Clinical Neurophysiology Practice最新文献_第7页

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

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-06-18 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。

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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 Epub Date: 2025-06-17 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

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

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-08-29 DOI: 10.1016/j.cnp.2025.08.003

Stefano Meletti , Margitta Seeck

引用次数: 0

Breach rhythm-induced asymmetric post-arousal hypersynchrony mimicking ictal EEG in coma 缺口节律诱导的非对称觉醒后高同步模拟昏迷脑电图

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-11-06 DOI: 10.1016/j.cnp.2025.11.001

Philippe GELISSE , Arielle CRESPEL

Objective

To highlight the risk of misinterpreting stimulation-related EEG patterns as seizures in the ICU, and to illustrate how awakening hypersynchrony and breach rhythm can mimic a focal seizure, leading to an erroneous diagnosis of nonconvulsive status epilepticus (NCSE).

Method

A single patient case observation of a 17-year-old male with a severe traumatic brain injury, resulting in a left depressed skull fracture and coma. A continuous EEG was analyzed during repeated auditory/somatosensory stimulations. Pharmacologic reactivity was assessed with IV clonazepam.

Results

Several episodes of awakening hypersynchrony were initially misinterpreted as subclinical focal seizures, leading to a diagnosis of NCSE. The EEGs displayed asymmetrical, sharply contoured rhythmic delta waves after stimulations, showing evolution and lasting more than 10 s. These delta waves demonstrated reactivity to IV-clonazepam, resulting in an improved EEG. Although no clinical improvement was observed, the patient returned to sleep immediately. The EEGs were reinterpreted as representing arousal reactions during the awakening process. The asymmetry of the rhythmic delta waves corresponded to a breach rhythm.

Conclusion

In comatose or sedated ICU patients, stimulation-induced rhythmic delta waves with apparent evolution, and even benzodiazepine responsiveness, may represent normal arousal phenomena amplified by a breach rhythm rather than ictal activity. Significance: As stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) strictly describe EEG morphology and evolution without reference to the cause, normal arousals/awakenings and their variations must be recognized in comatose patients. Due to the ambiguity of the term “ictal” and its clinical implications, “ictal” could be replaced with “intermittent”: Stimulus-Induced Rhythmic or Periodic Intermittent Discharges.

目的强调将刺激相关脑电图模式误解为ICU患者癫痫发作的风险，并说明觉醒高同步性和缺口节律如何模拟局灶性癫痫发作，从而导致非惊厥性癫痫持续状态（NCSE）的错误诊断。方法对1例17岁男性重型颅脑外伤致左侧凹陷性颅骨骨折并昏迷患者进行单例观察。在重复的听觉/体感刺激过程中分析连续脑电图。静脉注射氯硝西泮评估药理学反应性。结果几次觉醒高同步发作最初被误解为亚临床局灶性癫痫发作，导致NCSE的诊断。刺激后脑电图呈现不对称的、轮廓分明的节律性δ波，呈现演化性，持续时间超过10 s。这些δ波表现出对iv氯硝西泮的反应性，从而改善了脑电图。虽然没有观察到临床改善，但患者立即恢复睡眠。脑电图被重新解释为觉醒过程中的觉醒反应。节律性δ波的不对称性与断裂节律相对应。结论在昏迷或镇静的ICU患者中，刺激诱发的节律性δ波具有明显的演化，甚至苯二氮卓类药物的反应性，可能是由突破节律放大的正常唤醒现象，而不是由临界活动放大的。意义：由于刺激诱发的节律性、周期性或临界放电（sirpid）严格描述了脑电图形态和进化，而不涉及病因，因此必须在昏迷患者中认识到正常的唤醒/觉醒及其变化。由于术语“突发”及其临床含义的模糊性，“突发”可以用“间歇”代替：刺激诱导的节律性或周期性间歇放电。

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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

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-05-03 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

Comparative analysis of signal quality and usability for a novel wireless, wearable EEG sensor 一种新型无线可穿戴脑电图传感器的信号质量和可用性对比分析

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-06-18 DOI: 10.1016/j.cnp.2025.05.004

Vamshi K. Muvvala , Avidor B. Kazen , Tyler J. Newton , Zoë Tosi , Michael Elwood , Mark J. Lehmkuhle , Tobias Loddenkemper , Mark C. Spitz , Laura Strom , Daniel Friedman , Mitchell A. Frankel

Objective

This study details the design, efficacy, and usability of a novel wearable, wireless electroencephalography (EEG) sensor designed for extended-duration clinical monitoring in any environment.

Methods

Simultaneous EEG recordings from REMI sensors and a conventional scalp-EEG recording system were conducted across two cohorts: 1) participants undergoing routine epilepsy seizure monitoring and 2) healthy volunteers performing tasks to induce common EEG artifacts. Comparative time and spectral-based analyses were conducted between the recording modalities. Sensor usability was also evaluated.

Results

The temporal dynamics and signal morphology of artifacts and electrographic seizures were visually similar between the REMI sensor and conventional scalp-EEG. Additionally, spectral correlation between the two systems was high across all event types, ranging from 0.86 to 0.94. Patient-reported acceptance was also strong, with 69% of participants rating the sensors as comfortable to wear.

Conclusions

The REMI sensor showed strong agreement with conventional scalp-EEG in the signal characteristics of physiological artifacts and electrographic seizures. The positive comfort feedback further supports the REMI sensors’ everyday utility.

Significance

Although limited in electrode coverage compared to conventional scalp-EEG recording systems, the REMI sensor records comparable high-fidelity EEG data in both time and spectral domains. REMI sensor’s recording quality and wearability facilitate extended-duration monitoring in everyday environments.

目的：本研究详细介绍了一种新型可穿戴无线脑电图（EEG）传感器的设计、功效和可用性，该传感器设计用于任何环境下的长时间临床监测。方法用REMI传感器和传统的头皮-脑电图记录系统同时记录两组受试者的脑电图：1)接受常规癫痫发作监测的受试者和2)执行诱发常见脑电图伪影任务的健康志愿者。在记录方式之间进行了比较时间和基于光谱的分析。还对传感器的可用性进行了评估。结果在视觉上，REMI传感器与常规头皮-脑电图在伪影和癫痫发作的时间动态和信号形态上相似。此外，两个系统之间的光谱相关性在所有事件类型中都很高，在0.86 ~ 0.94之间。患者报告的接受度也很高，69%的参与者认为传感器佩戴舒适。结论REMI传感器在生理伪影和电痉挛的信号特征上与传统头皮-脑电图具有较强的一致性。积极的舒适反馈进一步支持了REMI传感器的日常用途。虽然与传统的头皮-脑电图记录系统相比，电极覆盖范围有限，但REMI传感器在时间和频谱域都记录了相当的高保真脑电图数据。REMI传感器的记录质量和可穿戴性便于在日常环境中进行长时间监测。

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引用次数: 0

Quantitative electroencephalography in the diagnosis of dementia with Lewy bodies 定量脑电图在路易体痴呆诊断中的应用

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-07-02 DOI: 10.1016/j.cnp.2025.06.008

Abhimanyu Mahajan , Alberto Jaramillo-Jimenez , Anita D’Anselmo , Giulia Prete , Lucrezia Bristot , Sara Varanese , Alberto Di Domenico , Nicola Mammarella , Luca Tommasi , Michele Tinazzi , Dag Aarsland , Claudio Babiloni , Alberto J. Espay , Laura Bonanni

The spectral analysis of the resting-state eyes-closed electroencephalographic (rsEEG) activity typically shows abnormal delta (< 4 Hz), theta (4–7 Hz), and alpha (8–12 Hz) power in older patients with cognitive deficits due to progressive neurodegenerative diseases. Interestingly, abnormally prominent posterior rsEEG power < 8 Hz with periodic fluctuations in the pre-alpha/theta range has been considered a supportive biomarker for diagnosing patients with prodromal or manifest dementia due to Lewy bodies (DLB) in international guidelines. Here, a panel of experts shortly reviews the concepts of thalamocortical dysrhythmia as a possible neurophysiological oscillatory mechanism generating those rsEEG abnormalities in DLB patients. It also recommends how to record and quantitatively analyze rsEEG activity in prodromal and manifesting DLB patients for the application of that cost-effective and largely available diagnostic procedure in clinical practice.

静息状态闭眼脑电图（rsEEG）活动的频谱分析通常显示异常的δ (<；4赫兹),θ（4 - 7赫兹）和α（8-12赫兹）功率的老年患者由于进行性神经退行性疾病的认知障碍。有趣的是，异常突出的后侧rsEEG功率<；在国际指南中，在α前/ θ范围内周期性波动的8hz已被认为是诊断路易体（DLB）引起的前驱或明显痴呆患者的支持性生物标志物。在这里，一个专家小组简要回顾了丘脑皮质节律异常作为一种可能的神经生理振荡机制在DLB患者中产生这些rsEEG异常的概念。它还建议如何记录和定量分析前驱和表现为DLB的患者的rsEEG活性，以便在临床实践中应用这种成本效益高且广泛可用的诊断程序。

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引用次数: 0

Averted weakness from a large Martin-Gruber anastomosis 避免了马丁-格鲁伯吻合术造成的虚弱。

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2024-12-15 DOI: 10.1016/j.cnp.2024.12.003

Emily Cheung, Karl Ng

引用次数: 0

Home-Based sensing of the nervous system with clinical neurophysiology technologies: IFCN handbook chapter 基于家庭的神经系统传感与临床神经生理学技术：IFCN手册章节

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-09-21 DOI: 10.1016/j.cnp.2025.09.003

Christian Sandøe Musaeus , Pedro F. Viana , Mark Cook , Jonas Duun-Henriksen , Sándor Beniczky , Preben Kidmose , Bart Vanrumste , Benjamin Filtjens , Troels Wesenberg Kjaer

Background

Home-based neurophysiological monitoring is improving the assessment and management of neurological conditions such as epilepsy. Technologies such as electroencephalography (EEG), electromyography (EMG), and accelerometry are increasingly integrated into wearable systems for at-home use. Due to an increasing amount of data from long-term monitoring, machine learning algorithms assist in automated data analysis. However, ensuring device accuracy, signal quality, and user compliance remains crucial for clinical useability.

Objective

This chapter explores advances and challenges in at-home neurophysiological monitoring, with a primary focus on EEG systems and their applications.

Content: The discussion highlights the technological advances and the challenges associated with at-home monitoring. The focus will be on EEG systems, as well as a discussion of EMG in epilepsy. Next, we will provide an overview of the clinical applications for home-based monitoring of epilepsy and sleep disorders. Lastly, we will briefly discuss emerging topics within home-based monitoring in movement disorders and neurodegenerative disorders.

Conclusion

Future advancements are expected with new generations of wearable systems capable of providing long-term monitoring with minimal maintenance. Beyond epilepsy and sleep disorders, home-based technologies are also being investigated in other neurological diseases including movement disorders and neurodegenerative diseases showing the expanding scope of home-based technologies in neurology.

家庭神经生理监测正在改善癫痫等神经系统疾病的评估和管理。脑电图（EEG）、肌电图（EMG）和加速度计等技术越来越多地集成到家庭使用的可穿戴系统中。由于长期监测的数据量不断增加，机器学习算法有助于自动数据分析。然而，确保设备的准确性、信号质量和用户依从性仍然是临床可用性的关键。目的本章探讨了家庭神经生理监测的进展和挑战，主要关注脑电图系统及其应用。内容：讨论强调了与家庭监测相关的技术进步和挑战。重点将是脑电图系统，以及癫痫的肌电图的讨论。接下来，我们将概述家庭监测癫痫和睡眠障碍的临床应用。最后，我们将简要讨论运动障碍和神经退行性疾病家庭监测中的新主题。新一代可穿戴系统能够以最少的维护提供长期监测，预计未来将取得进展。除了癫痫和睡眠障碍之外，还在研究其他神经系统疾病的家庭技术，包括运动障碍和神经退行性疾病，这表明家庭技术在神经学方面的范围正在扩大。

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引用次数: 0

Pre-ictal temperature increases detected by ear canal thermometry in the epilepsy monitoring unit. An exploratory study 癫痫病监测装置的耳道测温仪检测到癫痫发作前的体温升高。探索性研究

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 Epub Date: 2025-08-05 DOI: 10.1016/j.cnp.2025.07.006

Masud Seyal, Todd Chatlos, George Savvides, Shari Barela

Objective

There is evidence for a pre-ictal state, distinct from the interictal state, that can be detected minutes before the onset of a clinical seizure. Analysis of scalp EEG signals do not reliably distinguish the pre-ictal EEG from the interictal EEG. Changes in cerebral blood flow and oxygenation occur several minutes before EEG evidence of a seizure. Local increases in cerebral activity are associated with increases in brain temperature. Brain temperature changes are reflected in the tympanic membrane temperature. This exploratory study investigated whether a brain temperature change could be detected noninvasively in the immediate pre-ictal period.

Methods

Patients with focal seizures undergoing inpatient video-EEG telemetry had epitympanic temperatures recorded. Pre-ictal temperature changes deviating from the interictal temperature were studied.

Results

Data was available for 25 seizures in 12 patients. For a given seizure, the mean temperature at seizure onset exceeded the interictal temperature by 0.31 °C. Peri-ictal peak temperature exceeded the interictal temperature by a mean of 0.37 °C. Duration of temperature rise was 1081 s.

Conclusions

Pre-ictal temperature increases were detected non-invasively in focal onset seizures.

Significance

This finding provides the basis for development of temperature-based technology for seizure warning in ambulatory patients with refractory epilepsy.

目的有证据表明，在临床癫痫发作前几分钟就可以检测到一种不同于发作间期的发作前状态。头皮脑电信号的分析不能可靠地区分峰前脑电信号和间期脑电信号。脑电图显示癫痫发作前几分钟脑血流和氧合发生变化。局部大脑活动的增加与大脑温度的升高有关。脑温度的变化反映在鼓膜温度上。本探索性研究探讨了是否可以无创地检测到在直接的孕前期的脑温度变化。方法对局灶性癫痫患者进行视频-脑电图遥测，记录耳膜温度。研究了偏离峰间温度的峰前温度变化。结果12例患者中有25例癫痫发作数据。对于给定的癫痫发作，癫痫发作时的平均温度比间歇温度高0.31°C。周期峰值温度比周期温度平均高出0.37℃。升温持续时间为1081 s。结论局灶性癫痫发作时可无创检测到柱前温度升高。意义本研究结果为开发基于温度的非卧床难治性癫痫发作预警技术提供了基础。

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引用次数: 0