div>Resting-state EEG was collected from 57 adults: non-users (n = 18), low-frequency users (≤ 1x/week; n = 24), and frequent users (≥ 2x/week; n = 15). MSE values were binned into fine, medium, coarse, and very-coarse scale ranges. Linear mixed-effects models assessed group × scale bin interactions in the PFC and regional differences among lobes, irrespective of cannabis use.</div></div><div><h3>Results</h3><div>Entropy increased with coarser scales in all groups, but the slope was significantly flatter in frequent users. From the medium bin onward, their PFC scale–entropy slope was ∼ 0.12 bits lower than in non-users, widening to ∼ 0.16 bits at very-coarse scales (FDR-corrected q < 0.012). Across all participants, the PFC exhibited lower MSE than parietal, occipital, and temporal lobes, with regional gaps expanding at coarser scales.</div></div><div><h3>Conclusions</h3><div>The PFC exhibits intrinsically reduced signal complexity compared with other cortical regions, with further attenuation in frequent cannabis users.</div></div><div><h3>Significance</h3><div>MSE captures regional cortical dynamics in resting EEG and detects cannabis-related reductions in prefrontal signal complexity at longer temporal scales.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 135-141"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-16DOI: 10.1016/j.cnp.2025.12.004
A. Naidoo , KE. Jones
Objectives
To examine how stimulus amplitude and width influence subthreshold superexcitability of peripheral axons and to provide evidence-based recommendations for minimizing inadvertent compound muscle action potential (CMAP) generation during intraoperative corticobulbar monitoring.
Methods
Fifteen healthy participants received median nerve stimulation under nine conditions combining three amplitudes (80 %, 85 %, and 90 % of threshold) and three pulse widths (0.1 ms, 0.5 ms, 1.0 ms). Trains of 1–7 subthreshold pulses (2 ms interpulse interval) were delivered 10 times per condition. CMAPs were recorded from the abductor pollicis brevis (APB), and the probability of a response exceeding 100 µV (baseline-to-negative-peak) was calculated. Persistent sodium current was estimated using the latent addition test (LAh).
Results
Higher pulse amplitudes and wider pulse widths significantly increased CMAP probability, with a significant interaction (F(4,56) = 4.853, p = 0.002, partial η2 = 0.257). All pairwise comparisons were significant (p ≤ 0.023). When controlling for rheobase, LAh was positively correlated with response probability (rpartial(12) = 0.539, p = 0.047).
Conclusions & significance
Subthreshold trains activate motor axons in a predictable manner depending on amplitude, width, and train length. These findings challenge current IONM assumptions and highlight the need for threshold-referenced, standardized protocols.
目的探讨刺激幅度和宽度如何影响外周轴突的阈下超兴奋性，并为术中皮质球监测中减少无意复合肌动作电位（CMAP）的产生提供循证建议。方法15名健康受试者分别在阈值的80%、85%和90%三个幅度和0.1 ms、0.5 ms、1.0 ms三个脉宽的9种条件下接受正中神经刺激。每个条件下传递1-7个亚阈值脉冲序列（脉冲间隔2 ms） 10次。从短掌外展肌（APB）记录cmap，并计算反应超过100µV（基线到负峰）的概率。使用潜在添加试验（LAh）估计持久钠电流。结果较高的脉冲振幅和较宽的脉冲宽度显著提高了CMAP的发生概率，且存在显著的交互作用（F(4,56) = 4.853, p = 0.002，偏η2 = 0.257）。两两比较均显著（p≤0.023）。在控制流变酶的情况下，LAh与应答概率呈正相关（rpartial(12) = 0.539, p = 0.047）。阈下序列以可预测的方式激活运动轴突，这取决于振幅、宽度和序列长度。这些发现挑战了当前IONM的假设，并强调了阈值参考、标准化协议的必要性。
{"title":"Temporal summation of subthreshold stimuli in human motor axons: Implications for intraoperative neuromonitoring","authors":"A. Naidoo , KE. Jones","doi":"10.1016/j.cnp.2025.12.004","DOIUrl":"10.1016/j.cnp.2025.12.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine how stimulus amplitude and width influence subthreshold superexcitability of peripheral axons and to provide evidence-based recommendations for minimizing inadvertent compound muscle action potential (CMAP) generation during intraoperative corticobulbar monitoring.</div></div><div><h3>Methods</h3><div>Fifteen healthy participants received median nerve stimulation under nine conditions combining three amplitudes (80 %, 85 %, and 90 % of threshold) and three pulse widths (0.1 ms, 0.5 ms, 1.0 ms). Trains of 1–7 subthreshold pulses (2 ms interpulse interval) were delivered 10 times per condition. CMAPs were recorded from the abductor pollicis brevis (APB), and the probability of a response exceeding 100 µV (baseline-to-negative-peak) was calculated. Persistent sodium current was estimated using the latent addition test (LAh).</div></div><div><h3>Results</h3><div>Higher pulse amplitudes and wider pulse widths significantly increased CMAP probability, with a significant interaction (F(4,56) = 4.853, p = 0.002, partial η<sup>2</sup> = 0.257). All pairwise comparisons were significant (p ≤ 0.023). When controlling for rheobase, LAh was positively correlated with response probability (r<sub>partial</sub>(12) = 0.539, p = 0.047).</div></div><div><h3>Conclusions & significance</h3><div>Subthreshold trains activate motor axons in a predictable manner depending on amplitude, width, and train length. These findings challenge current IONM assumptions and highlight the need for threshold-referenced, standardized protocols.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 5-12"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-03-04DOI: 10.1016/j.cnp.2026.02.008
Sabrina Lorenz , Linda Bartusch , Cornelia Heusler , Stefan Götz , Thomas Kammer
Objective
To investigate whether transcranial static magnetic stimulation (tSMS) exerts inhibitory effects on the human motor cortex and whether these effects differ between dominant and non-dominant hemispheres.
Methods
Participants underwent tSMS (20 min) and sham stimulation, targeting either the left (dominant, n = 19) or right (non-dominant, n = 19) motor cortex in a between-subject design. Corticospinal excitability was assessed with transcranial magnetic stimulation (TMS), using single-pulse motor evoked potentials (MEPs) and paired-pulse paradigms (short-interval intracortical inhibition SICI, intracortical facilitation ICF). Neuronavigation ensured stable hotspot localization.
Results
No significant differences in MEP amplitudes were observed between tSMS and sham stimulation. Paired-pulse measures confirmed robust inhibition and facilitation, with higher reliability for SICI. However, neither SICI nor ICF showed modulation by tSMS.
Conclusions
tSMS modulated excitability in neither the dominant nor the non– dominant hemisphere. The results suggest that previously reported effects may reflect methodological limitations, particularly absence of neuronavigation or low trial numbers.
Significance
This study provides the first direct hemispheric comparison of tSMS using neuronavigation and robust stimulation protocols, questioning the robustness of earlier findings and highlighting methodological standards for future research.
{"title":"Re-evaluating transcranial static magnetic stimulation (tSMS): No inhibitory effects on motor cortex across hemispheres","authors":"Sabrina Lorenz , Linda Bartusch , Cornelia Heusler , Stefan Götz , Thomas Kammer","doi":"10.1016/j.cnp.2026.02.008","DOIUrl":"10.1016/j.cnp.2026.02.008","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate whether transcranial static magnetic stimulation (tSMS) exerts inhibitory effects on the human motor cortex and whether these effects differ between dominant and non-dominant hemispheres.</div></div><div><h3>Methods</h3><div>Participants underwent tSMS (20 min) and sham stimulation, targeting either the left (dominant, n = 19) or right (non-dominant, n = 19) motor cortex in a between-subject design. Corticospinal excitability was assessed with transcranial magnetic stimulation (TMS), using single-pulse motor evoked potentials (MEPs) and paired-pulse paradigms (short-interval intracortical inhibition SICI, intracortical facilitation ICF). Neuronavigation ensured stable hotspot localization.</div></div><div><h3>Results</h3><div>No significant differences in MEP amplitudes were observed between tSMS and sham stimulation. Paired-pulse measures confirmed robust inhibition and facilitation, with higher reliability for SICI. However, neither SICI nor ICF showed modulation by tSMS.</div></div><div><h3>Conclusions</h3><div>tSMS modulated excitability in neither the dominant nor the non– dominant hemisphere. The results suggest that previously reported effects may reflect methodological limitations, particularly absence of neuronavigation or low trial numbers.</div></div><div><h3>Significance</h3><div>This study provides the first direct hemispheric comparison of tSMS using neuronavigation and robust stimulation protocols, questioning the robustness of earlier findings and highlighting methodological standards for future research.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 163-171"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147385309","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}
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