Journal of Clinical Neurophysiology最新文献

{"title":"Trends and Demographic Disparities in the Utilization of Intraoperative Neuromonitoring in the United States, 2008 to 2021.","authors":"Ali Al-Salahat, Danielle B Dilsaver, Yu-Ting Chen, Rohan Sharma, Nidhi Kapoor, Evanthia Bernitsas","doi":"10.1097/WNP.0000000000001187","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001187","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative neuromonitoring (IONM) is a valuable tool to monitor the neural axis during various procedures and guide intervention aimed at managing operative complications. The literature lacks large scale data on trends and demographic disparities in IONM use in the United States.</p><p><strong>Methods: </strong>Data were abstracted from the 2008-2021 National Inpatient Sample. Hospitalizations for neurosurgical (spinal, craniotomy, carotid artery, cranial/peripheral nerve), cardiac/vascular, and head/neck/thyroid procedures were identified and stratified by IONM use. Logistic regression models were estimated to assess disparities and trends in IONM use. Multivariable models adjusted for patient- and facility-level characteristics.</p><p><strong>Results: </strong>From 2008 to 2021, the rate of IONM use increased significantly in neurosurgical (3.69% to 18.62%, p < 0.001) and cardiac/vascular procedures (0.018% to 0.6%, p < 0.001). IONM use for head/neck/thyroid procedures increased steadily until 2014 and then declined (p < 0.001). Compared with hospitalizations of White patients, Black (aOR = 0.87, 95% CI: 0.81-0.94) and Hispanic (aOR = 0.88, 95% CI: 0.81-0.96) patients were associated with lower odds of IONM use during craniotomy. Lower incomes (0-25th quartile) were associated with lower odds of IONM use in both spinal (aOR = 0.83, 95% CI: 0.78-0.88) and craniotomy procedures (aOR = 0.78, 95% CI: 0.72-0.85).</p><p><strong>Conclusions: </strong>There is a growing demand for IONM to enhance the safety of various procedures, indicating a need for neurologists and technologists with this expertise. In addition, we found significant racial/ethnic and socioeconomic disparities in IONM use. These findings can be valuable for health care administrators and policymakers to address disparities in the access to IONM.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call for the Inclusion of Standardized Filter Parameters in the ACNS Standardized Critical Care EEG Terminology.","authors":"Fábio A Nascimento, Lawrence J Hirsch, Peter W Kaplan, Aatif Husain, Donald Schomer, Sándor Beniczky","doi":"10.1097/WNP.0000000000001180","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001180","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial High-Frequency Oscillations and Epileptogenic Zone: Incorporating Neuroanatomic Variation.","authors":"Daniel Wendelken, Brian Ervin, Jason Buroker, Craig Scholle, Hansel M Greiner, Jeffrey R Tenney, Katherine D Holland, Jesse Skoch, Francesco T Mangano, Ali Minai, Ravindra Arya","doi":"10.1097/WNP.0000000000001182","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001182","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if incorporating neuroanatomic or intersubject variation in the occurrence rate of intracranial high-frequency oscillations improves its diagnostic performance for localization of epileptogenic zone (EZ).</p><p><strong>Methods: </strong>Five minutes of awake stereo-electroencephalography data from 59 patients were analyzed. High-frequency oscillations were analyzed using three different normalization methods: rate per minute, by neuroanatomic region across the patient population, and patient-wise. Generalized linear mixed effects models were trained in patients with good seizure outcomes after epilepsy surgery (higher confidence in the clinical localization of EZ) and tested in patients with poorer outcomes (validation set approach).</p><p><strong>Results: </strong>The generalized linear mixed model with region-wise normalization across the patient population best localized the EZ (highest area under the curve 0.69), closely followed by the rate per minute (0.68). In the test subgroup, the optimal generalized linear mixed model predicted EZ in individual patients with an accuracy of 0.18 to 0.86, sensitivity of 0.05 to 1.00, and specificity of 0.12 to 0.95. In patients with poorest performance of the generalized linear mixed model, although the electrode contacts within EZ were correctly identified, there was a high number of false positives (model-predicted electrode contacts lying outside clinically ascertained EZ). Model performance varied across neuroanatomic regions, with the highest accuracy in the medial/orbital frontal (0.8), lateral temporal (0.78), and lateral parietal (0.76) regions.</p><p><strong>Conclusions: </strong>Normalizing the high-frequency oscillation occurrence rate by neuroanatomic region improves its diagnostic performance as an interictal biomarker of EZ location. High-frequency oscillations are more likely to reliably identify electrode contacts within EZ in medial/orbital frontal lobe and temporal neocortex.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalizing Responsive Neurostimulation for Epilepsy.","authors":"Vikram R Rao","doi":"10.1097/WNP.0000000000001179","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001179","url":null,"abstract":"<p><strong>Summary: </strong>Over the past 20 years, responsive neurostimulation (RNS), a closed-loop device for treating certain forms of drug-resistant focal epilepsy, has become ensconced in the epileptologist's therapeutic armamentarium. Through neuromodulatory effects, RNS therapy gradually reduces seizures over years, providing diagnostically valuable intracranial recordings along the way. However, the neuromodulatory potential of RNS therapy has not been fully harnessed. Seizure reduction is often slow, outcomes vary across individuals and defy prognostication, seizure freedom is uncommon, and many patients do not derive significant benefit. These limitations may stem from the \"black box\" nature of RNS therapy. The antiseizure mechanism(s) of RNS remain poorly understood, and, in the absence of first principles to inform selection of the candidates most likely to benefit, the ideal brain regions to target, and the most effective stimulation parameters, contemporary use of RNS therapy is largely empiric. Fortunately, recent advances in neuroimaging, neurophysiology, artificial intelligence, and engineering have made the goal of rational, personalized neurostimulation a near-term reality. Here, we review recent progress toward this goal, focusing on novel approaches to patient selection, brain network topology, state-dependent effects, and stimulation parameter optimization. By considering the who, where, when, and how of RNS, we highlight emerging paradigm shifts that will help usher in a new age of RNS therapy that is more personalized and more effective.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alpha Rhythm, Alpha Coma, and Entropy in EEG.","authors":"Jose Luis Perez Velazquez, Diego Martin Mateos, Richard Wennberg","doi":"10.1097/WNP.0000000000001177","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001177","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor \"The Intracranial Source of Cortico-Cortical Evoked Potentials\" by Odile Feys and Fabrice Bartolomei.","authors":"Benjamin C Cox, Rachel J Smith, Ismail Mohamed, Jenna V Donohue, Mahtab Rostamihosseinkhani, Jerzy P Szaflarski, Rebekah J Chatfield","doi":"10.1097/WNP.0000000000001174","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001174","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic Muscle Thickness Assessment Correlates With Disease Burden and Progression in Charcot-Marie-Tooth 1A Disease.","authors":"Bar Ravid, David Krivitski, Elisheva Nechushtan, Alon Abraham","doi":"10.1097/WNP.0000000000001172","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001172","url":null,"abstract":"<p><strong>Purpose: </strong>Charcot-Marie-Tooth disease (CMT), the most common form of hereditary neuropathy causes varying disability. Valid and accessible tools are needed for clinical and research evaluation. Previous studies have shown sonographic muscle thickness correlates with clinical and electrophysiological findings in many neuromuscular disorders. This study examines the correlation between muscle thickness in CMT1A patients with disease progression and clinical parameters, including the CMT neuropathy scale.</p><p><strong>Methods: </strong>Prospective study evaluating CMT1A patients between January and December 2023 at the neuromuscular unit in Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Patients underwent comprehensive clinical evaluation including the CMT neuropathy scale, and quantitative sonographic evaluation of muscle thickness in eight limb muscles.</p><p><strong>Results: </strong>Eight CMT1A patients were examined, five on two occasions. Sum muscle thickness measured by ultrasound strongly correlated with most clinical parameters, including the CMT neuropathy scale. However, disease progression showed strong correlation with CMT neuropathy scale only.</p><p><strong>Conclusions: </strong>In CMT1A patients, standardized quantitative sonographic muscle thickness assessment is a valid and promising tool for evaluating disease burden and, to a lesser extent, progression, showing strong correlations with key clinical parameters. Consistent with prior studies of other neuromuscular disorders.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Adherence to a Subcutaneous Two-Channel EEG System in Patients With Focal Epilepsy.","authors":"Nicolas Zabler, Yulia Novitskaya, René Sprünken, Martin Hirsch, Matthias Dümpelmann, Andreas Schulze-Bonhage","doi":"10.1097/WNP.0000000000001169","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001169","url":null,"abstract":"<p><strong>Purpose: </strong>Outpatient seizure monitoring is crucial for optimizing treatment strategies in epilepsy; however, traditional approaches such as seizure diaries and wearables have limitations in accuracy and practicality. This study evaluated the adherence and utility of an implanted subcutaneous EEG monitoring system in patients with focal temporal lobe epilepsy.</p><p><strong>Methods: </strong>At a tertiary epilepsy center, patients with focal epilepsy received a subcutaneous two-channel EEG system for ultra-long-term monitoring. The system includes a subcutaneously implanted electrode for data recording and a behind-the-ear companion device for the power supply and data transmission. Patient adherence to the device was evaluated using generalized estimating equations, considering sex, daytime/nighttime periods, age, and temporal course of measurements. The correlations between adherence and electrographic or diary-recorded seizures were also assessed.</p><p><strong>Results: </strong>Fifteen adult patients (mean age: 45.6 years, 6 females) were monitored for an average of 200.6 days, with 416 electrographic seizures confirmed in 13 patients. The median adherence was 89.3% (interquartile range, [75.6%, 93.4%]), with females showing significantly higher adherence than males (β, -1.1600; P = 0.049). Seizure diary reporting sensitivity and precision were 20.8% and 56.4%, respectively, compared with confirmed electrographic seizures. Adherence correlated positively with confirmed electrographic seizures (r, 0.40; P, 0.004), but not with diary reports (r, -0.22; P, 0.13).</p><p><strong>Conclusions: </strong>Patients using the subcutaneous EEG system demonstrated high adherence and reliable seizure monitoring, suggesting that it could serve as a valuable tool for managing focal epilepsy in clinical practice.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Electroencephalography Biomarkers in Patients With Anti-N-methyl-D-aspartate Receptor Encephalitis: A Case-Control Study.","authors":"César Alejandro David Cancino, Carlos Trenado, Peter W Kaplan, Felipe Alberto Gómez Ávila, María Del Carmen Fernández González-Aragón, Álvaro José Moreno Avellán, Carlos Alberto Soto Rincón, Gerardo Arturo Quiñones Pesqueira, Daniel San-Juan","doi":"10.1097/WNP.0000000000001124","DOIUrl":"10.1097/WNP.0000000000001124","url":null,"abstract":"<p><strong>Purpose: </strong>Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune reaction involving Immunoglobulin G antibodies against GluN1 subunit of NMDAR. Absence of biomarkers for early diagnosis and prognosis poses a challenge. Several small case-control studies have emphasized the prospect of quantitative EEG measurements. This study aimed to analyze and identify novel scalp quantitative EEG biomarkers and their implications on outcome of NMDRA encephalitis compared with a control group.</p><p><strong>Methods: </strong>Retrospective (2012-2021) case-control study of patients with NMDRA encephalitis and with acute/subacute encephalitis from other causes. Clinical variables and outcomes were assessed with modified Rankin Scale at admission, discharge, and follow-up. All patients underwent extensive diagnostic workup, including scalp EEG within 72 hours of admission. Quantitative EEG was calculated for Renyi, Tsalis entropy, Hjorth complexity, mean energy, and spectral power of the following frequency bands and ratios: delta (0.5-4 Hz), theta (5-8 Hz), alpha (9-14 Hz), beta (15-30 Hz), gamma (31-45 Hz), gamma-beta, beta/alpha, beta/theta, and beta/delta. Descriptive statistics, power frequency bands, complexity measures, and Wilcoxon rank sum test were used.</p><p><strong>Results: </strong>Patients with anti-NMDAR encephalitis had significantly higher delta frequency peak power, higher beta/alpha and gamma/beta frequency ratios, lower alpha and beta peak power, and lower beta/delta frequency ratio than the control group. In patients with anti-NMDAR encephalitis, higher delta and alpha peak power had the worst clinical outcome, at discharge and follow-up, and patients with higher gamma peak power had better outcomes.</p><p><strong>Conclusions: </strong>Quantitative EEG is a valuable tool to differentiate anti-NMDAR encephalitis from other inflammatory encephalitis and predict outcomes in patients with anti-NMDAR encephalitis.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"314-322"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of Bereitschaftspotential in People With Functional Seizures.","authors":"Christoph S Dietze, Dieke van Waart-Houtman, Anne Marthe Meppelink, Mireille Bourez-Swart, Job van der Palen, Maeike Zijlmans, Sandra M A van der Salm","doi":"10.1097/WNP.0000000000001123","DOIUrl":"10.1097/WNP.0000000000001123","url":null,"abstract":"<p><strong>Purpose: </strong>Bereitschaftspotential (BP) or readiness potential in people with functional movement disorders can aid diagnostic workup. We evaluated the diagnostic value of BP as an interictal EEG marker in people with functional seizures (FS).</p><p><strong>Methods: </strong>We recorded and analyzed BP interictal before intended movements in 17 adults with FS and 17 controls with alternative diagnoses. We evaluated the signals for the presence of BP, latency, amplitude, and early versus late BP.</p><p><strong>Results: </strong>Bereitschaftspotential was present in all except one person with FS. We found no significant differences in the latency and amplitude of BP between participants with FS and controls. The early BP showed the most significant variance in amplitude, latency, and presence.</p><p><strong>Conclusions: </strong>We found interictal typical BP values in participants with FS and variable semiology, while earlier research found interictal no BP in functional movement disorders. These findings do not support the use of BP as an interictal diagnostic tool for FS. Differences in early BP and focus on FS with pure motor semiology are starting points for further research evaluating potential interictal markers in people with FS.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"331-335"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}