Journal of Clinical Neurophysiology最新文献

{"title":"Book Review for Neuromuscular and Electrodiagnostic Medicine Board Review.","authors":"Nicholas Purcell, Pitcha Chompoopong","doi":"10.1097/WNP.0000000000001111","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001111","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365430","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":"Density Spectral Array EEG for Sleep Staging in Pediatric Patients.","authors":"Robert J Rudock, Ashley D Turner, Michael Binkley, Rebekah Landre, Michael J Morrissey, Stuart R Tomko, Réjean M Guerriero","doi":"10.1097/WNP.0000000000001117","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001117","url":null,"abstract":"<p><strong>Purpose: </strong>Sleep is an essential physiologic process, which is frequently disrupted in children with illness and/or injury. Accurate identification and quantification of sleep may provide insights to improve long-term clinical outcomes. Traditionally, however, the identification of sleep stages has relied on the resource-intensive and time-consuming gold standard polysomnogram. We sought to use limited EEG data, converted into density spectrum array EEG, to accurately identify sleep stages in a clinical pediatric population.</p><p><strong>Methods: </strong>We reviewed 87 clinically indicated pediatric polysomnographic studies with concurrent full montage EEG, between March 2017 and June 2020, of which 11 had normal polysomnogram and EEG interpretations. We then converted the EEG data of those normal studies into density spectral array EEG trends and had five blinded raters classify sleep stage (wakefulness, nonrapid eye movement [NREM] 1, NREM 2, NREM 3, and rapid eye movement) in 5-minute epochs. We compared the classified sleep stages from density spectral array EEG to the gold standard polysomnogram.</p><p><strong>Results: </strong>Inter-rater reliability was highest (κ = 0.745, P < 0.0001) when classifying state into wakefulness, NREM sleep, and rapid eye movement sleep. Agreement between group classification and polysomnogram was highest (κ = 0.873, [0.819, 0.926], P < 0.0001) when state was classified into wakefulness and sleep and was lowest (κ = 0.674 [0.645, 0.703], P < 0.0001) when classified into wakefulness, NREM 1, NREM 2, NREM 3, and rapid eye movement. The most common error that raters made was overscoring of NREM 1.</p><p><strong>Conclusions: </strong>Density spectral array EEG can be used to identify sleep stages in clinical pediatric patients without relying on traditional polysomnography.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371979","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":"Early Electrophysiology in Suspected Acute Guillain-Barré Syndrome: A Prospective Study of Comprehensive Testing.","authors":"Antony Winkel, Lauren Sanders, Linda Seiderer, Mark Cook, Leslie Roberts","doi":"10.1097/WNP.0000000000001122","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001122","url":null,"abstract":"<p><strong>Purpose: </strong>Electrophysiologic changes in early Guillain-Barré Syndrome (GBS) can be nondiagnostic. Improved testing paradigms may improve hyperacute treatment.</p><p><strong>Methods: </strong>This work prospectively evaluated consecutive patients admitted to a metropolitan teaching hospital in Melbourne, Australia, with suspected acute GBS. We performed extensive neurophysiology at three different time points. Novel tests, including cutaneous silent periods, long latency reflexes, and contraction-induced H reflexes, were assessed.</p><p><strong>Results: </strong>Twenty-three participants were studied, including 13 cases of acute GBS. In total, 69% of acute cases of GBS were accurately diagnosed on the first nerve conduction study using published neurophysiologic criteria, with serial studies rarely altering the GBS subtype classification. Antidromic and orthodromic upper limb sensory studies were diagnostically equivalent. A sural sparing pattern was seen in 77% of cases of GBS at the first test. Long latency reflexes and contraction-induced H reflexes testing were abnormal in most participants but were limited by muscle weakness in some. Cutaneous silent periods testing was unobtainable in approximately 50% of cases because of weakness and did not discriminate from mimic disorders.</p><p><strong>Conclusions: </strong>Abnormalities of long latency reflexes and contraction-induced H reflexes may be helpful where initial electrophysiology is nondiagnostic but are nonspecific. Cutaneous silent periods testing seems of limited value. Comprehensive testing provides diagnostic certainty in most cases of GBS from the very first study.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347646","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":"Cochlear Implant Artifacts in Continuous Electroencephalogram Recording.","authors":"Anuranjita Nayak,Henri Traboulsi,Anne E Anderson,Alyssa Runco,James J Riviello","doi":"10.1097/wnp.0000000000001116","DOIUrl":"https://doi.org/10.1097/wnp.0000000000001116","url":null,"abstract":"Cochlear implants to aid sensorineural hearing loss are becoming commonplace. In this study, we describe two cases that showed artifacts related to the cochlear implant device during scalp EEG recording. To our knowledge, cochlear implant artifacts have not been reported previously. Recognizing cochlear implant artifacts will avoid misinterpretation and resultant inappropriate treatment.","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"33 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195619","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 Utility of Motor Evoked Potential Monitoring for Predicting Postoperative Motor Deficit in Patients With Insular Gliomas.","authors":"Xing Fan, Hao You, Jiajia Liu, Xiaorong Tao, Mingran Wang, Ke Li, Jun Yang, Jian Xie, Hui Qiao","doi":"10.1097/WNP.0000000000001026","DOIUrl":"10.1097/WNP.0000000000001026","url":null,"abstract":"<p><strong>Purpose: </strong>Motor evoked potential (MEP) monitoring has been widely applied in various neurosurgical operations. This study aimed to assess the predictive value of MEP monitoring for postoperative motor deficit (PMD) in patients with insular gliomas.</p><p><strong>Methods: </strong>Demographic and clinical data, MEP monitoring data, and follow-up data of 42 insular glioma patients were retrospectively reviewed, and 40 patients were finally enrolled. The value of MEP monitoring for predicting PMD was assessed with sensitivity, specificity, and false-positive/false-negative rates. Binary multivariate logistic regression analysis was performed to further identify the predictive value of MEP monitoring.</p><p><strong>Results: </strong>Statistical analysis showed that irreversible MEP changes, but not all MEP changes, were more effective in predicting PMD. The sensitivity and specificity of irreversible MEP changes for predicting long-term PMD were 85.71 and 93.94%, whereas the false-positive and -negative rates were 25.00 and 3.12% respectively. In addition, irreversible MEP changes were identified as the only independent predictor for long-term PMD (odds ratio, 101.714; 95% confidence interval, 6.001-1724.122; p = 0.001).</p><p><strong>Conclusions: </strong>MEP monitoring has been proven to be feasible in insular glioma surgery. Irreversible MEP changes showed good performance in predicting PMD. Their absence can offer an optimistic expectation for the long-term motor outcome. The findings can provide the surgical team with a more effective interpretation of MEP changes and contribute to exploring tailored MEP warning criteria.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"537-541"},"PeriodicalIF":2.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41118237","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":"Intraoperative Monitoring of the External Urethral Sphincter Reflex: A Novel Adjunct to Bulbocavernosus Reflex Neuromonitoring for Protecting the Sacral Neural Pathways Responsible for Urination, Defecation and Sexual Function.","authors":"Justin W Silverstein, Jon Block, Zachary T Olmsted, Ross Green, Thomas Pieters, Kristiana Babarevech, Alicia Ballas-Williamson, Stanley A Skinner, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1097/WNP.0000000000001019","DOIUrl":"10.1097/WNP.0000000000001019","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative bulbocavernosus reflex neuromonitoring has been utilized to protect bowel, bladder, and sexual function, providing a continuous functional assessment of the somatic sacral nervous system during surgeries where it is at risk. Bulbocavernosus reflex data may also provide additional functional insight, including an evaluation for spinal shock, distinguishing upper versus lower motor neuron injury (conus vs. cauda syndromes) and prognosis for postoperative bowel and bladder function. Continuous intraoperative bulbocavernosus reflex monitoring has been utilized to provide the surgeon with an ongoing functional assessment of the anatomical elements involved in the S2-S4 mediated reflex arc including the conus, cauda equina and pudendal nerves. Intraoperative bulbocavernosus reflex monitoring typically includes the electrical activation of the dorsal nerves of the genitals to initiate the afferent component of the reflex, followed by recording the resulting muscle response using needle electromyography recordings from the external anal sphincter.</p><p><strong>Methods: </strong>Herein we describe a complementary and novel technique that includes recording electromyography responses from the external urethral sphincter to monitor the external urethral sphincter reflex. Specialized foley catheters embedded with recording electrodes have recently become commercially available that provide the ability to perform intraoperative external urethral sphincter muscle recordings.</p><p><strong>Results: </strong>We describe technical details and the potential utility of incorporating external urethral sphincter reflex recordings into existing sacral neuromonitoring paradigms to provide redundant yet complementary data streams.</p><p><strong>Conclusions: </strong>We present two illustrative neurosurgical oncology cases to demonstrate the utility of the external urethral sphincter reflex technique in the setting of the necessary surgical sacrifice of sacral nerve roots.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"558-564"},"PeriodicalIF":2.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107591348","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":"High-Frequency Stimulation of the Centromedian Thalamic Nucleus Aborts Seizures and Ictal Apnea.","authors":"Cody L Nathan, Jay R Gavvala, Ganne Chaitanya, Elizabeth Cunningham, Jungwha Julia Lee, Scott Adney, Joshua Rosenow, Stephan Schuele, Elizabeth Gerard","doi":"10.1097/WNP.0000000000001098","DOIUrl":"10.1097/WNP.0000000000001098","url":null,"abstract":"<p><strong>Summary: </strong>A 32-year-old right-handed woman presented with medically and surgically refractory left temporal neocortical epilepsy secondary to focal cortical dysplasia who underwent stereoelectroencephalography involving the centromedian nucleus of the thalamus. With the use of real-time stereoelectroencephalography monitoring, four electroclinical seizures were aborted by administering high-frequency stimulation at the centromedian nucleus at seizure onset. Seizures before stimulation were all associated with ictal apnea, while those with stimulation had no ictal apnea. This case demonstrates how providing high-frequency stimulation to the centromedian nucleus of the thalamus can abort electroclinical seizures and ictal apnea.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"570-574"},"PeriodicalIF":2.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446288","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":"Comparison Between Cz-C3/C4 and C3-C4 Montages to Protect Against Peripheral Stimulation in Transcranial Facial Motor-Evoked Potential Monitoring.","authors":"Ryuta Matsuoka, Naoya Hamada, Nobuyuki Nishimura, Takaaki Mitsui, Yuki Shiraishi, Hiromichi Hayami, Kenji Fukutome, Rinsei Tei, Yasushi Shin, Shuta Aketa, Daizo Kato, Takashi Kita, Yasushi Motoyama","doi":"10.1097/WNP.0000000000001024","DOIUrl":"10.1097/WNP.0000000000001024","url":null,"abstract":"<p><strong>Introduction: </strong>In facial motor-evoked potential monitoring, efforts to reduce peripheral stimulation are necessary because it can cause false-negatives. The effects of peripheral stimulation on Cz-C3/C4 and C3-C4 montages were compared.</p><p><strong>Methods: </strong>Facial motor-evoked potentials were recorded from bilateral orbicularis oculi (Oculi) and oris (Oris) muscles. The double-train approach combining single-pulse and five-train pulse stimulation was used to determine the effect of peripheral stimulation. If the five-train pulse produced a significant waveform, it was defined as \"total success.\" In total success cases, \"true success\" was defined as a case in which no waveform appeared after the single pulse at the threshold level of the five-train pulse. The total and true success rates and the threshold value of Oculi and Oris were compared between Cz-C3/C4 and C3-C4 montages.</p><p><strong>Results: </strong>Thirty-six muscles each of Oculi and Oris of 18 patients were used for the analysis. True success was more likely to be obtained by the Cz-C3/C4 montage than the C3-C4 montage in Oculi (42% vs. 22%, p = 0.039). Both Oculi and Oris had higher thresholds to elicit facial motor-evoked potentials with the Cz-C3/C4 montage (Oculi: 101.7 vs. 71.4 mA, p = 0.038; Oris: 94.8 vs. 73.1 mA, p = 0.016).</p><p><strong>Conclusions: </strong>Cz-C3/4 montage is more effective at reducing peripheral stimulation compared with the C3-4 montage. This effect was primarily seen in the orbicularis oculi muscle. It should be noted that the Cz-C3/C4 montage has a higher threshold than the C3-C4 montage in facial muscles. In facial motor-evoked potential monitoring, the Cz-C3/C4 montage may be more suitable to eliminate peripheral stimulation.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"565-569"},"PeriodicalIF":2.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107591347","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":"Epileptiform Discharges Recorded as Monopoles and Dipoles in the EEG: A Practical Approach to Differentiate Tangential and Radial Generators Using Electrode Position Versus Voltage Graphs.","authors":"Naiara Garcia-Losarcos, Yu Hongxuyang, Suraj Thyagaraj, Johnson P Hampson, Hans Lüders","doi":"10.1097/WNP.0000000000001080","DOIUrl":"10.1097/WNP.0000000000001080","url":null,"abstract":"<p><strong>Summary: </strong>Differentiating dipoles (tangential generators) from monopoles (radial generators) in routine EEG reading can be difficult. The polarity of sharp waves seen on surface EEG will change depending on the generator being located at the wall of the sulcus versus the crown of a gyrus. In this article, the authors introduce visual rules that may be used to determine polarity and estimate the localization of potentials during analysis of the EEG. They also review a practical approach to differentiate monopoles (radial generators) from dipoles (tangential dipoles) in the surface EEG using \"electrode position versus voltage graphs.\" Finally, the authors illustrate examples of dipoles and monopoles with focal spikes located in the following locations: (1) bipolar spikes located in the anterior bank of the central sulcus, (2) bipolar spikes located in the posterior bank of the central sulcus, (3) monopolar spikes located in the crown of the precentral gyrus, (4) bipolar spikes with a vertically oriented dipole originated within the temporal (inferior) bank of the Sylvian fissure, and (5) monopolar spikes located in the convexity of a temporal gyrus. In summary, this article discusses electrographic features of spikes localized in various fissures and gyri and provides practical rules that permit the identification and location of dipoles and monopoles in standard scalp EEG recordings.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"41 6","pages":"495-506"},"PeriodicalIF":2.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072989","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 Intracranial EEG Lateralization of Epileptogenicity in Patients With Confirmed or Suspected Bilateral Mesial Temporal Lobe Onsets During Epilepsy Surgical Evaluation.","authors":"Amir M Arain, Emily A Mirro, Dan Brown, Angela Peters, Blake Newman, Sindhu Richards, John D Rolston","doi":"10.1097/WNP.0000000000001028","DOIUrl":"10.1097/WNP.0000000000001028","url":null,"abstract":"<p><strong>Purpose: </strong>The data resulting from epilepsy surgical evaluation are occasionally unclear in cases of mesial temporal lobe (MTL) epilepsy. Long-term intracranial EEG (iEEG) collected by the Responsive Neurostimulation (RNS) System may be an approach for capturing additional seizure data while treating patients with neurostimulation. We reviewed iEEG seizure lateralization and clinical outcomes in bilateral MTL patients at University of Utah.</p><p><strong>Methods: </strong>Long-term RNS System iEEG seizure lateralization was compared with pre-RNS System lateralization obtained during surgical evaluation. Safety and clinical outcomes were extracted retrospectively from patient records.</p><p><strong>Results: </strong>Twenty-six patients received an RNS System with bilateral MTL leads. Fifteen of the patients had adequate follow-up to report clinical outcomes ( > 1 year), and 25 patients had enough recorded data ( > 6 months) to perform iEEG analysis. Median percent reduction in clinical seizures at last follow-up was 58%, and 40% reported being seizure-free at last follow-up, for variable durations. The electrographic seizure lateralization (unilateral vs. bilateral) differed between surgical evaluation and long-term iEEG in 44% of our patients. In the subset of eight patients (32%) who had only unilateral seizures recorded during surgical evaluation, but were implanted with bilateral MTL leads based on bilateral interictal epileptiform discharges, 62% (5/8) had bilateral seizures recorded on long-term iEEG. Interestingly, in the 18 patients who had bilateral seizures recorded during surgical evaluation, 28% (5/18) were found to be unilateral on long-term iEEG.</p><p><strong>Conclusions: </strong>Our data suggest that RNS System implantation in suspected bilateral MTL cases may be an option to assess a patient's true seizure lateralization on long-term iEEG. Responsive neuromodulation should be considered before resection or ablation in cases that have evaluation data suggesting bilaterality.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"522-529"},"PeriodicalIF":2.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482166","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}