Clinical Neurophysiology Practice最新文献

英文中文

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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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]

IF 2 Q3 NEUROSCIENCES

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

IF 2 Q3 NEUROSCIENCES

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

IF 2 Q3 NEUROSCIENCES

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

IF 2 Q3 NEUROSCIENCES

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。

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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 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。

{"title":"Multiple factors contribute to pupillary light reflex: implications for screening of traumatic brain injury in military service members","authors":"Michael N. Dretsch , Katie M. Williams , Diana P. Evans , Katrina S. Monti , Brian J. Guise , Mark L. Ettenhofer , Jamie N. Hershaw","doi":"10.1016/j.cnp.2025.07.002","DOIUrl":"10.1016/j.cnp.2025.07.002","url":null,"abstract":"<div><h3>Objectives</h3><div>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).</div></div><div><h3>Methods</h3><div>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<sup>LOC-</sup>), or mTBI with LOC (mTBI<sup>LOC+</sup>). 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.</div></div><div><h3>Results</h3><div>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<sup>LOC+</sup> group. Posttraumatic stress and sex were not significant predictors in any of the models.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Significance</h3><div>Controlling for these factors is essential for validating the use of PLR for screening of mTBI.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 256-264"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605723","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

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 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

Increased central serotonergic activity in patients after an acute ischemic stroke. An EEG study 急性缺血性脑卒中后患者中枢血清素活性增高。脑电图研究

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.cnp.2025.10.003

Vera Flasbeck , Andreas Ebert , Bettina Klostermann , Daniel Richter , Ralf Gold , Christos Krogias , Georg Juckel

Objective

Acute ischemic stroke (AIS) is often accompanied by functional impairments and post-stroke depression (PSD), affecting ∼30 % of patients. Since central serotonergic dysfunction may contribute to PSD, similar to major depressive disorder, we examined depressive symptoms and serotonergic neurotransmission after AIS using the loudness dependence of auditory evoked potentials (LDAEP), a non-invasive EEG marker.

Methods

19 patients with AIS and 18 age-matched healthy participants completed depression questionnaires (BDI, HAMD). LDAEP was assessed within 14 days after AIS and after three months, analyzed with mixed-models ANOVA.

Results

Shortly after AIS, patients showed lower LDAEP compared to controls for all electrodes (AIS M = 0.072 ± 0.077; controls M = 0.133 ± 0.095; p = 0.037), frontal (p = 0.011) and frontocentral (p = 0.027) electrodes. After three months, differences reached trend-level (p = 0.12). Depression scores were higher in patients, but not clinically relevant.

Conclusions

AIS appears to be associated with altered serotonergic neurotransmission, with attenuated LDAEP differences at three months possibly reflecting remission. As depression scores were not clinically relevant, serotonergic changes likely reflect a general AIS effect rather than being specific to PSD.

Significance

Early LDAEP measurement may serve as a non-invasive biomarker to identify patients with altered serotonergic functioning and guide interventions, such as SSRI therapy, to reduce PSD risk and improve recovery.

急性缺血性卒中（AIS）通常伴有功能障碍和卒中后抑郁（PSD），约30%的患者受到影响。由于中枢5 -羟色胺功能障碍可能导致PSD，类似于重度抑郁症，我们使用听觉诱发电位（LDAEP）的响度依赖性（一种无创脑电图标志物）检查AIS后的抑郁症状和5 -羟色胺能神经传递。方法19例AIS患者和18例年龄匹配的健康受试者完成抑郁问卷（BDI、HAMD）。在AIS后14天和3个月内评估LDAEP，采用混合模型方差分析分析。结果AIS后不久，患者在所有电极（AIS M = 0.072±0.077；对照组M = 0.133±0.095;p = 0.037）、额侧电极（p = 0.011）和额中央电极（p = 0.027）上的LDAEP均低于对照组。三个月后，差异达到趋势水平（p = 0.12）。患者的抑郁评分较高，但无临床相关性。结论sais似乎与血清素能神经传递改变有关，LDAEP差异在3个月时减弱可能反映了缓解。由于抑郁评分与临床无关，血清素能变化可能反映了一般的AIS效应，而不是特定于PSD。早期LDAEP测量可作为一种非侵入性生物标志物，用于识别血清素能功能改变的患者，并指导干预措施，如SSRI治疗，以降低PSD风险并改善康复。

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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 DOI: 10.1016/j.cnp.2024.12.003

Emily Cheung, Karl Ng

引用次数: 0

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