Journal of Clinical Neurophysiology最新文献

{"title":"Characteristics and Usefulness of Neurophysiological Monitoring in Corrective Procedures for Abnormally Curved Spine in Young Patients.","authors":"Avner Michaeli, Sara Miller, Joseph Danto, Harel Arzi, Josh E Schroeder, Dror Ovadia","doi":"10.1097/WNP.0000000000001074","DOIUrl":"10.1097/WNP.0000000000001074","url":null,"abstract":"<p><strong>Purpose: </strong>To identify and characterize events of deterioration in intraoperative neuromonitoring data during correction procedures for thoracic and lumbar abnormal spinal curvature in young patients.</p><p><strong>Methods: </strong>Records of 1,127 cases were retrospectively reviewed to identify events with deterioration of the neuromonitoring data. General etiological and demographic variables were summarized, and neuromonitoring events were studied and characterized.</p><p><strong>Results: </strong>Adolescent idiopathic cases were associated with female dominance and older age. Nonadolescent idiopathic cases were associated with a higher rate of neuromonitoring events. The neuromonitoring events evolved during the different procedural stages, were primarily reflected in the motor-evoked potential data and affected a range of neural structures to varying degrees. Most of the events were resolved, partially or completely, following a corresponding intervention by the surgical team, before the end of the procedure. Significant immediate weakness of the lower extremities was demonstrated in patients with unresolved neuromonitoring events, most of them were nonadolescent idiopathic patients.</p><p><strong>Conclusions: </strong>Neurophysiological monitoring enables the intraoperative assessment of the integrity of neural pathways and allows the detection of surgery-related impending neural injuries. Neuromonitoring contributes to intraoperative decision making, either when data are uneventful and allow confident continuation or when data deteriorate and lead to corresponding intervention. Further awareness should be paid to the vulnerable characteristics of the patient, surgery course, and neuromonitoring data. Proper interpretation of the neuromonitoring data, together with corresponding intervention by the surgeon when necessary, has the potential to reduce postoperative neurological insults and improve clinical outcomes.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"111-117"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300782","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":"Normative Data and Quantile Regression Analysis of the Sural-to-Radial Nerve Amplitude Ratio.","authors":"Kaveh Pourhamidi","doi":"10.1097/WNP.0000000000001084","DOIUrl":"10.1097/WNP.0000000000001084","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to establish normative data for the sural-to-radial nerve amplitude ratio (SRAR) and develop a quantile regression model for individualized cutoff values.</p><p><strong>Methods: </strong>A cohort of 68 healthy individuals (36 female participants) aged 20 to 59 years was recruited. Sensory nerve conduction studies were conducted to measure sural and radial sensory nerve action potential amplitudes. Quantile regression analysis was used to determine the fifth percentile of SRAR after adjusting for age, sex, and other demographic variables.</p><p><strong>Results: </strong>This study found significant differences in body height and weight between the sexes, with radial sensory nerve action potential being higher in female participants. The sural-to-radial nerve amplitude ratio was negatively correlated with age ( r = -0.3, p = 0.007) and showed significant sex differences. The final regression equation, SRAR = 0.519 - 0.006 × age + 0.046 × sex (1 = male, 0 = female), was developed for the fifth percentile cutoff, accounting for age and sex.</p><p><strong>Conclusions: </strong>This study establishes normative SRAR data and introduces a novel quantile regression approach to determine individualized cutoff values. Age and sex are critical factors for SRAR variation, necessitating tailored diagnostic criteria for neuropathy assessment. This model enhances diagnostic accuracy and potentially reduces misdiagnosis in clinical settings. Further research is recommended to validate the clinical applicability of SRAR across different types of neuropathies.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"145-148"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432003","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 Role of High-Resolution Ultrasound in the Diagnosis of Nerve Trauma New Perspective: A Preliminary Systematic Review and Meta-Analysis of the Recent Evidence.","authors":"Aya Moustafa Aboutaleb, Ezzeldin Abouelatta, Talal Salem, Abdelbaki Idriss Ibrahim, Aya Sayed Serour, Nagham Bushara Abbas, Rana Ahmed Youssef, Osama Omar Ballut, Reda Ibrahim Shehta, Merna Wagih Awad, Khaled Walid Hassan, Hasnaa Ali Hassan Abdelrhem, Mona Ali, Mostafa Badr, Shady Sherif Mohamed Aref, Mohamed Abdelmohsen Bedewi, Khaled Ashraf Mohamed, Hubertus Axer, Ramy Abdelnaby","doi":"10.1097/WNP.0000000000001126","DOIUrl":"10.1097/WNP.0000000000001126","url":null,"abstract":"<p><strong>Summary: </strong>Precise localization of peripheral nerve injuries and evaluation of their prognosis based on clinical and electrodiagnostic examinations are particularly challenging in the acute phase. High-resolution ultrasound (HRUS) may offer a viable and cost-effective imaging option for assessing the morphology of nerve injuries. Consequently, a systematic review and meta-analysis of studies on the use of ultrasound for diagnosing traumatic nerve injuries were conducted. A total of 15 studies were included, reporting the most recent findings on using HRUS in the diagnosis of traumatic nerve injury. These studies assessed the diagnostic test accuracy of ultrasound for the detection of traumatic nerve injury in 272 participants, with the cross-sectional area at the site of traumatic nerve injury also reported in 1,249 participants. The pooled sensitivity and specificity of the included studies were 92% confidence interval (CI) (0.89-0.95) and 86% CI (0.82-0.89), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 13.76 CI (1.41-134.34), 0.08 CI (0.03-0.18), and 286.23 CI (21.22-3,860.40), respectively. In the summary of the receiver operating characteristic curve, the area under the curve was 0.986, and the Q* index was 0.949. Based on the current literature, HRUS has shown promising results in addition to its availability and feasibility. HRUS can serve as a valuable complement to clinical and electrodiagnostic examinations for diagnosing traumatic peripheral nerve injuries. Further research is recommended to better understand the ultrasound characteristics of these injuries.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"101-106"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621421","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":"Reflex Responses in Muscles of the Lower Extremities Elicited by Transcutaneous Stimulation of Cauda Equina: Part 1. Methodology and Normative Data.","authors":"Julija Rimac, Davor Jančuljak, Biserka Kovač, Miloš Jovičić, Josipa Forjan","doi":"10.1097/WNP.0000000000001088","DOIUrl":"10.1097/WNP.0000000000001088","url":null,"abstract":"<p><strong>Introduction: </strong>Transcutaneous electrical stimulation is used to stimulate the dorsal roots of the cauda equina. Multiple elicited responses recorded in the lower extremity muscles are called posterior root muscle reflexes (PRMRs). Normal PRMR values in the muscles of healthy lower extremities have yet to be determined.</p><p><strong>Methods: </strong>Thirty subjects without known lumbosacral spinal root illness were included in this study. Subsequently, they were subjected to transcutaneous electrical stimulation of the cauda equina. Posterior root muscle reflex was recorded in the four muscle groups of both lower extremities. We elicited multiple PRMR and examined their characteristics in order to establish normal electrophysiological parameter values.</p><p><strong>Results: </strong>Posterior root muscle reflex was successfully elicited in the tibialis anterior (96.7%), gastrocnemius (100%), quadriceps femoris (93.3%), and hamstring (96.7%). No statistically significant differences were found in the intensity of stimulation, latencies, or area under the PRMR between the right and left leg muscles. The area under PRMR varied significantly among the participants. Higher body weight and abdominal girth showed a significant positive correlation with stimulation intensity for eliciting PRMR, and a significant negative correlation with the area under PRMR. Older age showed a significant negative correlation with the success of eliciting PRMR and the area under the PRMR.</p><p><strong>Conclusions: </strong>Posterior root muscle reflex is a noninvasive and successful method for eliciting selective reflex responses of cauda equina posterior roots. Obtained values could be used in future studies to evaluate the utility of this methodology in clinical practice. This methodology could improve testing of the proximal lumbosacral nervous system functional integrity.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"176-183"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300784","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":"Patient Handoff Practices at the Epilepsy Centers in the United States: A Survey of the Medical Directors.","authors":"Olga Selioutski, Susan Herman, Eva Katharina Ritzl, Matthew Garlinghouse, Olga Taraschenko","doi":"10.1097/WNP.0000000000001081","DOIUrl":"10.1097/WNP.0000000000001081","url":null,"abstract":"<p><strong>Purpose: </strong>Communication failure is one of the most significant causes of medical errors. Providing care to patients with seizures at comprehensive epilepsy centers requires uninterrupted coverage and a multidisciplinary approach. However, handoff practices in these settings have not been comprehensively assessed, and recommendations for their standardization are currently lacking. The aim of this observational study was to define the scope of existing practices for patient handoffs across epilepsy centers in the United States and provide relevant recommendations.</p><p><strong>Methods: </strong>A 79-question survey was developed to establish the patterns of transition of care for patients undergoing continuous EEG recording, including the periodicity of handoffs and specifics of the relevant workflow. With permission from the National Association of Epilepsy Centers (NAEC), the survey was distributed to the medical directors of all Level 3 and 4 NAEC-accredited epilepsy centers in the United States.</p><p><strong>Results: </strong>The responses were obtained from 70 institutions yielding a survey response rate of 26%. Of these, more than 77% had established weekly handoff processes for both the epilepsy monitoring unit and continuous EEG (cEEG) monitoring services. However, only 53% and 43% of centers had procedures for daily service transfers for the patients admitted to the epilepsy monitoring unit or the patients undergoing cEEG, respectively. The patterns of handoffs were complex and utilized group handoffs in < 50% of institutions. In most centers (>70%), patient data transmitted through handoffs included history, clinical information, and EEG findings. However, templates were not applied to standardize this information. All participants agreed or strongly agreed that a culture of patient safety was maintained in their place of practice; however, 12% of participants felt that insufficient time was allowed to discuss these patients or carry out the handoffs without interruptions.</p><p><strong>Conclusions: </strong>Existing handoff practices are not uniform or fully established across epilepsy centers in the United States. This study recommends that guidelines for formal handoff procedures be developed and introduced as a quality metric for all NAEC-accredited epilepsy centers.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"139-144"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446290","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":"Real-Time Seizure Detection Using Behind-the-Ear Wearable System.","authors":"Jamie Lehnen, Pooja Venkatesh, Zhuoran Yao, Abdul Aziz, Phuc V P Nguyen, Jay Harvey, Sasha Alick-Lindstrom, Alex Doyle, Irina Podkorytova, Ghazala Perven, Ryan Hays, Rodrigo Zepeda, Rohit R Das, Kan Ding","doi":"10.1097/WNP.0000000000001076","DOIUrl":"10.1097/WNP.0000000000001076","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines the usability and comfort of a behind-the-ear seizure detection device called brain seizure detection (BrainSD) that captures ictal electroencephalogram (EEG) data using four scalp electrodes.</p><p><strong>Methods: </strong>This is a feasibility study. Thirty-two patients admitted to a level 4 Epilepsy Monitoring Unit were enrolled. The subjects wore BrainSD and the standard 21-channel video-EEG simultaneously. Epileptologists analyzed the EEG signals collected by BrainSD and validated it using video-EEG data to confirm its accuracy. A poststudy survey was completed by each participant to evaluate the comfort and usability of the device. In addition, a focus group of UT Southwestern epileptologists was held to discuss the features they would like to see in a home EEG-based seizure detection device such as BrainSD.</p><p><strong>Results: </strong>In total, BrainSD captured 11 of the 14 seizures that occurred while the device was being worn. All 11 seizures captured on BrainSD had focal onset, with three becoming bilateral tonic-clonic and one seizure being of subclinical status. The device was worn for an average of 41 hours. The poststudy survey showed that most users found the device comfortable, easy-to-use, and stated they would be interested in using BrainSD. Epileptologists in the focus group expressed a similar interest in BrainSD.</p><p><strong>Conclusions: </strong>Brain seizure detection is able to detect EEG signals using four behind-the-ear electrodes. Its comfort, ease-of-use, and ability to detect numerous types of seizures make BrainSD an acceptable at-home EEG detection device from both the patient and provider perspective.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"118-125"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905657","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":"Characterizing Seizure-Onset Patterns With the Responsive Neurostimulation System.","authors":"Zulfi Haneef, Alexandra Celine Vallera, Sameera Vedantam, Maximillian S Feygin, Stephen Cleboski, Jay R Gavvala","doi":"10.1097/WNP.0000000000001090","DOIUrl":"10.1097/WNP.0000000000001090","url":null,"abstract":"<p><strong>Purpose: </strong>The responsive neurostimulation system (RNS) aims to improve seizures by delivering electrical stimulation in response to epileptiform patterns detected by electrocorticograms. Seizure-onset patterns (SOPs) correspond to outcomes in intracranial EEG (IC-EEG), although whether this is true for RNS is unknown. This study characterizes common RNS SOPs and correlates them with seizure outcomes.</p><p><strong>Methods: </strong>Among 40 patients with RNS implants, long-episode electrocorticogram characteristics of each patient's seizures were classified by visual analysis as one of the eight patterns previously described in IC-EEG. Correlation between each type of SOP and eventual seizure outcome was analyzed, with ≥50% improvement in a number of patient-reported seizure counts defined as a favorable outcome.</p><p><strong>Results: </strong>Across 263 LEs analyzed, the most common SOP observed was low-voltage fast activity. There was no difference between the distribution of RNS SOPs and that of IC-EEG SOPs described in the literature (Kolmogorov-Smirnov test, P = 0.98). Additionally, there was no correlation between any particular SOP and favorable outcomes (Fisher's omnibus test, P = 0.997).</p><p><strong>Conclusion: </strong>This initial description of RNS SOPs finds them to be similar to previously described IC-EEG SOPs, which suggests similar prognostic/therapeutic potential. However, we found that RNS efficacy is independent of patient SOP, suggesting that RNS is likely an equally effective treatment for all SOPs. Future research on stimulation parameters for particular RNS SOPs and correlation with IC-EEG SOPs in the same patients would be instrumental in guiding personalized neurostimulation.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"156-163"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446283","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":"Revised Process for ACNS Guidelines Development.","authors":"Imran H Quraishi, Edgard Andrade, Gloria Galloway, Ann Hyslop, Olga Selioutski, Saurabh Sinha, Susan T Arnold, Ravindra Arya, Anto I Bagić, Frank Drislane, David Gloss, Abeer J Hani, Eliane Kobayashi, Ahmad Marashly, Mark R Nuwer, Jun Park, Dragos Sabau, Daniel San-Juan, Asim Shahid, Karen Skjei, William O Tatum, Michael Vengrow, Courtney J Wusthoff","doi":"10.1097/WNP.0000000000001133","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001133","url":null,"abstract":"<p><strong>Summary: </strong>The development of clinical practice guidelines is an evolving field. In response to the need for consistent, evidence-based medical practice, the American Clinical Neurophysiology Society identified the need to update the Society's guideline development process. The American Clinical Neurophysiology Society Guidelines Committee created an action plan with the goal of improving transparency and rigor for future guidelines and bringing existing guidelines to current standards. This article provides an overview of the new American Clinical Neurophysiology Society standards for the creation of clinical guidance documents, including clinical guidelines, technical standards, and consensus statements. This process is rooted in the importance of clinical guidance documents and their significance in the context of current behests for updated standards for practicing clinical neurophysiology. The need and rationale for updating the guideline development process from its prior state were described. The updated American Clinical Neurophysiology Society categories for clinical guidance and recommendations were defined and compared. Finally, the new process is summarized, focusing on methodologies, authorship, and conflicts of interest.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"42 2","pages":"95-100"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065993","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":"Late-Onset Findings During Extended EEG Monitoring Are Rare in Critically Ill Children.","authors":"France W Fung, Darshana S Parikh, Kathleen Walsh, Mark P Fitzgerald, Shavonne L Massey, Alexis A Topjian, Nicholas S Abend","doi":"10.1097/WNP.0000000000001083","DOIUrl":"10.1097/WNP.0000000000001083","url":null,"abstract":"<p><strong>Purpose: </strong>Electrographic seizures (ES) are common in critically ill children undergoing continuous EEG (CEEG) monitoring, and previous studies have aimed to target limited CEEG resources to children at highest risk of ES. However, previous studies have relied on observational data in which the duration of CEEG was clinically determined. Thus, the incidence of late occurring ES is unknown. The authors aimed to assess the incidence of ES for 24 hours after discontinuation of clinically indicated CEEG.</p><p><strong>Methods: </strong>This was a single-center prospective study of nonconsecutive children with acute encephalopathy in the pediatric intensive care unit who underwent 24 hours of extended research EEG after the end of clinical CEEG. The authors assessed whether there were new findings that affected clinical management during the extended research EEG, including new-onset ES.</p><p><strong>Results: </strong>Sixty-three subjects underwent extended research EEG. The median duration of the extended research EEG was 24.3 hours (interquartile range 24.0-25.3). Three subjects (5%) had an EEG change during the extended research EEG that resulted in a change in clinical management, including an increase in ES frequency, differential diagnosis of an event, and new interictal epileptiform discharges. No subjects had new-onset ES during the extended research EEG.</p><p><strong>Conclusions: </strong>No subjects experienced new-onset ES during the 24-hour extended research EEG period. This finding supports observational data that patients with late-onset ES are rare and suggests that ES prediction models derived from observational data are likely not substantially underrepresenting the incidence of late-onset ES after discontinuation of clinically indicated CEEG.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"149-155"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863957","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":"Ictal Direct Current Shifts Preceded Much Earlier Than High Frequency Oscillations After Status: Is It the Effect of Status or Antiseizure Medication?","authors":"Kyoko Kanazawa, Shunsuke Kajikawa, Riki Matsumoto, Miwa Takatani, Mitsuyoshi Nakatani, Masako Daifu-Kobayashi, Hisaji Imamura, Takayuki Kikuchi, Takeharu Kunieda, Susumu Miyamoto, Ryosuke Takahashi, Masao Matsuhashi, Akio Ikeda","doi":"10.1097/WNP.0000000000001087","DOIUrl":"10.1097/WNP.0000000000001087","url":null,"abstract":"<p><strong>Purpose: </strong>While spikes and sharp waves are considered as markers of epilepsy in conventional electroencephalography, ictal direct current (DC) shifts and high-frequency oscillations (HFOs) appear to be useful biomarkers for epileptogenicity. We analyzed how ictal DC shifts and HFOs were affected by focal status epilepticus and antiseizure medications (ASMs).</p><p><strong>Methods: </strong>A 20-year-old female patient who underwent long-term intracranial electrode implantation for epilepsy surgery presented with 72 habitual seizures and a focal status epilepticus episode lasting for 4 h. Ten, 3, and 10 consecutive habitual seizures were analyzed before the status, after the status, and after ASM (valproate) loading, respectively.</p><p><strong>Results: </strong>Before and immediately after the status, ictal DC shifts remained the same in terms of the amplitude, duration, and slope of DC shifts. High-frequency oscillations also remained the same in terms of the duration, frequency, and power except for the power of the lower frequency band. After ASM loading, the duration, amplitude, and slope of the ictal DC shift were significantly attenuated. The duration, frequency, and power of the HFOs were significantly attenuated. Furthermore, the interval between the DC onset and HFO onset was significantly longer and the interval between the HFO onset and ictal DC shift peak was significantly shorter.</p><p><strong>Conclusions: </strong>The attenuation of ictal DC shifts and HFOs after ASM loading implies that astrocyte and neuronal activity may be both attenuated by ASMs. This finding may help with our understanding of the pathophysiology of epilepsy and can aid with the discovery of new approaches for epilepsy management.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"164-171"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858143","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}