Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2024.12.004
Jinyang Zhuang , Xiyuan Lei , Xiaoli Guo , Li Ding , Jie Jia
Objective
To elucidate the immediate electrophysiological effects of mirror visual feedback (MVF) combined with or without touch task in subacute stroke.
Methods
Subacute stroke patients and healthy controls were recruited to participate in four grasping tasks (MVF or no MVF, combined with rubber ball or no ball) under electroencephalogram (EEG) monitoring. Event-related desynchronization (ERD) /event-related synchronization (ERS) and the lateralization index (LI) were utilized to observe the electrophysiological effects.
Results
MVF reduced ERD suppression in the contralateral primary motor cortex (M1) of stroke patients. This reduction was observed in the low mu band for the contralateral parietal cortex during pure MVF. The laterality effects in the low mu band under MVF was noted in M1 for stroke patients and in the parietal cortex for all participants.
Conclusions
MVF inhibits the excitability of the contralateral M1 for subacute stroke. MVF inhibit activities in the contralateral M1 and parietal cortex, and reestablished hemispheric balance in the low mu band.
Significance
MVF has an instantaneous effect on subacute stroke by inhibiting the excitability of the contralateral sensorimotor cortex. The attenuated ERD in the low mu band in contralateral M1 and parietal cortex may serve as biomarkers of MVF for stroke rehabilitation.
{"title":"Motor and parietal cortex activity responses to mirror visual feedback in patients with subacute stroke: An EEG study","authors":"Jinyang Zhuang , Xiyuan Lei , Xiaoli Guo , Li Ding , Jie Jia","doi":"10.1016/j.cnp.2024.12.004","DOIUrl":"10.1016/j.cnp.2024.12.004","url":null,"abstract":"<div><h3>Objective</h3><div>To elucidate the immediate electrophysiological effects of mirror visual feedback (MVF) combined with or without touch task in subacute stroke.</div></div><div><h3>Methods</h3><div>Subacute stroke patients and healthy controls were recruited to participate in four grasping tasks (MVF or no MVF, combined with rubber ball or no ball) under electroencephalogram (EEG) monitoring. Event-related desynchronization (ERD) /event-related synchronization (ERS) and the lateralization index (LI) were utilized to observe the electrophysiological effects.</div></div><div><h3>Results</h3><div>MVF reduced ERD suppression in the contralateral primary motor cortex (M1) of stroke patients. This reduction was observed in the low mu band for the contralateral parietal cortex during pure MVF. The laterality effects in the low mu band under MVF was noted in M1 for stroke patients and in the parietal cortex for all participants.</div></div><div><h3>Conclusions</h3><div>MVF inhibits the excitability of the contralateral M1 for subacute stroke. MVF inhibit activities in the contralateral M1 and parietal cortex, and reestablished hemispheric balance in the low mu band.</div></div><div><h3>Significance</h3><div>MVF has an instantaneous effect on subacute stroke by inhibiting the excitability of the contralateral sensorimotor cortex. The attenuated ERD in the low mu band in contralateral M1 and parietal cortex may serve as biomarkers of MVF for stroke rehabilitation.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 12-21"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013284","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2024.12.005
Steven Falowski , Mingyue Tang , Ashlesha Deshmukh , Ameya Nanivadekar , David Page , Mingming Zhang
Objective
This study aims to investigate the sources of later response in epidural spinal recordings (ESRs) obtained from implanted leads during spinal cord stimulation, a topic has not been widely studied in previous research.
Methods
Two patients with lower back and lower extremity pain underwent SCS implantation with intraoperative neuromonitoring (IONM). The timing of extracted peaks in ESRs and intramuscular electromyography (EMG) recordings were analyzed and compared to a Monte Carlo simulation for synchronization analysis.
Results
Our data show that, when using two most caudal electrodes for stimulation, late response in ESRs collected from SCS leads was not synchronized with EMG recordings from lower extremity muscles. However, parts of the late responses were synchronized with EMG recordings from abdominal muscle groups.
Conclusions
Late response in ESRs is believed to result from muscle contractions, although the exact sources have not been fully identified. They are likely to originate from muscles near the implanted leads.
Significance
This research indicates that components of the late response may originate beyond the abdominal region, potentially offering additional information for current IONM practice. Additionally, understanding the sources of the late response may be useful for emerging clinical applications in neurorehabilitation.
{"title":"Case report: Potential physiological sources of the late response in epidural spinal recordings induced by spinal cord stimulation during intraoperative neuromonitoring","authors":"Steven Falowski , Mingyue Tang , Ashlesha Deshmukh , Ameya Nanivadekar , David Page , Mingming Zhang","doi":"10.1016/j.cnp.2024.12.005","DOIUrl":"10.1016/j.cnp.2024.12.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to investigate the sources of later response in epidural spinal recordings (ESRs) obtained from implanted leads during spinal cord stimulation, a topic has not been widely studied in previous research.</div></div><div><h3>Methods</h3><div>Two patients with lower back and lower extremity pain underwent SCS implantation with intraoperative neuromonitoring (IONM). The timing of extracted peaks in ESRs and intramuscular electromyography (EMG) recordings were analyzed and compared to a Monte Carlo simulation for synchronization analysis.</div></div><div><h3>Results</h3><div>Our data show that, when using two most caudal electrodes for stimulation, late response in ESRs collected from SCS leads was not synchronized with EMG recordings from lower extremity muscles. However, parts of the late responses were synchronized with EMG recordings from abdominal muscle groups.</div></div><div><h3>Conclusions</h3><div>Late response in ESRs is believed to result from muscle contractions, although the exact sources have not been fully identified. They are likely to originate from muscles near the implanted leads.</div></div><div><h3>Significance</h3><div>This research indicates that components of the late response may originate beyond the abdominal region, potentially offering additional information for current IONM practice. Additionally, understanding the sources of the late response may be useful for emerging clinical applications in neurorehabilitation.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 22-29"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048233","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.02.005
Julian Theuriet , Adrien Bohic , Maxime Bonjour , Emilien Bernard , Florent Cluse , Juliette Svahn , Laurent Jomir , Anne-Evelyne Vallet , Marion Demia , Lucie Roux , Ioana Cristina Bârsan , Léa Alves , Matthias Dion , Lionel Meens , Martin Moussy , Françoise Bouhour , Yann Péréon , Antoine Pegat
Objective
This study aimed to compare the frequency of blink reflex’s contralateral R1 responses (R1′) between patients with amyotrophic lateral sclerosis (ALS), non-ALS motor deficit patients, and healthy volunteers.
Methods
A total of 120 participants were prospectively recruited: 40 with ALS, 40 with a non-ALS motor deficit, and 40 healthy volunteers. Blink reflexes were recorded from orbicularis oculi muscles following supraorbital nerve stimulation.
Results
R1′ was more frequent in the ALS group (42.5 %) compared to healthy volunteers (12.5 %, p = 0.00588), and compared to non-ALS patients (7.5 %, p = 0.000789). Bilateral R1′ was observed only in ALS patients (22.5 %). No clinically significant difference was found in the latencies or amplitudes of the R1, R2, or R1′ responses among groups. R1′ was more frequent in ALS patients with pseudobulbar affect (71.4 %) compared to those without (36.4 %).
Conclusions
The higher frequency of R1′ in ALS highlights its potential role in distinguishing ALS from other motor disorders. Its sensitivity was low, but bilateral R1′ was specific to ALS. The higher frequency of R1′ among ALS patients with pseudobulbar affect potentially reflects corticobulbar neuron degeneration.
Significance
The R1′, especially when bilateral, could serve as an additional diagnostic biomarker for ALS, although its clinical relevance should be considered within the broader diagnostic context.
{"title":"Contralateral R1 response in blink reflex in patients with amyotrophic lateral sclerosis","authors":"Julian Theuriet , Adrien Bohic , Maxime Bonjour , Emilien Bernard , Florent Cluse , Juliette Svahn , Laurent Jomir , Anne-Evelyne Vallet , Marion Demia , Lucie Roux , Ioana Cristina Bârsan , Léa Alves , Matthias Dion , Lionel Meens , Martin Moussy , Françoise Bouhour , Yann Péréon , Antoine Pegat","doi":"10.1016/j.cnp.2025.02.005","DOIUrl":"10.1016/j.cnp.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to compare the frequency of blink reflex’s contralateral R1 responses (R1′) between patients with amyotrophic lateral sclerosis (ALS), non-ALS motor deficit patients, and healthy volunteers.</div></div><div><h3>Methods</h3><div>A total of 120 participants were prospectively recruited: 40 with ALS, 40 with a non-ALS motor deficit, and 40 healthy volunteers. Blink reflexes were recorded from orbicularis oculi muscles following supraorbital nerve stimulation.</div></div><div><h3>Results</h3><div>R1′ was more frequent in the ALS group (42.5 %) compared to healthy volunteers (12.5 %, p = 0.00588), and compared to non-ALS patients (7.5 %, p = 0.000789). Bilateral R1′ was observed only in ALS patients (22.5 %). No clinically significant difference was found in the latencies or amplitudes of the R1, R2, or R1′ responses among groups. R1′ was more frequent in ALS patients with pseudobulbar affect (71.4 %) compared to those without (36.4 %).</div></div><div><h3>Conclusions</h3><div>The higher frequency of R1′ in ALS highlights its potential role in distinguishing ALS from other motor disorders. Its sensitivity was low, but bilateral R1′ was specific to ALS. The higher frequency of R1′ among ALS patients with pseudobulbar affect potentially reflects corticobulbar neuron degeneration.</div></div><div><h3>Significance</h3><div>The R1′, especially when bilateral, could serve as an additional diagnostic biomarker for ALS, although its clinical relevance should be considered within the broader diagnostic context.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 47-51"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509107","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.02.008
Kai Michael Schubert, Anton Schmick, Miranda Stattmann, Marian Galovic
Epilepsy is a frequent consequence of acute brain injuries, such as stroke, brain tumors, and traumatic brain injury (TBI). Accurate prediction of epilepsy is essential for early intervention and improved patient outcomes. This review evaluates the best-established prognostic models, including the SeLECT and CAVE scores, which estimate the risk of developing seizures and epilepsy following these injuries. The review highlights their clinical applicability, predictive accuracy, and limitations for different etiologies. In addition to providing practical tables for risk estimation, we also offer user-friendly online calculators for these models at www.predictepilepsy.com to facilitate clinical implementation. These tools help identify high-risk patients and support decision-making for follow-up and treatment. Furthermore, we discuss the potential of integrating electrophysiological data, including EEG biomarkers, to further enhance prediction accuracy and patient care. These insights highlight the need for further refinement and validation of predictive models, enabling more personalized treatment strategies and better patient care.
{"title":"Prognostic models for seizures and epilepsy after stroke, tumors and traumatic brain injury","authors":"Kai Michael Schubert, Anton Schmick, Miranda Stattmann, Marian Galovic","doi":"10.1016/j.cnp.2025.02.008","DOIUrl":"10.1016/j.cnp.2025.02.008","url":null,"abstract":"<div><div>Epilepsy is a frequent consequence of acute brain injuries, such as stroke, brain tumors, and traumatic brain injury (TBI). Accurate prediction of epilepsy is essential for early intervention and improved patient outcomes. This review evaluates the best-established prognostic models, including the SeLECT and CAVE scores, which estimate the risk of developing seizures and epilepsy following these injuries. The review highlights their clinical applicability, predictive accuracy, and limitations for different etiologies. In addition to providing practical tables for risk estimation, we also offer user-friendly online calculators for these models at <span><span>www.predictepilepsy.com</span><svg><path></path></svg></span> to facilitate clinical implementation. These tools help identify high-risk patients and support decision-making for follow-up and treatment. Furthermore, we discuss the potential of integrating electrophysiological data, including EEG biomarkers, to further enhance prediction accuracy and patient care. These insights highlight the need for further refinement and validation of predictive models, enabling more personalized treatment strategies and better patient care.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 116-128"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628171","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.04.001
Chen Yang , Nicole C. Veit , Kelly A. McKenzie , Shreya Aalla , Ameen Kishta , Kyle Embry , Elliot J. Roth , Richard L. Lieber , Arun Jayaraman
Objective
With growing interest in translating transcutaneous spinal cord stimulation (tSCS) into rehabilitation for different neurologic injuries, understanding the effects of various combinations of stimulation parameters becomes essential.
Methods
Twenty-one participants post-stroke completed an assessment to determine their resting motor threshold (RMT) (minimum current required to elicit a muscle response) and tolerance levels (uncomfortable current intensity) to 12 stimulation configurations: two square waveforms, biphasic and monophasic, paired with six carrier frequencies (unmodulated: 0, and modulated: 1, 3, 5, 7, and 10 kHz).
Results
The results demonstrated that increasing carrier frequency increased participants’ tolerance level and RMTs. Carrier frequency nor waveform type significantly altered discomfort when tolerance was normalized to the motor threshold, with 57 ± 23 % tolerated across all configurations. However, higher carrier frequencies, particularly biphasic waveforms at frequencies > 5 kHz, required more charge to reach a muscle activation and activated fewer muscles compared to unmodulated waveforms. No significant differences in discomfort relative to RMT were found between monophasic and biphasic waveforms.
Conclusions
Higher carrier frequency allows stimulation to be more comfortable at a given intensity, but it also requires more current to reach RMTs.
Significance
This study provides an essential feasibility assessment of tSCS configurations in a neurological population.
{"title":"The effects of stimulation waveform and carrier frequency on tolerance and motor thresholds elicited by transcutaneous spinal cord stimulation in stroke","authors":"Chen Yang , Nicole C. Veit , Kelly A. McKenzie , Shreya Aalla , Ameen Kishta , Kyle Embry , Elliot J. Roth , Richard L. Lieber , Arun Jayaraman","doi":"10.1016/j.cnp.2025.04.001","DOIUrl":"10.1016/j.cnp.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>With growing interest in translating transcutaneous spinal cord stimulation (tSCS) into rehabilitation for different neurologic injuries, understanding the effects of various combinations of stimulation parameters becomes essential.</div></div><div><h3>Methods</h3><div>Twenty-one participants post-stroke completed an assessment to determine their resting motor threshold (RMT) (minimum current required to elicit a muscle response) and tolerance levels (uncomfortable current intensity) to 12 stimulation configurations: two square waveforms, biphasic and monophasic, paired with six carrier frequencies (unmodulated: 0, and modulated: 1, 3, 5, 7, and 10 kHz).</div></div><div><h3>Results</h3><div>The results demonstrated that increasing carrier frequency increased participants’ tolerance level and RMTs. Carrier frequency nor waveform type significantly altered discomfort when tolerance was normalized to the motor threshold, with 57 ± 23 % tolerated across all configurations. However, higher carrier frequencies, particularly biphasic waveforms at frequencies > 5 kHz, required more charge to reach a muscle activation and activated fewer muscles compared to unmodulated waveforms. No significant differences in discomfort relative to RMT were found between monophasic and biphasic waveforms.</div></div><div><h3>Conclusions</h3><div>Higher carrier frequency allows stimulation to be more comfortable at a given intensity, but it also requires more current to reach RMTs.</div></div><div><h3>Significance</h3><div>This study provides an essential feasibility assessment of tSCS configurations in a neurological population.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 150-158"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876696","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.06.007
Ziyi Wang , Jiaojiao Guo , Eline Schaft , Sem Hoogteijling , Cyrille H. Ferrier , Gerhard H. Visser , Dongqing Sun , Friso Hoefnagels , Taku Inada , Sandra van der Salm , Geertjan Huiskamp , Nicole van Klink , Maryse van’t Klooster , Maeike Zijlmans , On behalf of the RESPect database study group
Objective
In intraoperative electrocorticography (ioECoG), interictal epileptiform discharges (IEDs) and high-frequency oscillations (HFOs; ripples 80–250 Hz, fast ripples (FRs) 250–500 Hz) can be identified in average or bipolar montage. We studied how montage choice affects event identification.
Methods
Two reviewers independently marked IEDs and HFOs across three montages (average, horizontal- and vertical-bipolar) from 13 patients who were seizure-free after ioECoG-guided surgery. We analyzed the number of channels-with-events, total events count, events morphology (maximum-amplitude, duration, frequency), number of instances with overlapping events across multiple channels (event_instance), concordance of event_instances over montages, and percentage of channels-with-events in the resected-area.
Results
Bipolar montages yielded more channels-with-events, higher counts, and greater maximum-amplitude of IEDs and ripples compared to average montages. Average and horizontal-bipolar montages yielded more IED_instances than vertical-bipolar montages. Average montages detected the highest percentage of event_instances occurring only in this montage. Event duration, frequency, and percentage of channels-with-events in the resected-area did not differ across montages.
Conclusions
All three ioECoG montages are clinically useful to find epileptic events. The bipolar montage detects more events with greater amplitude, while the average montage uncovers a wider variety of unique events. Combining montages provides complementary information.
Significance
This study quantitatively revealed how different montages capture epileptiform events.
{"title":"The optimal montage to mark interictal epileptiform discharges and high-frequency oscillations in intraoperative electrocorticography","authors":"Ziyi Wang , Jiaojiao Guo , Eline Schaft , Sem Hoogteijling , Cyrille H. Ferrier , Gerhard H. Visser , Dongqing Sun , Friso Hoefnagels , Taku Inada , Sandra van der Salm , Geertjan Huiskamp , Nicole van Klink , Maryse van’t Klooster , Maeike Zijlmans , On behalf of the RESPect database study group","doi":"10.1016/j.cnp.2025.06.007","DOIUrl":"10.1016/j.cnp.2025.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>In intraoperative electrocorticography (ioECoG), interictal epileptiform discharges (IEDs) and high-frequency oscillations (HFOs; ripples 80–250 Hz, fast ripples (FRs) 250–500 Hz) can be identified in <em>average</em> or <em>bipolar</em> montage. We studied how montage choice affects event identification.</div></div><div><h3>Methods</h3><div>Two reviewers independently marked IEDs and HFOs across three montages (<em>average,</em> horizontal- and vertical-<em>bipolar</em>) from 13 patients who were seizure-free after ioECoG-guided surgery. We analyzed the number of channels-with-events, total events count, events morphology (maximum-amplitude, duration, frequency), number of instances with overlapping events across multiple channels (event_instance), concordance of event_instances over montages, and percentage of channels-with-events in the resected-area.</div></div><div><h3>Results</h3><div><em>Bipolar</em> montages yielded more channels-with-events, higher counts, and greater maximum-amplitude of IEDs and ripples compared to <em>average</em> montages. <em>Average</em> and horizontal<em>-bipolar</em> montages yielded more IED_instances than vertical<em>-bipolar</em> montages. <em>Average</em> montages detected the highest percentage of event_instances occurring only in this montage. Event duration, frequency, and percentage of channels-with-events in the resected-area did not differ across montages.</div></div><div><h3>Conclusions</h3><div>All three ioECoG montages are clinically useful to find epileptic events. The <em>bipolar</em> montage detects more events with greater amplitude, while the <em>average</em> montage uncovers a wider variety of unique events. Combining montages provides complementary information.</div></div><div><h3>Significance</h3><div>This study quantitatively revealed how different montages capture epileptiform events.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 246-255"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562782","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.03.002
Matthias Thomas Exl , Belén Rodriguez , Karl Ng , Stella Veronica Tan , James Howells , Hugh Bostock , Hatice Tankisi , Werner J. Z’Graggen
Objective
To establish normative data for muscle excitability testing in the tibialis anterior muscle of a healthy population, and to determine their dependence on age and sex.
Methods
Parameters of muscle velocity recovery cycle recordings with 1, 2 and 5 conditioning stimuli of 197 healthy subjects and frequency ramp recordings of 151 healthy subjects were retrospectively analysed for age and sex differences.
Results
There were no differences by sex and only small age differences were found in healthy subjects older than 60 years for the muscle excitability parameters muscle relative refractory period, early supernormality and latency to the first response in a train at 15 Hz and 30 Hz.
Conclusions
In this study, based on a large sample of muscle velocity recovery cycle and frequency ramp recordings, we have provided normative data and shown that muscle excitability testing is not influenced by sex, and that age only has an influence from the age of 60 years onwards on parameters reflecting muscle membrane potential.
Significance
Our results suggest that future studies no longer need to control for sex when using a healthy control group.
{"title":"Muscle excitability testing: Age and sex dependency of normative data","authors":"Matthias Thomas Exl , Belén Rodriguez , Karl Ng , Stella Veronica Tan , James Howells , Hugh Bostock , Hatice Tankisi , Werner J. Z’Graggen","doi":"10.1016/j.cnp.2025.03.002","DOIUrl":"10.1016/j.cnp.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>To establish normative data for muscle excitability testing in the tibialis anterior muscle of a healthy population, and to determine their dependence on age and sex.</div></div><div><h3>Methods</h3><div>Parameters of muscle velocity recovery cycle recordings with 1, 2 and 5 conditioning stimuli of 197 healthy subjects and frequency ramp recordings of 151 healthy subjects were retrospectively analysed for age and sex differences.</div></div><div><h3>Results</h3><div>There were no differences by sex and only small age differences were found in healthy subjects older than 60 years for the muscle excitability parameters muscle relative refractory period, early supernormality and latency to the first response in a train at 15 Hz and 30 Hz.</div></div><div><h3>Conclusions</h3><div>In this study, based on a large sample of muscle velocity recovery cycle and frequency ramp recordings, we have provided normative data and shown that muscle excitability testing is not influenced by sex, and that age only has an influence from the age of 60 years onwards on parameters reflecting muscle membrane potential.</div></div><div><h3>Significance</h3><div>Our results suggest that future studies no longer need to control for sex when using a healthy control group.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 129-133"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681141","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.07.007
Betül Baykan , John Dunne , Samuel Wiebe , Louis Maillard , Sandor Beniczky , Michalis Koutroumanidis , Margitta Seeck
Objective
A joint International Federation of Clinical Neurophysiology — International League Against Epilepsy (IFCN-ILAE) Taskforce was created to explore the published evidence for initial EEGs in the evaluation of patients who experienced their first unprovoked seizure, and to determine the diagnostic value of EEG in supporting the diagnosis of epilepsy.
Methods
We conducted a systematic literature review, with two independent authors screening each study. We extracted seizure recurrence data among patients with EEG showing interictal epileptiform discharges (IEDs) versus those with normal or nonspecific-abnormal EEG results. Random-effects meta-analyses of seizure recurrence in relation to IEDs was conducted in the included studies, calculating odds ratios (OR) with confidence intervals (CI) and diagnostic accuracy.
Results
A total of 4847 patients from 22 studies with variable follow-up durations were analysed. The random-effects pooled binary estimate of seizure recurrence was 47 % (95 % CI 40 %–55 %). The overall proportion with seizure recurrence was higher in patients with IEDs (60 %; 95 % CI 53 %–68 %) compared to those without (40 %; 95 % CI 33 %–48 %, p < 0.001). Random-effects meta-analysis showed that the presence of IEDs was associated with seizure recurrence (OR: 2.32, 95 % CI 1.69–3.17, p < 0.001). Subgroup analyses of adults and children showed that this difference remained significant in both groups: OR in children of 3.24 (95 % CI 2.19–4.79) and in adults of 1.55 (95 % CI 1.08–2.21). In eight studies (n = 1209, 923 children) patients remained untreated before the second seizure; the pooled probability of seizure recurrence in those with IED in these studies was no different than in studies in which some patients were treated.
Significance
In conclusion, the presence of IEDs in EEG recordings obtained after the first unprovoked seizure can help clinicians to confirm the clinical diagnosis of epilepsy after a first unprovoked seizure, according to the revised ILAE definition. These results support the relevance of IED detection on EEG as a predictor of seizure recurrence after a first unprovoked seizure. However, its prognostic value is influenced by age and other clinical factors.
目的成立国际临床神经生理学联合会-国际抗癫痫联盟（IFCN-ILAE）联合工作组，探讨已发表的脑电图在评估首次非诱发性癫痫发作患者中的证据，并确定脑电图在支持癫痫诊断中的诊断价值。方法我们进行了系统的文献综述，由两位独立作者对每项研究进行筛选。我们提取了脑电图显示间期癫痫样放电（IEDs）的患者与脑电图结果正常或非特异性异常的患者之间的癫痫复发数据。在纳入的研究中进行癫痫发作复发与ied相关的随机效应荟萃分析，计算优势比（OR）、置信区间（CI）和诊断准确性。结果共分析了22项不同随访时间的4847例患者。随机效应汇总二值估计癫痫复发率为47% （95% CI为40% - 55%）。发作复发的总体比例在ied患者中（60%;95% CI 53% - 68%）高于无ied患者（40%;95% CI 33% - 48%, p < 0.001）。随机效应荟萃分析显示，ied的存在与癫痫发作复发相关（OR: 2.32, 95% CI 1.69-3.17, p < 0.001）。成人和儿童的亚组分析显示，两组的差异仍然显著：儿童OR为3.24 (95% CI 2.19-4.79)，成人OR为1.55 （95% CI 1.08-2.21）。在8项研究中（n = 1209,923名儿童），患者在第二次发作前未接受治疗；在这些研究中，IED患者癫痫发作复发的总概率与一些患者接受治疗的研究没有什么不同。总之，根据修订后的ILAE定义，在首次非诱发性癫痫发作后获得的脑电图记录中存在ied可以帮助临床医生确认首次非诱发性癫痫发作后癫痫的临床诊断。这些结果支持EEG上IED检测作为第一次非诱发性癫痫发作后癫痫复发的预测因子的相关性。但其预后价值受年龄及其他临床因素的影响。
{"title":"Presence of interictal epileptiform EEG discharges implies increased risk of recurrence after the first unprovoked seizure: Report of the International League Against Epilepsy and International Federation of Clinical Neurophysiology","authors":"Betül Baykan , John Dunne , Samuel Wiebe , Louis Maillard , Sandor Beniczky , Michalis Koutroumanidis , Margitta Seeck","doi":"10.1016/j.cnp.2025.07.007","DOIUrl":"10.1016/j.cnp.2025.07.007","url":null,"abstract":"<div><h3>Objective</h3><div>A joint International Federation of Clinical Neurophysiology — International League Against Epilepsy (IFCN-ILAE) Taskforce was created to explore the published evidence for initial EEGs in the evaluation of patients who experienced their first unprovoked seizure, and to determine the diagnostic value of EEG in supporting the diagnosis of epilepsy.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review, with two independent authors screening each study. We extracted seizure recurrence data among patients with EEG showing interictal epileptiform discharges (IEDs) versus those with normal or nonspecific-abnormal EEG results. Random-effects meta-analyses of seizure recurrence in relation to IEDs was conducted in the included studies, calculating odds ratios (OR) with confidence intervals (CI) and diagnostic accuracy.</div></div><div><h3>Results</h3><div>A total of 4847 patients from 22 studies with variable follow-up durations were analysed. The random-effects pooled binary estimate of seizure recurrence was 47 % (95 % CI 40 %–55 %). The overall proportion with seizure recurrence was higher in patients with IEDs (60 %; 95 % CI 53 %–68 %) compared to those without (40 %; 95 % CI 33 %–48 %, p < 0.001). Random-effects meta-analysis showed that the presence of IEDs was associated with seizure recurrence (OR: 2.32, 95 % CI 1.69–3.17, p < 0.001). Subgroup analyses of adults and children showed that this difference remained significant in both groups: OR in children of 3.24 (95 % CI 2.19–4.79) and in adults of 1.55 (95 % CI 1.08–2.21). In eight studies (n = 1209, 923 children) patients remained untreated before the second seizure; the pooled probability of seizure recurrence in those with IED in these studies was no different than in studies in which some patients were treated.</div></div><div><h3>Significance</h3><div>In conclusion, the presence of IEDs in EEG recordings obtained after the first unprovoked seizure can help clinicians to confirm the clinical diagnosis of epilepsy after a first unprovoked seizure, according to the revised ILAE definition. These results support the relevance of IED detection on EEG as a predictor of seizure recurrence after a first unprovoked seizure. However, its prognostic value is influenced by age and other clinical factors.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 380-391"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060317","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}
Pub Date : 2025-01-01DOI: 10.1016/j.cnp.2025.02.004
Sigrid Mues , Arndt Ebert , Marc Kämmerer , Marcus Kremers , Ulrich Sliwka , Rüdiger Hilker-Roggendorf , Dirk Woitalla , Iris Adelt , Thomas Günnewig , Ana Miron , Sulev Haldre , Tipakorn Tumnark , Kanjana Unnwongse , Wenke Grönheit , Tim Wehner , Vanessa Behrens , Jörg Wellmer
Objective
To realize multi-modal data exchange for telemedicine in epilepsy.
Methods
TE Ruhr is a multicenter, prospective pilot study. Primary endpoint of the study was the technical implementation of a platform between an epilepsy center and regional neurological departments and international cooperating epilepsy centers, respectively. A multi-professional board was established to develop technical workflows. After completion of the study a survey was conducted among users of the regional arm.
Results
Two workflows were developed, 1) a combination of web-application and use of an established teleradiology network, and 2) a web-application only data exchange. Technical workflow 1 comprised local EEG conversion into to a standard format (.besa) and its shipping as DICOM RAW object. Technically, both workflows could be implemented. Yet, workflow 1 was not realisable in peripheral hospitals. Via workflow 2, 149 consults for 144 patients were completed. Users of the regional arm were satisfied (1.6 on a grading scale of 1–6 (1-very good, 6- very bad)).
Conclusion
Technical feasibility alone does not determine the actual use of telemedicine. Web applications enables multimodal data exchange, but usability is limited due to lack of interoperability.
Significance
Genuine interoperability of medical data remains the desired goal for multi modal data exchange.
{"title":"Multimodal tele-epileptology: Challenges on the way to interoperable medical data","authors":"Sigrid Mues , Arndt Ebert , Marc Kämmerer , Marcus Kremers , Ulrich Sliwka , Rüdiger Hilker-Roggendorf , Dirk Woitalla , Iris Adelt , Thomas Günnewig , Ana Miron , Sulev Haldre , Tipakorn Tumnark , Kanjana Unnwongse , Wenke Grönheit , Tim Wehner , Vanessa Behrens , Jörg Wellmer","doi":"10.1016/j.cnp.2025.02.004","DOIUrl":"10.1016/j.cnp.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>To realize multi-modal data exchange for telemedicine in epilepsy.</div></div><div><h3>Methods</h3><div>TE Ruhr is a multicenter, prospective pilot study. Primary endpoint of the study was the technical implementation of a platform between an epilepsy center and regional neurological departments and international cooperating epilepsy centers, respectively. A multi-professional board was established to develop technical workflows. After completion of the study a survey was conducted among users of the regional arm.</div></div><div><h3>Results</h3><div>Two workflows were developed, 1) a combination of web-application and use of an established teleradiology network, and 2) a web-application only data exchange. Technical workflow 1 comprised local EEG conversion into to a standard format (.besa) and its shipping as DICOM RAW object. Technically, both workflows could be implemented. Yet, workflow 1 was not realisable in peripheral hospitals. Via workflow 2, 149 consults for 144 patients were completed. Users of the regional arm were satisfied (1.6 on a grading scale of 1–6 (1-very good, 6- very bad)).</div></div><div><h3>Conclusion</h3><div>Technical feasibility alone does not determine the actual use of telemedicine. Web applications enables multimodal data exchange, but usability is limited due to lack of interoperability.</div></div><div><h3>Significance</h3><div>Genuine interoperability of medical data remains the desired goal for multi modal data exchange.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 56-62"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552404","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}
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