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High-frequency oscillations in scalp EEG lateralize to the epileptogenic hemisphere in children and adults 儿童和成人头皮脑电图的高频振荡向致痫半球偏侧
IF 2 Q3 NEUROSCIENCES
Clinical Neurophysiology Practice
Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.09.004
Dhruva P. Achar , Karunakar A. Kotegar , Kurupath Radhakrishnan

Objectives:

High-frequency oscillations (HFO) in scalp electroencephalography (EEG) are promising biomarkers for localizing epileptogenic zones. Prior studies mainly used high sampling frequencies (>1000 Hz), whereas clinical monitoring often employs lower rates (<512 Hz). We assessed scalp EEG HFO detection feasibility at 512 Hz, examining whether HFO rates lateralize the epileptogenic hemisphere (EH) and localize seizure onset zone (SOZ).

Methods:

We retrospectively analyzed EEG from 32 patients during sleep, and seizures in 10 patients. A semi-automated algorithm combining band-pass filtering, sliding-window thresholding, and time-frequency validation was applied. HFO rates were compared between EH versus contralateral hemisphere (CH), and SOZ versus non-SOZ channels.

Results:

HFOs were detected in 27 patients, with higher rates in EH than CH (p = 0.0002). The asymmetry index lateralized EH in 22 patients (p = 0.0003). SOZ channels had higher HFO rates in 11 of 18 patients, though not significantly (p = 0.32). Pre-ictal HFO rates increased (p = 0.02), were higher in EH (p = 0.05), and decreased post-ictally (p = 0.004). Age-dependent decline was observed, with younger patients exhibiting higher median HFO rates than adults (≥18 years).

Conclusions:

Scalp EEG at 512 Hz reliably detects HFOs and lateralizes the EH, though SOZ localization remains limited.

Significance

: Routine 512 Hz EEG can analyze HFOs, potentially enhancing presurgical evaluation.
目的：头皮脑电图（EEG）的高频振荡（HFO）是定位癫痫区有希望的生物标志物。先前的研究主要使用高采样频率（> 1000hz），而临床监测通常使用较低的采样频率（< 512hz）。我们评估了512 Hz下头皮脑电图HFO检测的可行性，考察了HFO率是否使致痫半球（EH）偏侧，并定位了癫痫发作区（SOZ）。方法：回顾性分析32例睡眠时脑电图及10例癫痫发作的脑电图。采用带通滤波、滑动窗阈值和时频验证相结合的半自动算法。比较EH与对侧半球（CH）、SOZ与非SOZ通道之间的HFO率。结果：27例患者检出hfo， EH高于CH （p = 0.0002）。22例患者的不对称指数偏侧化EH （p = 0.0003）。18例患者中有11例SOZ通道HFO发生率较高，但差异无统计学意义（p = 0.32）。发作前HFO发生率升高（p = 0.02）， EH较高（p = 0.05），发作后HFO发生率降低（p = 0.004）。观察到年龄依赖性下降，年轻患者表现出高于成人（≥18岁）的中位HFO发生率。结论：512 Hz的头皮脑电图可靠地检测到HFOs并使EH偏侧，尽管SOZ定位仍然有限。意义：常规512 Hz脑电图可分析HFOs，有可能增强术前评价。
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引用次数: 0
The spatio-functional cortical representation of muscles innervated by the accessory nerve using nTMS 副神经支配肌肉的空间功能表征
IF 2 Q3 NEUROSCIENCES
Clinical Neurophysiology Practice
Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.11.004
J. Reinsch , M. Denker , M. Engelhardt , A. Zdunczyk , D. Huscher , P. Vajkoczy , T. Picht , N.F. Dengler

Objective

The accessory nerve is frequently affected by injury which causes disability due to a loss of function in the trapezius muscle and the sternocleidomastoid muscle. Navigated transcranial magnetic stimulation (nTMS) may be a valuable tool to quantify aspects of cortical motor reorganization.

Methods

nTMS was used to stimulate the motor cortex in 15 healthy volunteers and 3 accessory nerve lesion patients to determine the representation of the sternocleidomastoid muscle, trapezius, deltoid, biceps, first dorsal interosseus and zygomatic major muscles.

Results

The center of gravitiy (CoG) of the sternocleidomastoid muscle was located between the face (zygomatic major muscle) and hand (first dorsal interosseus muscle). CoG of the trapezius muscle was located superiorly to the hand. Distances to the lateral sulcus differed significantly (median: trapezius muscle 54.9 [9.4] mm, sternocleidomastoid muscle 30.1 [15.7] mm, p < 0.001). The radius (in mm) of the area of the sternocleidomastoid muscle was significantly larger compared to the trapezius (14.3 [5.7] and 11.5 [6.9], p = 0.004).

Conclusion

This study describes the detailed spatio-functional representation of trapezius and sternocleidomastoid muscle in comparison to four other muscles.

Significance

Our data may serve as a baseline for future studies on patients with accessory nerve injuries and a decision-making tool for the indication and timing for reconstructive surgery.
目的：副神经常因斜方肌和胸锁乳突肌功能丧失而损伤。导航经颅磁刺激（nTMS）可能是量化皮质运动重组方面的有价值的工具。方法15例健康志愿者和3例副神经病变患者，采用单脉冲磁刺激（sntms）对运动皮层进行刺激，确定胸锁乳突肌、斜方肌、三角肌、二头肌、第一背骨间肌和颧大肌的表现。结果胸锁乳突肌的重心位于面部（颧大肌）和手部（第一背骨间肌）之间。斜方肌的CoG位于手的上方。到外侧沟的距离差异显著（中位数：斜方肌54.9 [9.4]mm，胸锁乳突肌30.1 [15.7]mm, p < 0.001）。胸锁乳突肌面积的半径（mm）明显大于斜方肌（14.3[5.7]和11.5 [6.9],p = 0.004）。结论本研究详细描述了斜方肌和胸锁乳突肌与其他四种肌肉的空间功能表征。意义：我们的数据可以作为未来研究副神经损伤患者的基线，并为重建手术的适应证和时机提供决策工具。
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引用次数: 0
A new method to evaluate staircase phenomenon in skeletal muscle using piezoelectric sensor 一种利用压电传感器评价骨骼肌阶梯现象的新方法。
IF 2 Q3 NEUROSCIENCES
Clinical Neurophysiology Practice
Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2024.12.002
Bungo Hirose , Tomihiro Imai , Kazuna Ikeda , Emiko Tsuda , Rika Yamauchi , Tatsuya Abe , Shin Hisahara

Objective

The staircase phenomenon, which refers to the increases in the force of contraction with repetitive stimulation of the muscle, has been studied for many years, but the method is difficult and not widely used. Our objective was to evaluate the staircase phenomenon in skeletal muscle using a piezoelectric sensor.

Methods

Thirty-five subjects without neuromuscular diseases (normal controls), 11 patients with Becker muscular dystrophy (BMD), and 19 patients with myotonic dystrophy type 1 (MyD) were studied. Compound muscle action potential (CMAP) and movement-related potential (MRP) waveforms were recorded using piezoelectric sensors during repetitive stimulation of the median nerve, and the amplitudes and durations were measured. Excitation-contraction (E-C) coupling time (ECCT) was calculated from the difference between onset latencies of CMAP and MRP.

Results

In normal controls, MRP amplitude ratio (relative to baseline) increased significantly with increase in stimulation duration and with increase in stimulation frequency. In BMD and MyD, however, MRP amplitude ratio did not change significantly with increase in stimulation duration. Especially, in MyD, there was no change in MRP amplitude ratio with increase in frequency.

Conclusion

Staircase phenomenon abnormalities can be evaluated easily using piezoelectric sensors, indicating their potential utility for evaluating E-C coupling impairment in myopathies.

Significance

Piezoelectric sensors may be a useful tool to evaluate staircase phenomenon in skeletal muscle.
目的：楼梯现象是指随着肌肉的反复刺激收缩力的增加，这一现象已被研究多年，但方法难度大，应用不广泛。我们的目的是利用压电传感器来评估骨骼肌的阶梯现象。方法：选取35例无神经肌肉疾病（正常对照）、11例贝克肌营养不良症（BMD）和19例1型肌强直性营养不良症（MyD）患者作为研究对象。利用压电传感器记录正中神经重复刺激过程中复合肌肉动作电位（CMAP）和运动相关电位（MRP）波形，并测量其振幅和持续时间。根据CMAP和MRP发作潜伏期的差值计算兴奋-收缩耦合时间（ECCT）。结果：在正常对照中，MRP振幅比（相对于基线）随刺激持续时间的增加和刺激频率的增加而显著增加。然而，在BMD和MyD中，MRP振幅比随刺激时间的增加没有显著变化。特别是在MyD中，MRP振幅比没有随频率的增加而变化。结论：利用压电传感器可以很容易地评估楼梯现象异常，表明其在评估肌病E-C偶联损伤方面的潜在用途。意义：压电传感器可作为评估骨骼肌阶梯现象的有效工具。
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引用次数: 0
Competence of healthcare professionals performing electroencephalography test: A systematic review 医疗保健专业人员执行脑电图测试的能力：系统回顾
IF 2 Q3 NEUROSCIENCES
Clinical Neurophysiology Practice
Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.03.001
Elina Linnavuori , Irina Virtanen , Minna Stolt

Objective

To describe the EEG competence of healthcare professionals and how this competence has been measured in previous literature.

Methods

A systematic review following the preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted in CINAHL, PubMed, Scopus, and Web of Science databases focusing on studies that empirically examined the EEG competence of healthcare professionals.

Results

A total of 28 studies were included. EEG competence consists of two main categories: knowledge and skills of EEG, and attitudes and values towards EEG. The EEG competence of healthcare professionals was assessed in three different settings: tests, simulations, and real life. The data collection methods were knowledge tests, self-assessments, and observations. The tools were developed by a researcher(s) for the single study and were not psychometrically tested.

Conclusion

EEG competence is a multidimensional concept that includes knowledge, skills, attitudes, and values that need to be considered when defining EEG competence and developing tools to measure it.

Significance

This systematic review provides information to the educators of healthcare professionals and healthcare organizations involved in developing comprehensive EEG training programs and assessments to foster professional development and ensure reliable diagnostic test results for patients.
目的描述卫生保健专业人员的脑电图能力，以及在以往文献中如何测量这种能力。方法根据系统评价和元分析的首选报告项目进行系统评价。在CINAHL、PubMed、Scopus和Web of Science数据库中进行了文献检索，重点研究了医疗保健专业人员脑电图能力的实证研究。结果共纳入28项研究。脑电能力包括两大类：脑电知识和技能，以及对脑电的态度和价值观。在三种不同的环境中评估医疗保健专业人员的脑电图能力：测试、模拟和现实生活。资料收集方法为知识测验、自我评估和观察。这些工具是由研究人员为单个研究开发的，没有进行心理测量学测试。结论脑电能力是一个多维的概念，包括知识、技能、态度和价值观，在定义脑电能力和开发测量工具时需要考虑这些因素。本系统综述为参与制定全面脑电图培训计划和评估的医疗保健专业人员和医疗保健组织的教育者提供了信息，以促进专业发展并确保患者的诊断测试结果可靠。
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引用次数: 0
Two-year experience of a newly established epilepsy monitoring unit in a resource-limited setting 在资源有限的环境中新建立的癫痫监测单位的两年经验
IF 2 Q3 NEUROSCIENCES
Clinical Neurophysiology Practice
Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.02.012
Fridha V. Villalpando-Vargas , Fabrizio A. Mortola , Juan C. Barrera de León , Tania P. Sánchez-Murguía , Ilse M. Mora-Rodríguez , Jonathan A. Cisneros-Orozco , Andrea Enríquez-Zaragoza , Karla López-Jiménez , Alioth Guerrero-Aranda

Objective

Epilepsy Monitoring Units (EMUs) play a critical role in epilepsy management, yet they remain scarce in resource-limited settings. This study presents a 2-year experience of a newly implemented EMU in Mexico, evaluating its clinical impact, procedural metrics, and challenges. Methods: This retrospective study included 117 patients admitted to the EMU of a private hospital in central-western Mexico between February 2023 and December 2024. Patients underwent tailored protocols for long-term video-EEG monitoring for diagnostic clarification, treatment optimization, or presurgical evaluation. Diagnostic and therapeutic outcomes, seizure yield, and safety metrics were described. Results: The EMU facilitated diagnostic changes in 59% of patients, with 80.3% undergoing treatment modifications. Among presurgical evaluation patients, 80.8% exhibited seizures during admission. Seventy-two percent of patients achieved a favorable seizure outcome at one-year follow-up. Twelve patients underwent epilepsy surgery, with resective procedures being the most common. Status epilepticus and seizure clusters, occurred in 2.5% and 0.8% of patients, respectively. Conclusion: The implementation of a high-quality EMU is achievable in resource-limited settings. Significance: This study highlights the importance of tailored protocols and multidisciplinary collaboration, providing a practical framework enhancing epilepsy care and bridging gaps in epilepsy management in underserved regions.
目的癫痫监测单位（emu）在癫痫管理中发挥着至关重要的作用，但在资源有限的地区，emu仍然稀缺。本研究介绍了墨西哥新实施的EMU的2年经验，评估了其临床影响、程序指标和挑战。方法：本回顾性研究纳入了2023年2月至2024年12月在墨西哥中西部一家私立医院急诊住院的117例患者。患者接受量身定制的长期视频脑电图监测方案，以明确诊断、优化治疗或术前评估。描述了诊断和治疗结果、癫痫发作率和安全性指标。结果：EMU促进了59%的患者的诊断改变，80.3%的患者接受了治疗修改。在术前评估的患者中，80.8%在入院时出现癫痫发作。在一年的随访中，72%的患者获得了良好的癫痫发作结果。12名患者接受了癫痫手术，切除手术是最常见的。癫痫持续状态和发作集群分别发生在2.5%和0.8%的患者中。结论：在资源有限的情况下，实施高质量的EMU是可以实现的。意义：本研究强调了定制方案和多学科合作的重要性，为服务不足地区加强癫痫护理和缩小癫痫管理差距提供了实用框架。
{"title":"Two-year experience of a newly established epilepsy monitoring unit in a resource-limited setting","authors":"Fridha V. Villalpando-Vargas ,&nbsp;Fabrizio A. Mortola ,&nbsp;Juan C. Barrera de León ,&nbsp;Tania P. Sánchez-Murguía ,&nbsp;Ilse M. Mora-Rodríguez ,&nbsp;Jonathan A. Cisneros-Orozco ,&nbsp;Andrea Enríquez-Zaragoza ,&nbsp;Karla López-Jiménez ,&nbsp;Alioth Guerrero-Aranda","doi":"10.1016/j.cnp.2025.02.012","DOIUrl":"10.1016/j.cnp.2025.02.012","url":null,"abstract":"<div><h3>Objective</h3><div>Epilepsy Monitoring Units (EMUs) play a critical role in epilepsy management, yet they remain scarce in resource-limited settings. This study presents a 2-year experience of a newly implemented EMU in Mexico, evaluating its clinical impact, procedural metrics, and challenges. <em>Methods</em><strong>:</strong> This retrospective study included 117 patients admitted to the EMU of a private hospital in central-western Mexico between February 2023 and December 2024. Patients underwent tailored protocols for long-term video-EEG monitoring for diagnostic clarification, treatment optimization, or presurgical evaluation. Diagnostic and therapeutic outcomes, seizure yield, and safety metrics were described. <em>Results</em><strong>:</strong> The EMU facilitated diagnostic changes in 59% of patients, with 80.3% undergoing treatment modifications. Among presurgical evaluation patients, 80.8% exhibited seizures during admission. Seventy-two percent of patients achieved a favorable seizure outcome at one-year follow-up. Twelve patients underwent epilepsy surgery, with resective procedures being the most common. Status epilepticus and seizure clusters, occurred in 2.5% and 0.8% of patients, respectively. <em>Conclusion</em><strong>:</strong> The implementation of a high-quality EMU is achievable in resource-limited settings. <em>Significance</em>: This study highlights the importance of tailored protocols and multidisciplinary collaboration, providing a practical framework enhancing epilepsy care and bridging gaps in epilepsy management in underserved regions.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 84-89"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594095","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}
引用次数: 0
Intraoperative monitoring during awake craniotomy for glioblastoma resection in the second trimester of pregnancy. A case report and literature review 妊娠中期清醒开颅术中胶质母细胞瘤切除术的术中监测。病例报告及文献复习
IF 2 Q3 NEUROSCIENCES
Clinical Neurophysiology Practice
Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.02.006
Bayron A. Sandoval-Bonilla , Isela Valverde Luna , Aleida Arritola-Uriarte , Daniel San-Juan , Ricardo García-Iturbide , Alma Edith Gress Mendoza , Lorely Cumplido Pulido , Lizzette Hinojosa González , Alfredo Lara Bahena , Maria F. De la Cerda Vargas

Objective

To demonstrate the feasibility and safety of awake craniotomy (AC) with intraoperative neurophysiological monitoring (IONM) for glioblastoma (GB) resection in a pregnant patient, ensuring preservation of neurological functions and fetal well-being.

Methods

A 27-year-old gravida 2, para 1 woman presented at 19.4 weeks of pregnancy with severe headaches and a generalized tonic-clonic seizure. Imaging confirmed a malignant glioma, and an interdisciplinary team opted for AC with IONM to achieve maximal tumor resection while minimizing maternal and fetal risks.

Results

Surgery was performed during the second trimester with successful gross total resection of the tumor. IONM strategies preserved neurological function, and fetal well-being was maintained. Postoperative evaluations showed no complications, and the patient was discharged in improved condition.

Conclusions

AC with IONM is a viable and safe surgical approach for GB resection during pregnancy. Tailoring the surgical plan by considering gestational age, maternal health, and fetal safety is crucial.

Significance

This case highlights the importance of multidisciplinary management in optimizing outcomes for pregnant patients with GB, contributing valuable insights to the limited literature on neurosurgical interventions during pregnancy.
目的探讨清醒开颅术（AC）联合术中神经生理监测（IONM）用于妊娠患者胶质母细胞瘤（GB）切除术的可行性和安全性，确保胎儿神经功能和胎儿健康。方法1例27岁妊娠2期妇女，妊娠19.4周时出现严重头痛和全身性强直阵挛发作。影像学证实了恶性胶质瘤，一个跨学科的团队选择了AC与IONM，以实现最大程度的肿瘤切除，同时最大限度地降低了母亲和胎儿的风险。结果妊娠中期手术成功切除肿瘤。IONM策略保留了神经功能，并维持了胎儿的健康。术后评估显示无并发症，患者出院时病情好转。结论sac联合IONM是妊娠期GB切除术可行、安全的手术方式。通过考虑胎龄、产妇健康和胎儿安全来调整手术计划是至关重要的。本病例强调了多学科管理在优化妊娠期GB患者预后中的重要性，为有限的妊娠期神经外科干预文献提供了有价值的见解。
{"title":"Intraoperative monitoring during awake craniotomy for glioblastoma resection in the second trimester of pregnancy. A case report and literature review","authors":"Bayron A. Sandoval-Bonilla ,&nbsp;Isela Valverde Luna ,&nbsp;Aleida Arritola-Uriarte ,&nbsp;Daniel San-Juan ,&nbsp;Ricardo García-Iturbide ,&nbsp;Alma Edith Gress Mendoza ,&nbsp;Lorely Cumplido Pulido ,&nbsp;Lizzette Hinojosa González ,&nbsp;Alfredo Lara Bahena ,&nbsp;Maria F. De la Cerda Vargas","doi":"10.1016/j.cnp.2025.02.006","DOIUrl":"10.1016/j.cnp.2025.02.006","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate the feasibility and safety of awake craniotomy (AC) with intraoperative neurophysiological monitoring (IONM) for glioblastoma (GB) resection in a pregnant patient, ensuring preservation of neurological functions and fetal well-being.</div></div><div><h3>Methods</h3><div>A 27-year-old gravida 2, para 1 woman presented at 19.4 weeks of pregnancy with severe headaches and a generalized tonic-clonic seizure. Imaging confirmed a malignant glioma, and an interdisciplinary team opted for AC with IONM to achieve maximal tumor resection while minimizing maternal and fetal risks.</div></div><div><h3>Results</h3><div>Surgery was performed during the second trimester with successful gross total resection of the tumor. IONM strategies preserved neurological function, and fetal well-being was maintained. Postoperative evaluations showed no complications, and the patient was discharged in improved condition.</div></div><div><h3>Conclusions</h3><div>AC with IONM is a viable and safe surgical approach for GB resection during pregnancy. Tailoring the surgical plan by considering gestational age, maternal health, and fetal safety is crucial.</div></div><div><h3>Significance</h3><div>This case highlights the importance of multidisciplinary management in optimizing outcomes for pregnant patients with GB, contributing valuable insights to the limited literature on neurosurgical interventions during pregnancy.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 63-69"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580354","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}
引用次数: 0
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
IF 2 Q3 NEUROSCIENCES
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
IF 2 Q3 NEUROSCIENCES
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。
{"title":"Within five weeks: Rapidly grown glioblastoma discovered on repeat MRI after pathologic EEG","authors":"Zsuzsanna Szankai ,&nbsp;Egle Huggenberger ,&nbsp;Christoph Metzler ,&nbsp;Christian Musahl ,&nbsp;Markus Gschwind","doi":"10.1016/j.cnp.2025.02.002","DOIUrl":"10.1016/j.cnp.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Case Presentation</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 52-55"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509100","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}
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
IF 2 Q3 NEUROSCIENCES
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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