Clinical Neurophysiology Practice最新文献

英文中文

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.11.001

引用次数: 0

Challenges in evaluating forearm muscle activity based on the compound muscle action potential of the flexors of the whole forearm 基于整个前臂屈肌复合肌动作电位评估前臂肌肉活动的挑战

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.05.004

Tomoo Mano , Naohiko Iguchi , Naoki Iwasa , Shigekazu Fujimura , Tsunenori Takatani , Kazuma Sugie

Objective

Muscle strength, which correlates with the compound muscle action potential (CMAP), can also be estimated by measuring the CMAP. Therefore, we evaluated the CMAP of the flexor muscles of the whole forearm to identify their muscle strength.

Methods

Fourteen healthy volunteers were enrolled. The elbow was determined to be the stimulation point, and the recording site for the flexor muscles of the whole forearm was set at approximately 8 cm distal to the elbow. We prospectively evaluated the baseline-to-peak amplitude of the CMAP of the whole forearm flexor muscles (WFFM), including that obtained from the median nerve stimulation (WFFMm), ulnar nerve stimulation (WFFMu), and their sum (WFFMsum). Additionally, we analyzed the relationships between WFFMm and WFFMu amplitudes with other quantitative parameters, including grip strength and routine CMAP amplitudes.

Results

The CMAP’s test–retest analysis revealed high reliability. Grip power was significantly correlated with WFFMm and WFFMsum and mildly correlated with WFFMu. Tip-pinch strength with WFFMm and flexor pollicis longus (FPL) measurements correlated significantly. Lateral-pinch strength was significantly correlated with the first dorsal interosseous muscle (FDI) measurements but not with WFFM. The abductor digiti minimi (ADM) and abductor pollicis brevis (APB) were not correlated with grip power or pinch strength.

Conclusions

By electrophysiology examination, this study demonstrated that WFFMm is involved in grip power and other pinch strengths. This method may serve as a novel tool for measurement of distal muscle strengths.

Significance

This is the first study to attempt to evaluate the muscle strength of forearm flexor muscles by measuring the CMAP.

目的肌肉力量与复合肌肉动作电位（CMAP）相关，也可以通过测量CMAP来估计。因此，我们评估了整个前臂屈肌的CMAP，以确定其肌肉力量。方法选择健康志愿者14名。肘部被确定为刺激点，整个前臂屈肌的记录位置被设置为大约8 肘部远端cm处。我们前瞻性地评估了整个前臂屈肌（WFFM）的CMAP的基线-峰值振幅，包括正中神经刺激（WFFMm）、尺神经刺激（WFFMu）及其总和（WFFMsum）。此外，我们还分析了WFFMm和WFFMu振幅与其他定量参数的关系，包括握力和常规CMAP振幅。结果CMAP的测试-再测试分析具有较高的可靠性。握力与WFFMm和WFFMsum显著相关，与WFFMu轻度相关。尖端挤压强度与WFFMm和拇长屈肌（FPL）测量值显著相关。外侧挤压强度与第一次骨间背侧肌（FDI）测量值显著相关，但与WFFM无关。小指展肌（ADM）和拇短展肌（APB）与握力或握力无关。结论通过电生理检查，本研究表明WFFMm与握力和其他握力有关。这种方法可以作为测量远端肌肉强度的新工具。值得注意的是，这是第一项试图通过测量CMAP来评估前臂屈肌肌力的研究。

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引用次数: 0

Clinical neurophysiological tests as objective measures for acute and long-term COVID-19 临床神经生理测试作为新冠肺炎急性和长期的客观指标

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2022.10.002

Margitta Seeck, Hatice Tankisi

引用次数: 0

The effect of acute respiratory events and respiratory stimulants on EEG-recorded brain activity in neonates: A systematic review 急性呼吸事件和呼吸刺激剂对新生儿脑电图记录的脑活动的影响:一项系统综述

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.11.002

Fatima Usman , Simon Marchant , Luke Baxter , Hamisu M. Salihu , Muktar H. Aliyu , Eleri Adams , Caroline Hartley

Objective

We conducted a systematic review to investigate electroencephalography (EEG) changes during periods of acute respiratory events such as apnoea and the effect of respiratory stimulants on EEG features in infants.

Methods

Studies examining respiration and EEG-recorded brain activity in human neonates between 28 and 42 weeks postmenstrual age were included. Two reviewers independently screened all records and included studies were assessed using the Joanna Briggs Institute Critical Appraisal Tool. The protocol was registered in PROSPERO (CRD42022339873).

Results

We identified 14 studies with a total of 534 infants. Nine articles assessed EEG changes in relation to apnoea, one assessed hiccups, and four investigated the effect of respiratory stimulants. The relationship between neonatal apnoea and EEG changes was inconsistent; EEG suppression and decreased amplitude and frequency were observed during some, but not all, apnoeas. Respiratory stimulants increased EEG continuity compared with before use.

Conclusions

Current studies in this area are constrained by small sample sizes. Diverse exposure definitions and outcome measures impact inference.

Significance

This review highlights the need for further work; understanding the relationship between respiration and the developing brain is key to mitigating the long-term effects of apnoea.

目的对婴儿急性呼吸事件(如呼吸暂停)期间的脑电图变化及呼吸刺激剂对脑电图特征的影响进行系统回顾。方法对经后28 ~ 42 周的新生儿进行呼吸和脑电图记录的脑活动研究。两位审稿人独立筛选了所有记录，并使用乔安娜布里格斯研究所关键评估工具对纳入的研究进行了评估。该协议已在PROSPERO (CRD42022339873)中注册。结果:我们纳入了14项研究，共纳入534名婴儿。九篇文章评估了与呼吸暂停有关的脑电图变化，一篇评估了打嗝，四篇研究了呼吸兴奋剂的作用。新生儿呼吸暂停与脑电图变化的关系不一致;在部分(但不是全部)呼吸暂停期间观察到脑电图抑制和幅度和频率下降。与使用前相比，呼吸兴奋剂增加了脑电图的连续性。结论目前在该领域的研究受样本量小的限制。不同的暴露定义和结果测量影响推断。本综述强调了进一步工作的必要性;了解呼吸和大脑发育之间的关系是减轻呼吸暂停长期影响的关键。

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引用次数: 0

Nerve ultrasound: Unravelling the different patterns of nerve enlargement in CIDP subtypes 神经超声：揭示 CIDP 亚型中神经扩张的不同模式

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.11.003

Cheng-Yin Tan, Mingsheng Liu, Nortina Shahrizaila

引用次数: 0

Rapid response EEG with needle electrodes in an intensive care unit with limited resources 在资源有限的重症监护病房使用针电极快速反应脑电图

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.02.002

Karine J. Abou Khaled , Mei Bou Nasif , Claudia Freiji , Lawrence J. Hirsch , Michael W.K. Fong

Objective

Continuous EEG (cEEG) is the gold standard for detecting seizures and rhythmic and periodic patterns (RPPs) in critically ill patients but is often not available in health systems with limited resources. The current study aims to determine the feasibility and utility of low-cost, practical, limited montage, sub-dermal needle electrode EEG in a setting where otherwise no EEG would be available.

Methods

The study included all adult patients admitted to the intensive care unit of a single center over a 24-month period. Members of the existing ICU care team, mostly nurses, were trained to place 8 sub-dermal needle EEG electrodes to achieve rapid, limited montage-EEG recording. Clinical outcomes were recorded, including any reported major complications; and the EEG findings documented, including background characterization, RPPs, and seizures.

Results

One hundred twenty-three patients, mean age 68 years, underwent an average of 15.6 min of EEG recording. There were no complications of electrode placement. Overall, 13.0% had seizures (8.1% qualifying as status epilepticus [SE]), 18.7 % had generalized periodic discharges (GPDs), 4.9% had lateralized periodic discharges (LPDs), and 11.4 % sporadic epileptiform discharges (sEDs). Greater mortality was observed in patients with worse background EEGs, seizures, LPDs, or sEDs.

Conclusions

Rapid, limited montage EEG could be achieved safely and inexpensively in a broad population of critically ill patients following minimal training of existing care teams.

Significance

For resource poor centers or centers outside of major metropolitan areas who otherwise have no access to EEG, this may prove a useful method for screening for non-convulsive seizures and status epilepticus.

目的连续脑电图（cEEG）是检测危重患者癫痫发作和节律周期模式（RPP）的金标准，但在资源有限的卫生系统中往往不可用。目前的研究旨在确定低成本、实用、有限蒙太奇的皮下针电极脑电图在没有脑电图的情况下的可行性和实用性。方法该研究包括在24个月内入住单一中心重症监护室的所有成年患者。现有ICU护理团队的成员，主要是护士，接受了放置8个皮下针脑电图电极的培训，以实现快速、有限的蒙太奇脑电图记录。记录临床结果，包括任何报告的主要并发症；以及记录的脑电图结果，包括背景特征、RPP和癫痫发作。结果123例患者，平均年龄68岁 年，平均15.6 分钟脑电图记录。电极放置无并发症。总体而言，13.0%有癫痫发作（8.1%符合癫痫持续状态[SE]），18.7%有全身性周期性放电（GPD），4.9%有偏侧性周期性发作（LPD），11.4%有散发性癫痫样放电（sED）。背景脑电图、癫痫发作、LPD或sEDs较差的患者死亡率更高。结论在现有护理团队的最低限度培训下，可以在广泛的危重患者群体中安全、廉价地实现快速、有限的蒙太奇脑电图。值得注意的是，对于资源匮乏的中心或大城市以外无法获得脑电图的中心来说，这可能是筛查非惊厥性癫痫发作和癫痫持续状态的有用方法。

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引用次数: 0

Median nerve ultrasound cross sectional area and wrist-to-forearm ratio in relation to carpal tunnel syndrome related axonal damage and patient age 正中神经超声截面积及腕前臂比值与腕管综合征相关轴突损伤及患者年龄的关系

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.02.003

Henri Grönfors , Sari-Leena Himanen , Lauri Martikkala , Mika Kallio , Katri Mäkelä

Objective

Primary objective was to retrospectively examine the effects of patient age and carpal tunnel syndrome (CTS) related axon loss on median nerve (MN) high resolution ultrasound (HRUS) in younger and older patients. HRUS parameters evaluated in this study were MN cross sectional area at the wrist (CSA) and wrist-to-forearm ratio (WFR).

Methods

The material comprised 467 wrists of 329 patients. The patients were categorized into younger (<65 years) and older (≥65 years) groups. Patients with moderate to extreme CTS were included in the study. Axon loss of the MN was assessed by needle EMG and graded by the interference pattern (IP) density. The association between axon loss and CSA and WFR was studied.

Results

The older patients had smaller mean CSA and WFR values compared to the younger patients. CSA correlated positively to the CTS severity only in the younger group. However, WFR correlated positively to CTS severity in both groups. In both age groups, CSA and WFR correlated positively with IP reduction.

Conclusions

Our study complemented recent findings on the effects of patient age on the CSA of the MN. However, although the MN CSA did not correlate with the CTS severity in older patients, the CSA increased in respect to the amount of axon loss. Also, as a new result, we presented the positive association of WFR with CTS severity among older patients.

Significance

Our study supports the recently speculated need for different MN CSA and WFR cut-off values for younger and older patients in assessing the severity of CTS. With older patients, WFR may be a more reliable parameter to assess the CTS severity than the CSA. CTS related axonal damage of the MN is associated to additional nerve enlargement at the carpal tunnel intel site.

主要目的是回顾性研究患者年龄和腕管综合征（CTS）相关轴突丢失对中老年患者正中神经（MN）高分辨率超声（HRUS）的影响。本研究评估的HRUS参数为手腕MN横截面积（CSA）和腕前臂比（WFR）。将患者分为较年轻的（<；65 岁）及以上（≥65 年）组。中度至重度CTS患者被纳入研究。通过针刺EMG评估MN的轴突损失，并通过干扰模式（IP）密度进行分级。研究了轴突丢失与CSA和WFR的关系。结果与年轻患者相比，老年患者的CSA和WFR平均值较小。CSA仅在年轻组中与CTS严重程度呈正相关。然而，WFR与两组CTS严重程度呈正相关。在两个年龄组中，CSA和WFR与IP减少呈正相关。结论我们的研究补充了最近关于患者年龄对MN CSA影响的研究结果。然而，尽管MN CSA与老年患者的CTS严重程度无关，但CSA随着轴突丢失量的增加而增加。此外，作为一项新的研究结果，我们发现WFR与老年患者CTS严重程度呈正相关。值得注意的是，我们的研究支持了最近推测的年轻和老年患者在评估CTS严重程度时需要不同的MN-CSA和WFR临界值。对于老年患者，WFR可能是比CSA更可靠的评估CTS严重程度的参数。与CTS相关的MN轴索损伤与腕管内点的额外神经增大有关。

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引用次数: 1

EEG-Delta brushes in DPPX encephalitis – Welcome to the club 脑电图-三角洲刷在DPPX脑炎-欢迎加入俱乐部

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2022.11.003

Christine Heuer , Leah Disse , Debora Ledergerber , Ilijas Jelcic , Lukas L. Imbach

Background

Extreme Delta Brushes are a rare interictal EEG pattern that was first described in NMDA-R encephalitis and has been considered a pathognomonic pattern for this subtype of autoimmune encephalitis. Recently, extreme delta brushes have been described as a rare EEG phenomenon in other forms of encephalitis.

Case report

We describe to our knowledge the first occurrence of EEG Delta brushes in DPPX encephalitis. In this article, we present a comprehensive case report and discuss clinical differential diagnosis with special emphasis on the diagnostic value of the EEG, leading the way to the correct diagnosis. We also present current diagnostic criteria and clinical screening scales for initial evaluation for patients with suspected autoimmune encephalitis.

背景极端德尔塔刷是一种罕见的发作间期脑电图模式，首次在NMDA-R脑炎中描述，并被认为是该亚型自身免疫性脑炎的一种病理特征模式。最近，在其他形式的脑炎中，极端德尔塔刷被描述为一种罕见的脑电图现象。病例报告据我们所知，我们描述了DPPX脑炎中首次出现脑电图三角刷。在这篇文章中，我们提出了一个全面的病例报告，并讨论了临床鉴别诊断，特别强调脑电图的诊断价值，为正确诊断指明了道路。我们还介绍了目前的诊断标准和临床筛查量表，用于对疑似自身免疫性脑炎患者进行初步评估。

引用次数: 0

Utility of nerve ultrasound in the management of primary neurolymphomatosis: Case report and review of the literature 神经超声在原发性神经淋巴瘤治疗中的应用:病例报告及文献复习

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.04.003

Arena Wada , Yudai Uchida , Keiichi Hokkoku , Amuro Kondo , Yuki Fujii , Takashi Chiba , Takuji Matsuo , Hiroshi Tsukamoto , Yuki Hatanaka , Shunsuke Kobayashi , Masahiro Sonoo

Introduction

Primary neurolymphomatosis (NL) is a critical differential diagnosis of asymmetric multiple mononeuropathy and radiculoplexopathy. Its diagnosis is often challenging due to the lack of typical clinical signs of systemic lymphoma. We report a case of primary NL where nerve ultrasound (NUS) played an important role in the diagnosis and follow-up of the disease.

Case presentation

A 52-year-old man developed asymmetric painful multiple mononeuropathy in the right upper limb with cranial nerve involvement. After being referred to our department, the patient underwent NUS, which revealed marked enlargement and increased vascularity in the right upper limb nerves, brachial plexus, and cervical nerve roots. Furthermore, an epineural hypoechoic mass, a characteristic finding of NL, was seen in the right median nerve. These NUS findings prompted us to perform 18F-fluorodeoxyglucose positron emission tomography/computed tomography and a subsequent biopsy on the right axillary lymph node, confirming NL. Notably, the NUS abnormalities dramatically subsided, demonstrating the effectiveness of chemotherapy.

Discussion

The diagnostic utility of NUS for NL has been documented by many recent reports. Additionally, NUS can work as a quick follow-up tool for NL, as seen in our case.

引言原发性神经淋巴瘤（NL）是不对称多发性单神经病和神经根型神经病的重要鉴别诊断。由于缺乏系统性淋巴瘤的典型临床症状，其诊断往往具有挑战性。我们报告了一例原发性NL，其中神经超声（NUS）在疾病的诊断和随访中发挥了重要作用。病例介绍：一名52岁男子在右上肢出现不对称疼痛性多发性单神经病，并伴有脑神经受累。转诊至我科后，患者接受了NUS，结果显示右上肢神经、臂丛神经和颈神经根明显增大并血管增多。此外，在右侧正中神经可见一个表神经低回声肿块，这是NL的特征性发现。这些NUS的发现促使我们对右腋窝淋巴结进行18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和随后的活检，证实了NL。值得注意的是，NUS异常显著消退，证明了化疗的有效性。讨论NUS对NL的诊断效用已被许多最近的报告所记录。此外，NUS可以作为NL的快速跟进工具，如我们的案例所示。

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引用次数: 0

Repetitive transcranial magnetic stimulation for early-onset Alzheimer’s disease – A case report 重复经颅磁刺激治疗早发性阿尔茨海默病1例报告

IF 1.7 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2023-01-01 DOI: 10.1016/j.cnp.2023.07.003

Ali Elahi, Tiffany Frechette

Background

Early-onset Alzheimer’s Disease (AD) is a rare form of AD defined as exhibiting signs and symptoms before age 65. Several studies have shown high frequency repetitive transcranial magnetic stimulation (rTMS) to be an effective treatment for individuals with mild cognitive impairment (MCI) and AD when applied to the left and/or right dorsolateral prefrontal cortex (DLPFC) with clear improvements found on standardized assessments of cognitive function.

Case report

Here, we present a case report of a 44-year-old patient with clinical and laboratory characteristics of definite early-onset AD.

Findings

rTMS led to marked cognitive improvements. We hope to inspire more clinical interest in exploring rTMS for treatment of dementia.

背景早发性阿尔茨海默病（AD）是一种罕见的AD，被定义为在65岁之前表现出体征和症状。几项研究表明，当应用于左和/或右背外侧前额叶皮层（DLPFC）时，高频重复性经颅磁刺激（rTMS）对轻度认知障碍（MCI）和AD患者是一种有效的治疗方法，在认知功能的标准化评估中发现了明显的改善。病例报告在这里，我们提出了一个44岁的患者的病例报告，该患者具有明确的早发性AD的临床和实验室特征。我们希望在探索rTMS治疗痴呆症方面激发更多的临床兴趣。

引用次数: 0

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