Clinical Neurophysiology Practice最新文献_第3页

Tibial to ulnar nerve amplitude ratio as a marker of length-dependent neuropathy 胫尺神经振幅比作为长度依赖性神经病变的标志

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.10.006

Chikashi Yano , Tomonori Nakamura , Masahiro Ando , Yujiro Higuchi , Jun-Hui Yuan , Akiko Yoshimura , Takahiro Hobara , Fumikazu Kojima , Yu Hiramatsu , Satoshi Nozuma , Yusuke Sakiyama , Akihiro Hashiguchi , Raymond L. Rosales , Kimiyoshi Arimura , Hiroshi Takashima

Objective

To evaluate the utility of nerve conduction studies as a marker of length-dependent neuropathy.

Methods

We conducted a retrospective study of 44 chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients and 365 genetically confirmed Charcot-Marie-Tooth disease (CMT) patients, including those with PMP22 duplications or mutations in GJB1, MFN2, MPZ, and MME. Nerve conduction study parameters were compared, with subgroup analyses of CIDP-mimicking CMT (genetically confirmed CMT with a prior clinical diagnosis of CIDP) and gene-based classifications. Receiver operating characteristic (ROC) analysis assessed the sensitivity and specificity of these parameters.

Results

The tibial to ulnar nerve distal compound muscle action potential (T/U CMAP) amplitude ratio was significantly higher in CIDP patients compared to those with genetically confirmed CMT, CIDP-mimicking CMT, and gene-based subgroups. This ratio yielded the highest area under the curve (AUC: 0.95) among all evaluated parameters, with a cutoff value of 0.385 demonstrating high diagnostic sensitivity (95.5%) and specificity (85.5%). In CIDP-mimicking CMT group, a similar sensitivity and specificity were observed.

Conclusions

The T/U CMAP amplitude ratio is a simple, robust electrophysiological index of length-dependent neuropathy.

Significance

This marker offers a reliable and accessible way to distinguish between acquired and inherited neuropathies, improving diagnostic accuracy and helping prioritize genetic testing.

目的评价神经传导检查作为长度依赖性神经病变标志物的应用价值。方法对44例慢性炎症性脱髓鞘性多根神经病变（CIDP）患者和365例遗传确诊的沙克-玛丽-图斯病（CMT）患者进行回顾性研究，包括GJB1、MFN2、MPZ和mme中PMP22重复或突变的患者。神经传导研究参数进行比较，并对模拟CIDP的CMT（既往临床诊断为CIDP的遗传确诊CMT）进行亚组分析和基于基因的分类。受试者工作特征（ROC）分析评估这些参数的敏感性和特异性。结果cdp患者胫尺神经远端复合肌动作电位（T/U CMAP）振幅比明显高于遗传确诊CMT、cdp模拟CMT和基因亚组。该比值在所有评估参数中产生最高的曲线下面积（AUC: 0.95），截止值为0.385，具有较高的诊断敏感性（95.5%）和特异性（85.5%）。在模拟CMT组中，观察到相似的敏感性和特异性。结论T/U CMAP振幅比是一种简单、可靠的长度依赖性神经病变电生理指标。该标记提供了一种可靠且易于获取的方法来区分获得性和遗传性神经病变，提高诊断准确性并帮助优先进行基因检测。

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引用次数: 0

Challenging the electrophysiological interpretation of mirror visual feedback in stroke 挑战脑卒中中镜像视觉反馈的电生理解释

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.08.008

Brijesh Sathian , Javed Iqbal , Hanadi Al Hamad

引用次数: 0

Optimising electrical vestibular stimulation (EVS) for assessing vestibular function 优化前庭电刺激（EVS）评估前庭功能

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.08.006

Raphael Hamel , Peter Gaskell , Sophie Prosser , Darren Whelan , Richard Irving , Raymond Francis Reynolds

Objective

Electrical vestibular stimulation (EVS) exhibits similar diagnostic performance to caloric irrigation for assessing interaural vestibular asymmetry. To optimise EVS for clinical uses, we investigated the influence of EVS stimulus parameters upon absolute torsional eye response amplitude and asymmetry assessments.

Methods

In young healthy adults (n = 72), monoaural sinusoidal EVS was delivered to each mastoid process for 40 s whilst ocular torsion was assessed. Ambient lights, electrode montage, and stimulus frequency were systematically manipulated.

Results

Ambient lights (250 lx) attenuated torsional responses by 20 % compared to darkness. When the reference electrode was next to C7 (i.e., mastoid-C7 montage), responses to monoaural stimuli were 50 % those of binaural stimulation. Sinusoidal stimuli at 0.5 Hz evoked torsional responses 250 % larger than at 2 Hz but required 300 % more time to estimate asymmetry (12sec vs 4sec). Perceived discomfort was lower at 0.5 Hz than at 2 Hz. Pooled results (n = 53) suggest a normative asymmetry range of 0 ± 25 % for assessing pathological asymmetry.

Conclusions

Darkness and lower stimulus frequencies optimise absolute torsional eye response amplitude. Higher stimulus frequencies accelerate asymmetry assessments. To activate a single vestibular end organ, a mastoid-C7 (or mastoid-acromioclavicular) montage should be used.

Significance

These results extend the clinical potential of EVS for assessing vestibular function.

目的前庭电刺激（EVS）在评估耳间前庭不对称方面表现出与热灌相似的诊断性能。为了优化EVS的临床应用，我们研究了EVS刺激参数对绝对扭眼反应振幅和不对称性评估的影响。方法对72例年轻健康成人进行单耳正弦EVS注射，观察眼扭转情况，观察其对乳突的影响。环境光、电极蒙太奇和刺激频率被系统地操纵。结果与黑暗相比，环境光（250 lx）可使扭转响应减弱20%。当参考电极靠近C7（即乳突-C7蒙太奇）时，对单耳刺激的反应是双耳刺激的50%。0.5 Hz的正弦刺激引起的扭转反应比2 Hz大250%，但需要多300%的时间来估计不对称性（12秒比4秒）。0.5 Hz时的感觉不适感低于2 Hz。合并结果（n = 53）表明，评估病理不对称性的标准不对称性范围为0±25%。结论黑暗和较低的刺激频率可优化绝对扭眼反应幅度。较高的刺激频率加速了非对称性评估。要激活单个前庭末端器官，应使用乳突- c7（或乳突-肩锁）蒙太奇。意义这些结果拓展了EVS在评估前庭功能方面的临床应用潜力。

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引用次数: 0

Evaluating pediatric peripheral neuromuscular disorders using deep neural networks on electrodiagnostic data 基于电诊断数据的深度神经网络评估小儿周围神经肌肉疾病

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.08.001

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

Objective:

This study aims to assess application of deep neural networks to predict neuromuscular disorders in patients based on electrodiagnostic data and compare with clinical assessment.

Methods:

Patients evaluated with electrodiagnostic tests in intensive care over a 10-year period were included in this study. The data set contained both electrodiagnostic and clinical information. Based on the final diagnosis, patients were classified into six groups: non-primary neuromuscular disorders, neuropathy, motor-neuronopathy, myopathy, neuromuscular-junction disorders, and critical-illness neuromyopathy. The neural network was trained on the data.

Results:

The data set was small, allowing training of the neural network on a standard laptop. The validation results were promising, with an accuracy of 0.92, an ROC-AUC of 0.99, and a precision recall AUC of 0.97. The confusion and positive predictive value matrix demonstrated high performance, with diagonal values exceeding 0.82.

Conclusion:

This study demonstrates the efficacy of neural networks in predicting neuromuscular disorders using electrodiagnostic tests. The performance of the model was comparable to clinical assessment. These findings suggest that with more extensive datasets, neural networks can provide reliable estimates of neuromuscular diagnoses.

Significance:

Incorporating neural networks into diagnostic workflows could enhance decision-making, especially in scenarios requiring reassessment or complementary investigations.

目的：探讨基于电诊断数据的深度神经网络在患者神经肌肉疾病预测中的应用，并与临床评估进行比较。方法：在10年的重症监护期间接受电诊断试验评估的患者纳入本研究。数据集包含电诊断和临床信息。根据最终诊断，将患者分为6组：非原发性神经肌肉疾病、神经病变、运动神经病变、肌病、神经肌肉连接疾病和危重症神经肌病。神经网络在数据上进行训练。结果：数据集很小，允许在标准笔记本电脑上训练神经网络。验证结果令人满意，准确度为0.92，ROC-AUC为0.99，精密度召回AUC为0.97。混淆和阳性预测值矩阵表现出良好的性能，对角线值超过0.82。结论：本研究证明了神经网络在电诊断测试中预测神经肌肉疾病的有效性。该模型的性能与临床评估相当。这些发现表明，有了更广泛的数据集，神经网络可以提供神经肌肉诊断的可靠估计。意义：将神经网络纳入诊断工作流程可以提高决策能力，特别是在需要重新评估或补充调查的情况下。

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引用次数: 0

Efficacy of cerebellar cathodal transcranial direct current stimulation for post-stroke aphasia: A randomized controlled trial 小脑阴极经颅直流电刺激治疗脑卒中后失语症的疗效：一项随机对照试验

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.10.001

Xiaoyi Xu , Shuping Chen , Zifan Li , Lijie Zhang , Tianjin Pan , Siying Long , Tingting Yang , Meng Li , Qianru Li , Na Chen , Shangjie Chen , Qing Zeng

Objective

Growing evidence highlights the cerebellum, particularly the right posterior lobule, in advanced language processes such as fluency, syntax, and phonological memory. However, its specific role in post-stroke aphasia recovery—especially its modulation of cortical networks and functional connectivity (FC)—remains unclear, which limits targeted intreventions.

Methods

Sixteen post-stroke aphasia patients were randomized to receive either cerebellar transcranial direct current stimulation (tDCS) with speech therapy or sham stimulation with therapy. Language performance was assessed via the Chinese Standard Aphasia Scale (CRRCAE), and brain activation was monitored using functional near-infrared spectroscopy (fNIRS).

Results

Both groups showed significant CRRCAE score improvements post-treatment (P < 0.05), without between-group differences (P > 0.05). FC reductions were noted across several interhemispheric and right-hemispheric pathways, while increased FC was observed in left hemisphere language-related areas.

Conclusion

After baseline adjustment, the intervention group showed superior gains. Cerebellar tDCS modulates FC, suggesting a potential mechanism for enhancing aphasia recovery.

Significance

Findings support the cerebellum as a promising neuromodulation target for post-stroke aphasia treatment.

目的：越来越多的证据表明，小脑，特别是右脑后小叶，在流利性、句法和语音记忆等高级语言过程中起着重要作用。然而，其在脑卒中后失语恢复中的具体作用——尤其是其对皮质网络和功能连接（FC）的调节——仍不清楚，这限制了有针对性的干预。方法将16例脑卒中后失语患者随机分为两组，一组接受经颅直流电刺激(tDCS) +言语治疗，另一组接受假刺激+言语治疗。采用中国标准失语量表（CRRCAE）评估语言表现，用功能近红外光谱（fNIRS）监测脑活动。结果两组患者治疗后CRRCAE评分均有显著改善（P < 0.05），组间差异无统计学意义（P < 0.05）。在几个半球间和右半球通路中发现FC减少，而在左半球语言相关区域观察到FC增加。结论经基线调整后，干预组疗效显著。小脑tDCS调节FC，提示其促进失语恢复的潜在机制。研究结果支持小脑作为脑卒中后失语治疗的一个有希望的神经调节靶点。

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引用次数: 0

The effects of multi-session dual-tDCS on the bilateral transfer of motor skill learning in patients with stroke 多期双tdcs对脑卒中患者双侧运动技能学习转移的影响

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.06.005

Mohammad Mahdi Talimkhani , Ailin Talimkhani , Vida Dinarvand , Somayeh Mohamadi , Hamzeh Baharlouei

Objective

This study investigates the potential effects of combining motor skill learning transfer from the unaffected to the affected hand with multiple sessions of dual-transcranial direct current stimulation (tDCS) over the primary motor cortex to enhance motor skills in stroke patients.

Methods

Eleven stroke patients participated in a randomized, sham-controlled, double-blind crossover study. Over two periods separated by a 3-week washout, participants underwent either sham or dual-tDCS concurrently with serial response time tasks (SRTT). Each intervention included 20 min of stimulation during SRTT for three consecutive days. The skill index, the primary variable, was assessed pre-intervention, immediately post-intervention, and 24 h later.

Results

Both groups showed significant improvement in motor skill learning across the three intervention days (P < 0.001). The dual-tDCS group demonstrated significantly greater skill improvement in the affected hand compared to the sham group (P < 0.01), while no significant differences were found for the unaffected hand (P = 0.98).

Conclusions

Multi-session dual-tDCS combined with motor learning tasks significantly enhances motor skill transfer to the affected hand in stroke patients, with greater and more durable effects compared to sham stimulation.

Significance

This approach may improve bilateral motor skill transfer and hand fatigue management in stroke rehabilitation.

目的探讨脑卒中患者运动技能学习转移与多期双经颅直流电刺激（tDCS）对初级运动皮质的潜在影响。方法采用随机、假对照、双盲交叉研究。在为期3周的洗脱期中，参与者接受假tdcs或双tdcs同时进行系列反应时间任务（SRTT）。每次干预包括连续三天SRTT期间20分钟的刺激。主要变量技能指数分别在干预前、干预后和24小时后进行评估。结果两组在干预3天内运动技能学习均有显著改善(P <；0.001)。与假手术组相比，双tdcs组在患手的技能提高明显更大(P <；0.01)，而未受影响的手无显著差异（P = 0.98）。结论多阶段双tdcs联合运动学习任务可显著提高脑卒中患者患手的运动技能转移，且效果比假刺激更显著、更持久。意义该方法可改善脑卒中康复患者的双侧运动技能转移和手部疲劳管理。

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引用次数: 0

Triphasic waves: To treat or not to treat? 三相波：治疗还是不治疗？

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.06.001

Brin E. Freund , Khalil S. Husari , José L. Fernández-Torre , Philippe Gélisse , Peter W. Kaplan

Generalized periodic discharges (GPDs) with triphasic morphology (triphasic waves, TWs) are EEG waveforms that have been a frequent topic of research evaluating their etiology and clinical correlates. More specifically, prior studies have tried to better elucidate their implications regarding seizures to help guide decision making regarding empiric treatment and EEG monitoring and in spite of multiple studies, controversies remain due to disparate findings. In this review we discuss the historical views of TWs and their clinical and radiographic correlates, highlight the typical and atypical features of TWs, discuss the controversy related to the association between TWs and seizures, and propose an approach to their management.

具有三相形态的广义周期性放电（gpd）（三相波，TWs）是脑电图波形，已成为评估其病因和临床相关性的研究热点。更具体地说，先前的研究试图更好地阐明它们对癫痫发作的影响，以帮助指导有关经验性治疗和脑电图监测的决策，尽管有多项研究，但由于不同的发现仍然存在争议。在这篇综述中，我们讨论了TWs的历史观点及其临床和影像学相关性，强调了TWs的典型和非典型特征，讨论了TWs与癫痫发作之间关系的争议，并提出了治疗方法。

引用次数: 0

When genetics prevail: brain stimulation fails to overcome learning deficits from brain-derived neurotrophic factor Val66Met 当遗传学占上风时：脑刺激无法克服脑源性神经营养因子Val66Met的学习缺陷

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.08.009

Perianen Ramasawmy , Krisztián Iszak , Steffen Brüshaber , Viktória Kállay , Géza Gergely Ambrus , Walter Paulus , Andrea Antal

Background

The dorsolateral prefrontal cortex (DLPFC) is a key contributor to memory categorization. Brain-Derived Neurotrophic Factor (BDNF) Val66Met polymorphism affects the efficacy of neuronal plasticity induction. We investigated whether DLPFC-transcranial direct current stimulation (tDCS) influences categorization performance, and whether BNDF genotype modulates this effect.

Methods

Sixty-two healthy individuals were randomized to receive 10 min of either anodal right DLPFC-tDCS at 1 mA, or sham tDCS during the training phase of a prototype distortion task. Categorization performance was assessed during, shortly after, and the morning following the stimulation. Val66Met polymorphism status was determined through BNDF genotyping.

Results

Val66Met carriers showed poorer categorization ability than Val/Val homozygotes (p < 0.0001). tDCS did not enhance categorization performance overall, or reduce genotype-associated differences with these specific stimulation parameters. However, tDCS extinguished the prototype effect of the categorization task observed in our sample.

Conclusions

Our findings underscore the importance of BDNF polymorphism in category learning. 1 mA anodal right DLPFC over the right DLPFC does not improve performance or offset genotype differences under tested conditions.

Significance

BDNF Val66Met polymorphism influences category learning, and low-intensity tDCS does not counteract this effect, emphasizing the need to refine stimulation protocols for genotype-specific cognitive enhancement.

背外侧前额叶皮层（DLPFC）是记忆分类的关键贡献者。脑源性神经营养因子（BDNF） Val66Met多态性影响神经元可塑性诱导的效果。我们研究了dlpfc -经颅直流电刺激（tDCS）是否影响分类性能，以及BNDF基因型是否调节这种影响。方法在原型扭曲任务的训练阶段，将62名健康个体随机分为两组，分别接受10 min的1 mA正极右DLPFC-tDCS和假tDCS。在刺激期间、刺激后不久和刺激后的早晨分别评估了分类性能。通过BNDF基因分型确定Val66Met多态性状态。结果val66met携带者的分类能力较Val/Val纯合子差（p < 0.0001）。tDCS总体上没有提高分类性能，也没有减少与这些特定刺激参数相关的基因型差异。然而，tDCS消除了我们样本中观察到的分类任务的原型效应。结论BDNF多态性在类别学习中的重要作用。在测试条件下，1 mA阳极右DLPFC优于右DLPFC并不能改善性能或抵消基因型差异。bdnf Val66Met多态性影响类别学习，而低强度tDCS并不能抵消这种影响，这强调了完善基因型特异性认知增强刺激方案的必要性。

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引用次数: 0

Comparison of lateralization and spatial patterns of hemodynamic and neuromagnetic language brain mapping 血流动力学和神经磁语言脑图的偏侧和空间模式的比较

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.10.007

Tim Coolen , Alexandru Mihai Dumitrescu , Vincent Wens , Mathieu Bourguignon , Antonin Rovai , Niloufar Sadeghi , Charline Urbain , Xavier De Tiège

Objective

To compare and integrate hemispheric lateralization and spatial patterns of language mapping derived from functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG).

Method

Twenty right-handed healthy adults performed three language tasks (verb/noun generation, phonological/semantic fluency, and sentence completion). A unified framework ensured methodological consistency across modalities: (i) identical tasks; (ii) individual mapping of block-level signal changes in fMRI and broadband (4–40 Hz) oscillatory power decreases in MEG; (iii) subject-level spatial extent-based thresholding of intramodality maps and quantification of intermodality overlap. Laterality indices (LI) were compared and combined across tasks and modalities to assess lateralization discordances. Spatial patterns were obtained by averaging individual maps, while permutation statistics evaluated intermodality spatial differences.

Results

Task- and modality-combined LI reduced intermodality lateralization discordance from 45% to 10%. MEG showed twice the LI variability of fMRI. Overlap was concentrated in left fronto-temporal regions, while spatial differences emerged in left fronto-parietal areas (fMRI) and temporal/opercular regions (MEG).

Conclusion

Although core language areas were identified in both modalities, modality- and task-integration may enhance robustness of language mapping in healthy subjects.

Significance

Lateralization discordances and modality-specific spatial patterns, along with MEG’s higher lateralization variability, suggest that multimodal integration could aid in presurgical clinical decision-making.

目的比较和整合功能性磁共振成像（fMRI）和脑磁图（MEG）获得的半球侧化和语言映射的空间模式。方法20名健康的右撇子成人进行了三个语言任务（动词/名词生成、语音/语义流畅性和句子完成）。统一的框架确保了各模式方法的一致性：(i)相同的任务；（ii） fMRI中块级信号变化和MEG中宽带（4-40 Hz）振荡功率下降的个体映射；（iii）基于主体层面空间范围的模态内地图阈值划分和模态间重叠的量化。横向指数（LI）进行比较，并结合跨任务和模式来评估横向不一致。空间格局是通过平均个体地图获得的，而排列统计则评估了多式联运的空间差异。结果任务和模式联合LI将模式间偏侧不一致性从45%降低到10%。MEG显示的LI变异性是fMRI的两倍。重叠集中在左侧额颞区，而左侧额顶区（fMRI）和颞/眼区（MEG）出现空间差异。结论虽然在两种模式下都确定了核心语言区域，但情态和任务整合可以增强健康受试者语言映射的稳健性。侧化不一致和模式特异性空间模式，以及MEG较高的侧化变异性，表明多模式整合可以帮助术前临床决策。

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引用次数: 0

Switch-Off response to mid-cingulate cortex stimulation: a video case report 中扣带皮层刺激的关闭反应：一个视频病例报告

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.10.008

Paola Vassallo , Olivia Poole , Xiaodong Guan , Davide Giampiccolo , Eduardo Marques , Umesh Vivekananda , John S. Duncan , Beate Diehl

Background

Electrical cortical stimulation (ECS) is commonly used during invasive presurgical evaluation of drug-resistant focal epilepsy for functional mapping and delineation of the epileptogenic zone.

Case presentation

A 31-year-old woman underwent stereo-EEG evaluation for presurgical assessment of drug-resistant focal epilepsy, likely left frontal or multifocal. During 50 Hz ECS of the right mid-cingulate cortex, a reproducible behavioural response was observed, characterised by left ear popping, head drop, eye closure, and speech/motor arrest, without loss of awareness. This semiology differed from her habitual seizures, and the region was not considered part of the presumed epileptogenic zone.

Conclusion

This case represents a rare video-documentation of stimulation-induced complex motor and behavioural response localised to the mid-cingulate cortex and supports mid-cingulate’s role as connection hub for volitional control and sensorimotor integration.

背景：皮层电刺激（ECS）常用于有创性术前评估耐药局灶性癫痫的功能定位和癫痫区描绘。一名31岁女性接受了立体脑电图评估，用于术前评估耐药局灶性癫痫，可能是左额叶或多灶性癫痫。在右侧扣带皮层中部50 Hz的ECS中，观察到可重复的行为反应，其特征是左耳突起，头下垂，闭上眼睛，语言/运动停止，没有意识丧失。这种符号学不同于她的习惯性癫痫发作，该区域不被认为是假定的癫痫发病区。结论本病例是一个罕见的视频记录，表明刺激诱导的复杂运动和行为反应定位于中扣带皮层，并支持中扣带作为意志控制和感觉运动整合的连接枢纽的作用。

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引用次数: 0