Clinical Neurophysiology Practice最新文献

英文中文

Longitudinal, EEG-based assessment of sleep in people with epilepsy: An automated sleep staging algorithm non-inferior to human raters 癫痫患者睡眠的纵向、基于脑电图的评估：一种不逊于人类评分者的自动睡眠分期算法

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.01.001

Asbjoern W. Helge , Federico G. Arguissain , Lukas Lechner , Gerhard Gritsch , Jonas Duun-Henriksen , Esben Ahrens , Tilmann Kluge , Manfred Hartmann

Objective

There is an unmet need in epilepsy management for tools that measure sleep objectively over long timespans. Subcutaneous EEG is well-suited for the task, but it requires a reliable automatic algorithm. Here, we present and evaluate such an algorithm, and we show clinical examples of how it produces important information.

Methods

A mix of scalp EEG and subcutaneous EEG was used to develop an algorithm to output sleep stages and common sleep parameters. The algorithm was tested on unseen data from 11 healthy subject and 12 people with epilepsy (PwE). Lastly, data (>3months) from three exemplary PwE were analyzed for sleep.

Results

The algorithm proved non-inferior at sleep stage segmentation on data from PwE compared to human raters using scalp EEG. It reached a Cohen’s kappa score of 0.8 [CI 0.78 – 0.83] on healthy subjects and on data from PwE it got to 0.705 [CI 0.663–––0.744] against rater D and 0.686 [CI 0.632–––0.739] against rater E. The three examples showed that useful information can be gained from longitudinal sleep analysis.

Conclusion

Subcutaneous EEG and a sleep algorithm can be employed to effectively review sleep in PwE at a level that is non-inferior compared to human raters.

Significance

This has the potential to make objective sleep parameters available in the clinic as a valuable addition to subjective sleep assessments.

目的在癫痫管理中，对长时间客观测量睡眠的工具的需求尚未得到满足。皮下脑电图很适合这项任务，但需要可靠的自动算法。在这里，我们提出并评估了这样的算法，并展示了它如何产生重要信息的临床例子。方法采用头皮脑电图和皮下脑电图的混合方法，开发一种输出睡眠阶段和常见睡眠参数的算法。该算法在11名健康受试者和12名癫痫患者（PwE）的未见数据上进行了测试。最后，对三个典型PwE的数据（3个月）进行睡眠分析。结果该算法对PwE数据的睡眠阶段分割效果优于头皮脑电图的人类评分者。健康受试者的Cohen 's kappa评分为0.8 [CI 0.78 - 0.83]， PwE的数据与评分者D的对比为0.705 [CI 0.663 - 0.744]，与评分者e的对比为0.686 [CI 0.632 - 0.739]。这三个例子表明，纵向睡眠分析可以获得有用的信息。结论皮下脑电图和睡眠算法可以有效地评价PwE的睡眠水平，且睡眠水平不低于人类评分者。这有可能使客观睡眠参数在临床中可用，作为主观睡眠评估的有价值的补充。

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引用次数: 0

EEG focal delta slowing in focal epilepsy – A didactic review 局灶性癫痫的脑电图局灶δ变慢-一个教学回顾

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.09.001

Laurent Sheybani , Pia De Stefano , Margitta Seeck , Serge Vulliémoz , Pierre Mégevand

Focal slowing in scalp electroencephalography (EEG) is classically seen as an unspecific entity in terms of its association with both epilepsy and distinct aetiologies. This could be due to a lack of standardization in the assessment of slowing morphology, in distinction to precise guidelines utilized in the evaluation of pathological activities, such as interictal epileptiform discharges (IEDs). However, consistent features can be identified, which can be informative about the underlying brain pathology and risk of seizures. In this review, we discuss the different kinds of focal slowing, focusing mainly on the delta range (0.5–4 Hz), their respective pathological processes and their prognostic value in terms of likelihood to be associated with acute seizures or epilepsy. We then present new findings on source localization of focal slowing. Last, we review recent evidence of interaction between focal slow activities and epileptic activities. Our didactic approach will guide readers through important aspects of an EEG entity that might have been neglected despite past and recent observations of its relevance in epilepsy.

头皮脑电图（EEG）的局灶性减慢通常被视为与癫痫和不同病因相关的非特异性实体。这可能是由于在评估缓慢形态方面缺乏标准化，而不是用于评估病理活动的精确指南，例如癫痫样间歇放电（ied）。然而，可以确定一致的特征，这可以提供有关潜在脑病理和癫痫发作风险的信息。在这篇综述中，我们讨论了不同类型的局灶性减慢，主要集中在delta范围（0.5 - 4hz），它们各自的病理过程以及它们与急性发作或癫痫相关的可能性的预后价值。然后，我们提出了有关震源慢化定位的新发现。最后，我们回顾了局灶慢活动和癫痫活动之间相互作用的最新证据。我们的教学方法将引导读者了解脑电图实体的重要方面，尽管过去和最近的观察结果与癫痫有关，但这些方面可能被忽视了。

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引用次数: 0

Within five weeks: Rapidly grown glioblastoma discovered on repeat MRI after pathologic EEG 5周内：病理脑电图后复查MRI发现快速生长的胶质母细胞瘤

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.02.002

Zsuzsanna Szankai , Egle Huggenberger , Christoph Metzler , Christian Musahl , Markus Gschwind

Background

According to the recommendations of the International League against Epilepsy, a timely workup with a brain MRI is recommended after a first epileptic seizure. However, if the MRI is unrevealing, it is normally not repeated.

Case Presentation

We present a patient with an unprovoked epileptic seizure and only slight focal abnormalities in the EEG and a normal brain MRI. Only 35 days later, after a third seizure and now a focally pathological EEG, we repeated the brain MRI and discovered a large mass in the left temporal lobe, which was resected and histologically classified as glioblastoma multiforme.

Conclusion

This case of a very fast-growing tumor suggests that recurrent seizures, with or without anti-seizure medications, or new changes in the EEG should prompt the clinician to consider a repeat brain MRI, even if the first scan was normal.

根据国际抗癫痫联盟的建议，首次癫痫发作后应及时进行脑部核磁共振检查。然而，如果MRI没有显示，通常不会重复。病例介绍：我们报告了一个无因性癫痫发作的病人，脑电图和脑MRI显示只有轻微的局灶性异常。仅仅35天后，在第三次发作和局部病理脑电图后，我们重复了脑部MRI，发现左侧颞叶有一个大肿块，我们切除了这个肿块，组织学上分类为多形性胶质母细胞瘤。结论：该病例肿瘤生长迅速，提示复发性癫痫发作，无论是否使用抗癫痫药物，或脑电图的新变化应促使临床医生考虑再次进行脑部MRI检查，即使第一次扫描正常。

引用次数: 0

The role of EEG in the emergency department: Its contribution to the patient’s diagnostic–therapeutic pathway. The EMINENCE study 脑电图在急诊科的作用：它对病人的诊断-治疗途径的贡献。隆起研究

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.02.010

Scarpino Maenia , Verna Maria Teresa , Grippo Antonello , Lolli Francesco , Piccardi Benedetta , Nazerian Peiman , Nencini Patrizia , Boccardi Cristina , Nencioni Andrea

Objectives

To investigate the utility of the emergency electroencephalogram(emEEG) in the diagnostic work-up of patients admitted to the Emergency Department(ED).

Methods

Data from consecutive patients admitted to the ED during a 1-year period. We evaluated the usefulness of emEEGs based on the subsequent patient clinical management.

Results

1125 emEEGs from 1018 patients were analyzed. The overall usefulness of an emEEG was 86.7%, mainly influenced by its contribution to diagnosis(75.0%), often excluding initial working diagnosis(50.0%), and to patient management(78.0%). EmEEGs showed their best overall usefulness in Status Epilepticus(SE) and altered level of consciousness both in contributing to the final diagnosis and in patient management and therapeutic pathway. In speech and cognitive/behavioural disorders, emEEGs contributed to the diagnosis(80.6% and 79.8%, respectively), often excluding the initial suspicion of seizures/SE. Normal emEEGs contributed to diagnosis(79.0%), patient management(87.0%) and discharge to home(82.0%).

Conclusions

In ED, attending physicians have to make quick decisions about the diagnostic–therapeutic management of patients, and also the ruling out of the initial diagnosis and safely discharging the patient to home are also important goals.

Significance

This study provides valuable guidance to ED clinicians in selecting patients for an emEEG and evaluates its contribution to their diagnostic–therapeutic management.

目的探讨急诊脑电图（emEEG）在急诊科（ED）患者诊断中的应用价值。方法收集1年内连续入住急诊科的患者资料。我们根据随后的患者临床管理来评估emegs的有效性。结果共分析1018例患者的1125例emegs。emEEG的总体有用性为86.7%，主要受其对诊断的贡献（75.0%）和对患者管理的贡献（78.0%）的影响，通常不包括初始工作诊断（50.0%）。emegs在癫痫持续状态（SE）和意识水平改变的最终诊断、患者管理和治疗途径方面显示出最佳的总体用途。在言语和认知/行为障碍中，emegs有助于诊断（分别为80.6%和79.8%），通常排除了最初对癫痫发作/SE的怀疑。emegs正常有助于诊断（79.0%）、患者管理（87.0%）和出院（82.0%）。结论在急诊科，主治医师必须对患者的诊治管理做出快速决策，排除初步诊断，使患者安全出院也是急诊科的重要目标。意义：本研究为急诊科临床医生选择患者进行emEEG检查提供了有价值的指导，并评估了其对诊断和治疗管理的贡献。

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引用次数: 0

Corrigendum to “Neurophysiological monitoring during anterior cervical discectomy and fusion for ossification of the posterior longitudinal ligament” [Clin. Neurophysiol. Pract. 6 (2021) 56–62] “颈椎前路椎间盘切除术和融合治疗后纵韧带骨化的神经生理监测”的勘误[临床。Neurophysiol。惯例6 (2021)56-62]

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.02.001

Jee-Eun Kim , Jun-Soon Kim , Sejin Yang , Jongsuk Choi , Seung-Jae Hyun , Ki-Jeong Kim , Kyung Seok Park

引用次数: 0

Cortical evoked responses to evaluate the effect of spinal cord stimulation on the pain pathways 皮质诱发反应评价脊髓刺激对疼痛通路的影响

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.04.003

Laurien J. Reinders, Cecile C. de Vos

Objectives

The mechanisms of spinal cord stimulation (SCS) are insufficiently understood. Conditioned pain modulation (CPM) measures how a painful stimulus is affected by a second painful stimulus. We investigated whether cortical evoked response can be used to evaluate CPM in a patient treated with burst, tonic and sham SCS.

Methods

A 40-year-old patient underwent 3 magnetoencephalography sessions (burst, tonic, sham SCS) with 1-week intervals. Painful electrical stimuli were applied to the tibial nerve before, during and after CPM (conditioning: icepack on forearm). Evoked responses were analysed in the primary somatosensory and anterior cingulate cortices.

Results

Before CPM, the highest evoked response amplitude occurred under sham SCS, followed by tonic SCS. During CPM pain ratings remained unchanged. However, CPM reduced evoked response amplitudes in the primary somatosensory cortex under tonic and sham SCS and in the anterior cingulate cortex under all SCS paradigms.

Conclusions

CPM reduced evoked response amplitudes, while pain ratings were unaffected, suggesting neurophysiological measures provide additional insights into CPM effects. Tonic and burst SCS both appeared to reduce cortical capacity to attend to stimuli, with burst showing the greatest effect.

Significance

Cortical responses offer a valuable tool to assess pain pathways. Larger scale studies are needed to enhance our understanding of SCS mechanisms.

目的脊髓刺激（SCS）的机制尚不清楚。条件疼痛调节（CPM）测量一个疼痛刺激如何受到第二个疼痛刺激的影响。我们研究了皮质诱发反应是否可以用来评估经破裂、强直和假性SCS治疗的患者的CPM。方法40岁患者每隔1周进行3次脑磁图检查（burst、tonic、sham SCS）。在CPM之前、期间和之后分别对胫骨神经施加疼痛性电刺激（调节：前臂冰袋）。分析了初级体感皮层和前扣带皮层的诱发反应。结果CPM前，假性SCS诱发反应幅度最大，紧张性SCS次之。在CPM期间，疼痛评分保持不变。然而，CPM降低了强直性和假性SCS下初级体感觉皮层以及所有SCS模式下前扣带皮层的诱发反应振幅。结论scpm降低了诱发反应幅度，而疼痛评分未受影响，提示神经生理学测量为CPM的作用提供了额外的见解。强直性和突发性SCS均表现出降低皮层对刺激的响应能力，其中突发性表现出最大的影响。皮层反应为评估疼痛通路提供了一个有价值的工具。需要更大规模的研究来加强我们对SCS机制的理解。

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引用次数: 0

The eastern Association of EEG: A Legacy with Contemporary lessons 东部脑电图协会：具有当代教训的遗产

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.08.003

Stefano Meletti , Margitta Seeck

引用次数: 0

Correlation analysis between excitability in the somatosensory cortex and structural changes in amyotrophic lateral sclerosis 肌萎缩性侧索硬化症体感觉皮层兴奋性与结构变化的相关性分析

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Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.06.003

Aysegul Gunduz , Tuba Akıncı , Osman Aykan Kargın , Melih Tutuncu , Serdar Arslan , Nurten Uzun

Objective

We aimed to investigate the excitability of the somatosensory cortex and its relationship to structural changes in motor and sensory pathways, and motor excitability in amyotrophic lateral sclerosis (ALS).

Patients and method

We included all consecutive individuals with ALS, fulfilling the “definite” or “probable” ALS criteria. We recorded surround inhibition (SI) and recovery function (RC) of somatosensory evoked potentials (SEPs), resting motor threshold, and cortical silent period (cSP), and performed volumetric analysis and diffusion tensor imaging (DTI).

Results

We included 15 patients with ALS and 12 healthy individuals of similar age and sex. At the group level, the mean SEP-RC% at ISI 5 ms was higher in the ALS group than in healthy participants (all SEP-RC% at 5 ms p < 0.001). SEP-SI was lost in one-third of individuals with ALS. A negative correlation was found between the duration of the cSP and SEP-RC%, whereas no correlations were observed between SEP parameters and radiological volumetric analysis of the corticospinal tract, medial lemniscus, or cortical thickness of the precentral and postcentral gyri.

Conclusion

Somatosensory hyperexcitability is present in ALS, and SI is lost in a subset of patients with ALS.

Significance

Somatosensory hyperexcitability correlates well with cSP but not with structural changes.

目的探讨肌萎缩性侧索硬化症（ALS）患者体感觉皮层的兴奋性及其与运动和感觉通路结构变化的关系。患者和方法我们纳入了所有符合“明确”或“可能”ALS标准的连续ALS患者。我们记录了体感诱发电位（sep）、静息运动阈值和皮质沉默期（cSP）的环绕抑制（SI）和恢复功能（RC），并进行了体积分析和扩散张量成像（DTI）。结果纳入15例ALS患者和12例年龄、性别相近的健康人。在组水平上，ALS组在ISI 5ms时SEP-RC%的平均值高于健康参与者(所有SEP-RC%在5ms时p <；0.001)。三分之一的ALS患者失去了SEP-SI。cSP持续时间与SEP- rc %呈负相关，而SEP参数与皮质脊髓束、内侧小网膜或中央前和后回皮质厚度的放射学体积分析无相关性。结论肌萎缩侧索硬化症患者存在躯体感觉亢奋性，而部分肌萎缩侧索硬化症患者的躯体感觉亢奋性缺失。意义：体感高兴奋性与cSP相关，但与cSP的结构变化无关。

{"title":"Correlation analysis between excitability in the somatosensory cortex and structural changes in amyotrophic lateral sclerosis","authors":"Aysegul Gunduz , Tuba Akıncı , Osman Aykan Kargın , Melih Tutuncu , Serdar Arslan , Nurten Uzun","doi":"10.1016/j.cnp.2025.06.003","DOIUrl":"10.1016/j.cnp.2025.06.003","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to investigate the excitability of the somatosensory cortex and its relationship to structural changes in motor and sensory pathways, and motor excitability in amyotrophic lateral sclerosis (ALS).</div></div><div><h3>Patients and method</h3><div>We included all consecutive individuals with ALS, fulfilling the “definite” or “probable” ALS criteria. We recorded surround inhibition (SI) and recovery function (RC) of somatosensory evoked potentials (SEPs), resting motor threshold, and cortical silent period (cSP), and performed volumetric analysis and diffusion tensor imaging (DTI).</div></div><div><h3>Results</h3><div>We included 15 patients with ALS and 12 healthy individuals of similar age and sex. At the group level, the mean SEP-RC% at ISI 5 ms was higher in the ALS group than in healthy participants (all SEP-RC% at 5 ms p < 0.001). SEP-SI was lost in one-third of individuals with ALS. A negative correlation was found between the duration of the cSP and SEP-RC%, whereas no correlations were observed between SEP parameters and radiological volumetric analysis of the corticospinal tract, medial lemniscus, or cortical thickness of the precentral and postcentral gyri.</div></div><div><h3>Conclusion</h3><div>Somatosensory hyperexcitability is present in ALS, and SI is lost in a subset of patients with ALS.</div></div><div><h3>Significance</h3><div>Somatosensory hyperexcitability correlates well with cSP but not with structural changes.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 202-208"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366657","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}

引用次数: 0

Methotrexate-induced neurotoxicity: Diagnostic challenges and the role of neurophysiological testing 甲氨蝶呤诱导的神经毒性：诊断挑战和神经生理测试的作用

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.06.004

Pauline D’hoore , Joke Terryn

Methotrexate (MTX) is widely used in the treatment of acute lymphocytic leukemia (ALL) and other onco-hematological conditions. Although subacute MTX-related neurotoxicity is relatively rare, it can present with dramatic, fluctuating neurological deficits that mimic other serious conditions. Diagnosis may be complicated by the frequent presence of asymptomatic white matter abnormalities on MRI, commonly attributed to chronic MTX toxicity.

We report an 18-year-old ALL patient who developed severe, fluctuating neurological symptoms 11 days after the third intrathecal administration of MTX. MRI showed bilateral, symmetric diffusion-restrictive white matter lesions. Absent cortical motor evoked potentials (MEPs) with preserved responses to spinal stimulation indicated corticospinal tract involvement localized to the brain, supporting a diagnosis of MTX-induced neurotoxicity. Treatment with high-dose dextromethorphan led to rapid and complete recovery.

This case underscores the value of early neurophysiological testing – particularly MEPs – in identifying corticospinal tract involvement and differentiating symptomatic neurotoxicity from chronic, asymptomatic MRI findings. Prompt recognition can accelerate diagnosis, guide treatment, and prevent unnecessary interventions.

甲氨蝶呤（MTX）广泛用于治疗急性淋巴细胞白血病（ALL）和其他肿瘤血液系统疾病。虽然亚急性mtx相关的神经毒性相对罕见，但它可以表现出戏剧性的，波动的神经功能障碍，类似于其他严重疾病。由于MRI上经常出现无症状的白质异常，诊断可能会变得复杂，通常归因于慢性MTX毒性。我们报告了一位18岁的ALL患者，他在第三次鞘内给药MTX 11天后出现了严重的、波动的神经系统症状。MRI显示双侧对称弥漫性白质病变。脊髓刺激反应保留的皮质运动诱发电位（MEPs）缺失表明皮质脊髓束受累局限于大脑，支持mtx诱导的神经毒性诊断。大剂量右美沙芬治疗可迅速完全恢复。本病例强调了早期神经生理检查（尤其是MEPs）在识别皮质脊髓束受累和区分症状性神经毒性与慢性无症状MRI表现方面的价值。及时识别可以加快诊断、指导治疗并防止不必要的干预。

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引用次数: 0

Multiple factors contribute to pupillary light reflex: implications for screening of traumatic brain injury in military service members 多种因素影响瞳孔光反射：对军人创伤性脑损伤筛查的意义

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.07.002

Michael N. Dretsch , Katie M. Williams , Diana P. Evans , Katrina S. Monti , Brian J. Guise , Mark L. Ettenhofer , Jamie N. Hershaw

Objectives

This study aimed to assess the contribution of demographics, medical history, and psychological health to pupillary light reflex (PLR) indices in Service members with and without a history of mild traumatic brain injury (mTBI).

Methods

PLR data from NeurOptics NPi-300 were analyzed on 216 participants who were categorized as non-injured controls (NIC), mTBI with no loss of consciousness (mTBI^LOC-), or mTBI with LOC (mTBI^LOC+). Multiple independent regression models were conducted for each PLR index to assess the contribution of these factors to the variability of PLR indices by group.

Results

There were no significant group differences on the PLR indices. Age was a significant factor across groups, but more robust for those with mTBI. Sleep duration, injury characteristics, and psychological health effects on PLR indices were primarily observed in the mTBI^LOC+ group. Posttraumatic stress and sex were not significant predictors in any of the models.

Conclusions

When using PLR for screening of mTBI, an individual’s age, history of prior mTBI, total lifetime TBI-related alterations in consciousness, sleep, and anxiety and depression symptoms should be considered when interpreting PLR metrics.

Significance

Controlling for these factors is essential for validating the use of PLR for screening of mTBI.

目的探讨人口统计学、病史和心理健康状况对有和无轻度创伤性脑损伤（mTBI）史军人瞳孔光反射（PLR）指数的影响。方法分析来自NeurOptics NPi-300的216名参与者的splr数据，这些参与者分为非损伤对照组（NIC）、无意识丧失mTBI （mTBILOC-）和LOC mTBI （mTBILOC+）。对各PLR指数建立多个独立回归模型，按组评估各因素对PLR指数变异性的贡献。结果两组间PLR指标差异无统计学意义。年龄是各组的重要因素，但对mTBI患者更为明显。在mTBILOC+组中主要观察到睡眠时间、损伤特征和心理健康对PLR指数的影响。在所有模型中，创伤后压力和性都不是显著的预测因子。结论：当使用PLR筛查mTBI时，在解释PLR指标时应考虑个体的年龄、既往mTBI病史、意识、睡眠、焦虑和抑郁症状的终生tbi相关改变。控制这些因素对于验证PLR筛查mTBI的使用至关重要。

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