Journal of Clinical Neurophysiology最新文献

{"title":"Low Frequency Stimulation and Seizure Induction in Pediatric and Young Adult Patients With Drug Resistant Epilepsy Undergoing Stereoelectroencephalography.","authors":"Caren Armstrong, Samuel B Tomlinson, Patrick Davis, William Ojemann, Sudha Kilaru Kessler, Benjamin C Kennedy, Erin C Conrad, Eric D Marsh","doi":"10.1097/WNP.0000000000001250","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001250","url":null,"abstract":"<p><strong>Purpose: </strong>Describe the tolerability and outcome of direct brain stimulation for seizure induction in children and young adults undergoing intracranial electroencephalography.</p><p><strong>Methods: </strong>Patients received low frequency stimulation (LFS) consisting of 30 seconds of 1 Hz bipolar, biphasic brain stimulation. A subset also received high frequency stimulation (HFS) for clinical purposes. Clinical data regarding epilepsy characteristics, stimulation, and outcomes were collected.</p><p><strong>Results: </strong>Fifty-four patients (aged 1.8 to 23.4 years) with pediatric onset epilepsy were enrolled at Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania. Side effects during LFS included focal sensation (22%) and motor responses (41%). Non-seizure electrographic abnormalities were noted during stimulation in 87% of patients. During LFS, typical clinical seizures were seen in 24% of patients. During HFS (50 Hz), 58% of 36 patients had seizures (71% typical semiology). In 30% of patients, stimulated typical clinical seizures identified a contact not previously identified as part of the seizure onset zone. Of 43 patients who went on to have resection, ablation, or neuromodulation, 39 patients had ≥12 months of follow-up. Although 84% of 19 patients with stimulated typical clinical seizures had a good outcome, 60% of 20 patients with atypical or no clinical seizures during stimulation had good outcomes (P = 0.09).</p><p><strong>Conclusions: </strong>LFS is well tolerated in pediatric and young adult DRE patients and in one fourth of cases identifies potential additional nodes of the seizure network. These data, consistent with adult studies, affirm that LFS has a role complementing HFS in evaluating pediatric DRE patients undergoing stereoelectroencephalography.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444031","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":"The Impact of Transcranial Direct Current Stimulation on Drug-Resistant Temporal Lobe Epilepsy.","authors":"Omar El-Nakah, Ann Ali AbdelKader, Nirmeen A Kishk, Radwa Mahmoud Azmy, Mohamed Khaled Al Menabbawy, Hagar Hassan Mourad, Eman El-Zamarany","doi":"10.1097/WNP.0000000000001201","DOIUrl":"10.1097/WNP.0000000000001201","url":null,"abstract":"<p><strong>Purpose: </strong>Cathodal transcranial direct current stimulation (c-tDCS), a noninvasive neuromodulation technique, is effective in reducing cortical excitability in patients with drug-resistant epilepsy.This study aimed to examine the impact of c-tDCS on seizure frequency, Liverpool Seizure Severity Scale, and electroencephalography in patients with drug-resistant temporal lobe epilepsy.</p><p><strong>Methods: </strong>A randomized, double-blind, placebo-controlled clinical trial was conducted on 30 patients with temporal lobe drug-resistant epilepsy. The patients were randomized into two groups. Group A received a once-daily split session (20 minutes stimulation-20 minutes break-20 minutes stimulation) on five consecutive days of 1 mA c-tDCS over the side of most frequent interictal epileptiform discharges or the area of suspected ictal onset. Group B underwent the sham sessions.</p><p><strong>Results: </strong>A statistically significant reduction in seizure frequency, Liverpool Seizure Severity Scale, and epileptiform discharges on the EEG record was detected in the c-tDCS group after one month of the five daily sessions.</p><p><strong>Conclusions: </strong>In patients with temporal lobe drug-resistant epilepsy, c-tDCS improved seizure control by lowering seizure frequency, severity, and epileptiform discharges in the EEG for up to one month after the sessions.</p><p><strong>Significance: </strong>This confirmatory study is consistent with several previous studies showing the efficacy of c-tDCS in reducing seizure frequency in patients with temporal lobe drug-resistant epilepsy.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"253-258"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707658","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":"Rapid EEG in Specific Clinical Situations.","authors":"Bogdan Patedakis Litvinov, Selim R Benbadis, Lawrence J Hirsch","doi":"10.1097/WNP.0000000000001237","DOIUrl":"10.1097/WNP.0000000000001237","url":null,"abstract":"<p><strong>Summary: </strong>Electroencephalography (EEG) is a critical tool for diagnosing epilepsy and recording seizures. Rapid EEG (rEEG) technology addresses challenges associated with traditional EEG by offering portable, easy-to-use systems that nonspecialists can deploy quickly. This review focuses on the clinical utility of rEEG, highlighting studies that explore its effectiveness in various settings, compare its performance to conventional EEG, and discuss its impact on patient outcomes, health care costs, and resource utilization. Among rEEG systems, Ceribell is the most studied, with clinical trials supporting its utility across multiple settings. Although rEEG offers significant advantages in rapid deployment and ease of use, limitations include reduced EEG channels and reliance on automated detection tools, emphasizing the need for expert oversight. Case studies illustrate both the utility and limitations of rEEG. Integration of rEEG into routine clinical practice promises improved patient outcomes, reduced healthcare costs, and more efficient resource utilization, particularly in emergency departments, critical care settings, and underserved areas.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"211-221"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344484","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":"Rapid-EEG Software Architecture's Clinical Impact: Advantages and Limitations.","authors":"Urs Fisch, Jong Woo Lee","doi":"10.1097/WNP.0000000000001188","DOIUrl":"10.1097/WNP.0000000000001188","url":null,"abstract":"<p><strong>Summary: </strong>Rapid electroencephalography (EEG) devices are portable, easy-to-use systems that provide automated EEG interpretation to guide clinical decisions at the bedside. The scope of this review outlines the principles of automatic EEG analysis methods and the impact of recent developments in artificial intelligence and machine learning on these techniques in the context of seizure detection. The first generation of rapid EEG devices, primarily developed for anesthesia management, were tested for seizure detection; although raw EEG traces and power density arrays from these devices were helpful in seizure monitoring, their proprietary algorithms were not reliable for this purpose. The next generation of rapid EEG devices were principally aimed at seizure detection. In several large retrospective research studies, deep learning algorithms have demonstrated equal or superior proficiency as compared with human experts. Recent guidelines from the US Food and Drug Administration describe several guiding principles for this class of algorithms to be incorporated into medical devices. However, the \"black box\" nature of proprietary algorithms remains a concern because it hinders understanding of the device's limitations and potential pitfalls. We advocate for transparent reporting of essential software features to foster a constructive interaction between clinical users and rapid EEG device developers. This transparency is crucial for the continuous improvement of these devices, their acceptance among users, and ultimately, better patient care.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"204-210"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344499","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":"Clinical Significance of Positive Spike Wave Discharges in the Pediatric Population: Insights Beyond Neonates.","authors":"Shishir Duble, Anita N Datta","doi":"10.1097/WNP.0000000000001203","DOIUrl":"10.1097/WNP.0000000000001203","url":null,"abstract":"<p><strong>Introduction: </strong>Positive spike wave (PSW) discharges on EEG are well-documented in neonates, but data regarding their significance in other populations are limited. This study aimed to assess the clinical significance of PSW in children aged 1 month to 19 years at a single tertiary care center over approximately three decades.</p><p><strong>Methods: </strong>Clinical information of children with focal PSW ( n = 326) was compared with control patients with focal negative interictal epileptiform discharges ( n = 898).</p><p><strong>Results: </strong>From 77,500 pediatric EEGs in our laboratory from 1992 to 2020, PSW were identified in 445 (0.57%) children, of which 326 met inclusion criteria. Positive spike waves were located in the following brain regions: occipital (139), central (65), frontal (63), temporal (43), parietal (9), and centro-temporal (7). Positive spike wave patients had a younger median age of seizure onset than control patients (1.1 years [0.30, 4.00] versus 4 years [1.3, 7.5], P < 0.001).Logistic regression analysis confirmed that PSW were associated with high odds of seizures [odds ratios (OR) 3.78; CI: 2.14-2.14; P < 0.005], epilepsy [OR 2.05; CI: 1.39-1.39; P < 0.005], and drug-resistant epilepsy, [OR 3.51; CI: 2.67-2.67; P < 0.005]. Furthermore, PSW correlated with a greater odd of developmental delay [OR 3.69; CI: 2.77-2.77; P < 0.005], school difficulties [OR 2.85; CI: 2.07-2.07; P < 0.005], abnormal neurologic exam [OR 2.8; CI: 2.15-2.15; P < <0.005], and structural brain abnormalities [OR 1.74; CI: 1.32-1.32; P < 0.005], such as malformation of cortical development, compared with control patients.</p><p><strong>Conclusions: </strong>Positive spike waves on pediatric EEG are associated with congenital or acquired brain abnormalities and less favorable seizure and neurodevelopmental outcomes.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"245-252"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855385","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":"Hardware Technology for Point-of-Care EEG: A Comprehensive Review.","authors":"Susan T Herman","doi":"10.1097/WNP.0000000000001240","DOIUrl":"10.1097/WNP.0000000000001240","url":null,"abstract":"<p><strong>Summary: </strong>Rapid or point-of-care (POC) EEG devices, bolstered by advancements in portability, ease of use, wireless technology, and artificial intelligence, are transforming the EEG field. Increasing demand for immediate neurophysiologic diagnosis, previously limited by the operational complexities and specialized personnel required for traditional EEG, has driven these critical shifts. These innovations extend EEG's reach beyond traditional neurophysiology labs to diverse clinical settings, including emergency departments, intensive care units, remote locations, and homes. POC EEG is particularly valuable for diagnosing acute neurologic emergencies such as nonconvulsive status epilepticus and nonconvulsive seizures, traumatic brain injury, and stroke, enabling faster seizure detection, improved triage, and timely treatment. POC EEG systems facilitate rapid acquisition of clinically acceptable EEG by nonexperts, including physicians and other health care providers, emergency personnel, nurses, and in some cases, remote caregivers and patients. Bedside interpretation is augmented by real-time artificial intelligence algorithms. POC EEG hardware, including its sensors, headsets, amplifiers, connectivity, form factor, and power, diverges significantly from conventional EEG systems. These modifications are explicitly engineered to optimize rapid deployment, patient comfort, and operational simplicity in resource-constrained or time-sensitive scenarios. The adaptations, however, may necessitate trade-offs in signal quality, flexibility, channel count, reliability, and cost compared with laboratory-grade systems. Understanding these inherent differences and how hardware designs address them is critical for selecting the optimal POC EEG technology for a specific use.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"191-203"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344521","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: Usefulness of the H-Reflex for Intraoperative Monitoring of Thoracoabdominal Aneurysms.","authors":"Guillermo Martín-Palomeque, Jaime R López","doi":"10.1097/WNP.0000000000001200","DOIUrl":"10.1097/WNP.0000000000001200","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"276-277"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707657","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":"Resection After Responsive Neurostimulation for Bilateral Mesial Temporal Epilepsy: Why Continuing Neurostimulation After Resection Matters.","authors":"Lia de Leon Ernst, Ahmed M Raslan, Christopher Zimmerman, Marissa Kellogg, William Brewster Smith","doi":"10.1097/WNP.0000000000001224","DOIUrl":"10.1097/WNP.0000000000001224","url":null,"abstract":"<p><strong>Purpose: </strong>Prior research has suggested that select patients with refractory bilateral mesial temporal lobe epilepsy (MTLE) treated with responsive neurostimulation (RNS) may benefit from eventual resection of the more active side. However, there is little guidance regarding the role for continuing RNS therapy after unilateral resection. Our series aims to help define the utility of continued RNS therapy after resection and offer guiding principles for neurostimulation in this context.</p><p><strong>Methods: </strong>Retrospective chart review was performed for patients who underwent RNS implant surgery for bilateral MTLE at our institution between the years 2015-2024.</p><p><strong>Results: </strong>Five patients with RNS treating bilateral hippocampi ultimately underwent selective mesial temporal lobe resection on the primary side. After resection, 4/5 became seizure-free immediately; patient 4 had a 70% seizure reduction, with reemergence of seizures on the less active side. After reprogramming RNS to increase total number of daily stimulations, patient 4 became seizure-free. All patients continued RNS therapy after resection with the ipsilateral electrode used for monitoring, while the contralateral electrode monitored and delivered stimulation. Two patients had transient interruptions of RNS stimulation after resection associated with seizure relapse, followed by return to seizure freedom once stimulation was restored.</p><p><strong>Conclusions: </strong>This series suggests that (1) unilateral remission in patients with bilateral MTLE being treated with RNS may be stimulation dependent; thus, stimulation should continue after unilateral resection; (2) unilateral seizure remission may depend on a particular threshold of number of stimulations per day.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"278-281"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541104","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":"H-reflex Monitoring During Thoracoabdominal Aneurysm Surgery: Optimizing Clinical Application.","authors":"Jongsuk Choi, Kieob Kim","doi":"10.1097/WNP.0000000000001199","DOIUrl":"10.1097/WNP.0000000000001199","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"276"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674931","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":"Inter-Rater Reliability of EEG-Based Encephalopathy Grading.","authors":"Ryan A Tesh, Anika Zahoor, Jayme Banks, Kaileigh Gallagher, Christine A Eckhardt, Haoqi Sun, Ioannis Karakis, Roohi Katyal, Jonathan Williams, Chetan Nayak, Aline Herlopian, Marcus C Ng, Adam S Greenblatt, Emma Meyers, Mike Westmeijer, Daniel S Harrison, Wolfgang Ganglberger, Galina Gheihman, Tracey Fan, Aaron F Struck, Irfan S Sheikh, Fábio A Nascimento, M Brandon Westover","doi":"10.1097/WNP.0000000000001185","DOIUrl":"10.1097/WNP.0000000000001185","url":null,"abstract":"<p><strong>Purpose: </strong>Visual EEG Confusion Assessment Method-Severity (VE-CAM-S) quantifies encephalopathy severity based on electroencephalography features. This study evaluated inter-rater reliability among experts using the VE-CAM-S scale.</p><p><strong>Methods: </strong>Nine experts from six institutions independently reviewed 32 15-second electroencephalography samples in an online test, assessing 29 features (16 in the VE-CAM-S and 13 additional, or \"VE-CAM-S+\"). A consensus of three experts served as the gold standard. Performance was measured by the median Matthews correlation coefficient between expert and gold-standard VE-CAM-S+ scores, along with average sensitivity and specificity. Qualitative analysis identified common feature-recognition errors affecting scores.</p><p><strong>Results: </strong>Experts achieved a median Matthews correlation coefficient of 0.82 [95% CI: 0.74-0.99]. Specificity exceeded 90% for most features except background β (87%) and generalized delta (71%). Sensitivity was ≥65% except for burst suppression with epileptiform activity (61%), extreme delta brush (EDB; 61%), posterior dominant rhythm (50%), background α (59%) and β (42%). Common errors included missing subtle findings, confusing features, and misidentifying extreme delta brush.</p><p><strong>Conclusions: </strong>This pilot study offers some initial support for the reliability of VE-CAM-S+ scoring. The largest errors occurred when experts missed or falsely identified features with higher weight in the VE-CAM-S. Encephalopathy grading through VE-CAM-S may be improved by breaking high-stakes features into smaller parts, creating a \"cheat sheet\" with scored examples, and designing teaching materials.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"237-244"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}