Journal of Clinical Neurophysiology最新文献

{"title":"Semiology of Seizures Involving the OFC: A Narrative Review About a Silent Epilepsy.","authors":"Alice Despins, Dang K Nguyen, Olivier Aron","doi":"10.1097/WNP.0000000000001183","DOIUrl":"10.1097/WNP.0000000000001183","url":null,"abstract":"<p><strong>Summary: </strong>The orbitofrontal cortex (OFC) is a highly interconnected region, cytoarchitectonically diverse. Seizures involving the OFC present significant diagnostic challenges because of their variable semiological features, which often overlap with those typically attributed to frontal and temporal epilepsies. Moreover, OFC seizures semiology is shaped by the epileptogenic zone network (EZN), involving either ictal propagation or reconfiguration of functional networks. We systematically reviewed 87 patients presenting seizures involving the OFC to analyze semiological profiles using the latest International League Against Epilepsy classification. We found that seizures with EZN restricted to the OFC displayed sparse semiology, including hyperkinetic behaviors, verbal automatisms, and frequent sleep association, while extended EZN seizures exhibited richer semiological profiles, varying according to EZN distribution. Temporal involvement correlated with more auras, oro-alimentary automatisms, and occurred more often with sleep, while frontal and insular participation involved hyperkinetic behaviors with more mimic and gestural automatisms. Semiological profiles of the OFC-restricted EZN seizures are concordant with propagation patterns that align with the functional connectivity of the OFC: lateral OFC seizures tend to propagate to the lateral and mesial frontal lobe while medial OFC seizures propagated to temporal lobe, either medial or polar. Despite population-level observations, semiological profiles alone seem insufficient for delimitation of extension or distribution of EZN. According to seizure semiology, \"frontal\" like profiles appear more frequent (∼2/3 of patients) while \"temporal\" like profiles were more associated with an extended EZN. These findings underscore the importance of comprehensive presurgical evaluations, to delineate EZN extension and distribution in seizures involving the OFC.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591367","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":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-02","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}

{"title":"Artificial Intelligence and Machine Learning in Neuromodulation for Epilepsy.","authors":"Brian Ervin, Ravindra Arya","doi":"10.1097/WNP.0000000000001186","DOIUrl":"10.1097/WNP.0000000000001186","url":null,"abstract":"<p><strong>Summary: </strong>Recent advances in artificial intelligence (AI) and machine learning (ML) can revolutionize neuromodulation therapies for drug-resistant epilepsy. Successful incorporation of AI/ML methods into the management of epilepsy can guide treatment decisions, enable interventions to adapt to dynamic epileptic networks, and hopefully improve patient outcomes. We introduce some common concepts in ML, focusing on neural networks, particularly convolutional and recurrent neural networks, and support vector machines, because these methods have been commonly applied to epilepsy neuromodulation. We discuss current AI/ML applications in neuromodulation, encompassing vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation, for the treatment of epilepsy. We consider how AI/ML methods leverage large data sets to enhance patient-specific epileptic network analysis, optimize stimulation targets, and refine closed-loop systems for real-time seizure detection and termination. AI/ML applications extend to recognizing autonomic and behavioral seizure surrogates, detecting interictal epileptiform activity, and forecasting seizures for preemptive interventions. Furthermore, AI-powered neuroimaging analysis can enhance segmentation accuracy for precise electrode placement, which can improve neuromodulation outcomes. We review which AI/ML tools have been applied to each problem, as well as their relative performance. Challenges remain, however, in translating AI/ML models into clinical settings due to interpatient variability and limited real-world validation. Future directions include integrating behavioral signals, developing AI-assisted clinical decision tools, and refining energy-efficient neurostimulation designs. Large language models and generative AI hold promise for optimizing patient-specific neuromodulation strategies. However, further research is required to validate AI/ML applications in clinical practice, enhance model generalizability, and address ethical concerns surrounding data privacy and AI-driven decision making.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"493-504"},"PeriodicalIF":1.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553628","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":"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":"Nerve Conduction Studies of Phrenic Nerve: Normative Data.","authors":"José Castro, Mamede de Carvalho","doi":"10.1097/WNP.0000000000001181","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001181","url":null,"abstract":"<p><strong>Introduction: </strong>In neuromuscular diseases, respiratory failure is a major complication. Pulmonary function tests are generally used to assess respiratory function but can be influenced by a number of factors. Nerve conduction studies of the phrenic nerve (PN) is a simple, noninvasive, and safe method to assess diaphragm compromise in neuromuscular diseases.</p><p><strong>Methods: </strong>A group of 132 (78 males) healthy subjects, aged between 23 and 90 years, was studied, with bilateral stimulation of the PN, with recording of diaphragm motor responses. Anthropometric variables (sex, age, height, and weight) were collected, and their influence on diaphragm motor response was assessed. Side-to-side differences were also analyzed.</p><p><strong>Results: </strong>PN compound muscle action potential (CMAP) had significantly higher amplitude and area on the left side. Men had longer latency, and higher amplitude and area when compared with women, on both sides. Age was a significant factor influencing CMAP latency, with an average increase of 0.25 ms per decade of life. In men, a latency longer than 9.5 ms and a CMAP amplitude lower than 0.62 mV should be considered abnormal, while in women, the values are 8.5 ms and 0.48 mV, respectively.</p><p><strong>Conclusions: </strong>PN conduction studies offer a simple and reliable technique readily applicable in clinical settings. Diaphragm CMAP parameters are significantly influenced by the anthropometric variables of sex and age. Notably, CMAP amplitude and area are greater for the left PN.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484606","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":"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":"505-512"},"PeriodicalIF":1.7,"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":"Response to: Alpha Rhythm, Alpha Coma and Entropy in EEG.","authors":"Giulio Degano, Pia De Stefano","doi":"10.1097/WNP.0000000000001178","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001178","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317050","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 Importance of Impedance: A Case of Responsive Neurostimulation Failure Characterized by Concurrent Stereoelectroencephalography.","authors":"Sandhya R Palit, Kevin Hines, Jamie J Van Gompel, Brian N Lundstrom, Nicholas M Gregg","doi":"10.1097/WNP.0000000000001176","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001176","url":null,"abstract":"<p><strong>Summary: </strong>Epilepsy neuromodulation treatment failure is a significant challenge, with multiple possible causes. The responsive neurostimulation (RNS) system delivers stimulation from a single current source, and the relative flow of the electrical current through each stimulating contact is inversely proportional to the relative impedance of each contact. Current shunting through low-impedance contacts (i.e., intraventricular contacts) can divert therapy away from the intended targets and may be a cause of treatment failure. We present a case of a patient with bitemporal epilepsy and bitemporal encephaloceles, with poor response to bilateral mesial temporal RNS, who completed stereotactic EEG (sEEG) monitoring to investigate the possible causes of treatment failure. The sEEG was safely completed without damaging the RNS device. The sEEG recorded independent bitemporal interictal epileptiform discharges and seizures, which did not arise from sampled encephalocele regions. The sEEG-recorded RNS stimulation artifact was reduced in the left mesial temporal region relative to the right, which suggested potential current shunting through the right-sided contacts. Impedance measurements confirmed several low-impedance contacts from the right lead, with associated intraventricular position on imaging. At last follow up, 161 days after replacement of the right lead, the patient experienced an additional 58% reduction in seizure burden. Effective therapy delivery by single-current-source neurostimulation systems, such as RNS, critically depends on relative electrode impedances. Current shunting through low-impedance contacts is an underappreciated potential cause of treatment failure. Routine impedance assessments and individualized stimulation programs are recommended to avoid unintended current diversion. Concurrent sEEG monitoring and active RNS are feasible and can characterize stimulation effects.</p>","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":"144289462","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}