Journal of Clinical Neurophysiology最新文献

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Beyond Stereo-EEG: Is It Worth Combining Stereo-EEG With Other Diagnostic Methods? 超越立体电子脑电图:是否值得将立体电子脑电图与其他诊断方法相结合?
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-07-01 Epub Date: 2024-06-25 DOI: 10.1097/WNP.0000000000001086
Julia Jacobs, Kerstin Alexandra Klotz, Francesca Pizzo, Paolo Federico
{"title":"Beyond Stereo-EEG: Is It Worth Combining Stereo-EEG With Other Diagnostic Methods?","authors":"Julia Jacobs, Kerstin Alexandra Klotz, Francesca Pizzo, Paolo Federico","doi":"10.1097/WNP.0000000000001086","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001086","url":null,"abstract":"<p><strong>Summary: </strong>Stereo-EEG is a widely used method to improve the diagnostic precision of presurgical workup in patients with refractory epilepsy. Its ability to detect epileptic activity and identify epileptic networks largely depends on the chosen implantation strategy. Even in an ideal situation, electrodes record activity generated in <10% of the brain and contacts only record from brain tissue in their immediate proximity. In this article, the authors discuss how recording stereo-EEG simultaneously with other diagnostic methods can improve its diagnostic value in clinical and research settings. It can help overcome the limited spatial coverage of intracranial recording and better understand the sources of epileptic activity. Simultaneous scalp EEG is the most widely available method, often used to understand large epileptic networks, seizure propagation, and EEG activity occurring on the contralateral hemisphere. Simultaneous magnetoencephalography allows for more precise source localization and identification of deep sources outside the stereo-EEG coverage. Finally, simultaneous functional MRI can highlight metabolic changes following epileptic activity and help understand the widespread network changes associated with interictal activity. This overview highlights advantages and methodological challenges for all these methods. Clinical use and research applications are presented for each approach.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"41 5","pages":"444-449"},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468441","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}
引用次数: 0
Corpus Callosum-Mediated Interhemispheric Interactions in Cervical Spondylotic Myelopathy. 胼胝体介导的颈椎病脊髓病半球间相互作用
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-07-01 DOI: 10.1097/WNP.0000000000000979
Yew Long Lo, Ruby Hwang, Peggy Pei Chee Teng, Yam Eng Tan
{"title":"Corpus Callosum-Mediated Interhemispheric Interactions in Cervical Spondylotic Myelopathy.","authors":"Yew Long Lo, Ruby Hwang, Peggy Pei Chee Teng, Yam Eng Tan","doi":"10.1097/WNP.0000000000000979","DOIUrl":"10.1097/WNP.0000000000000979","url":null,"abstract":"<p><strong>Purpose: </strong>The corpus callosum is crucial for interhemispheric interactions in the motor control of limb functions. Human and animal studies suggested spinal cord pathologies may induce cortical reorganization in sensorimotor areas. We investigate participation of the corpus callosum in executions of a simple motor task in patients with cervical spondylotic myelopathy (CSM) using transcranial magnetic stimulation.</p><p><strong>Methods: </strong>Twenty patients with CSM with various MRI grades of severity of cord compression were compared with 19 normal controls. Ipsilateral silent period, contralateral silent period, central motor conduction time, and transcallosal conduction time (TCT) were determined.</p><p><strong>Results: </strong>In both upper and lower limbs, TCTs were significantly increased for patients with CSM than normal controls ( p < 0.001 for all), without side-to-side differences. Ipsilateral silent period and contralateral silent period durations were significantly increased bilaterally for upper limbs in comparison to controls ( p < 0.01 for all), without side-to-side differences. There were no significant correlations of TCT with central motor conduction time nor severity of CSM for both upper and lower limbs ( p > 0.05 for all) bilaterally.</p><p><strong>Conclusions: </strong>Previous transcranial magnetic stimulation studies show increased motor cortex excitability in CSM; hence, increased TCTs observed bilaterally may be a compensatory mechanism for effective unidirectional and uniplanar execution of muscle activation in the distal limb muscles. Lack of correlation of TCTs with severity of CSM or central motor conduction time may be in keeping with a preexistent role of the corpus callosum as a predominantly inhibitory pathway for counteracting redundant movements resulting from increased motor cortex excitability occurring after spinal cord lesions.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"473-477"},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450613","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}
引用次数: 0
Back to Basics: Care of the Stereotactic EEG Implanted Patient. 回归基础:立体定向脑电图植入患者的护理。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-07-01 DOI: 10.1097/WNP.0000000000001044
Sasha Alick-Lindstrom, Pooja Venkatesh, Ghazala Perven, Angela Wabulya, Qian-Zhou JoJo Yang, Deepa Sirsi, Irina Podkorytova
{"title":"Back to Basics: Care of the Stereotactic EEG Implanted Patient.","authors":"Sasha Alick-Lindstrom, Pooja Venkatesh, Ghazala Perven, Angela Wabulya, Qian-Zhou JoJo Yang, Deepa Sirsi, Irina Podkorytova","doi":"10.1097/WNP.0000000000001044","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001044","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic EEG (SEEG) is gaining increasing popularity in the United States. Patients undergoing SEEG have unique challenges, and their needs are different compared with noninvasive cases. We aim to describe the medical, nursing, and other institutional practices of SEEG evaluations among tertiary referral (level IV) epilepsy centers accredited by the National Association of Epilepsy Centers.</p><p><strong>Methods: </strong>We analyzed data obtained from a Research Electronic Data Capture (REDCap) survey we formulated and distributed to directors of all level IV epilepsy centers listed by the National Association of Epilepsy Center. Most questions were addressed to the adult and pediatric SEEG programs separately.</p><p><strong>Results: </strong>Among 199 epilepsy center directors invited to complete the survey, 90 (45%) responded. Eighty-three centers (92%) reported they perform SEEG evaluations. Of the 83 respondents, 56 perform SEEG in adult and 47 in pediatric patients. Twenty-two centers evaluate both pediatric and adult subjects. The highest concordance of SEEG workflow was in (1) epilepsy monitoring unit stay duration (1-2 weeks, 79% adult and 85% pediatric programs), (2) use of sleep deprivation (94% both adult and pediatric) and photic stimulation (79% adult and 70% pediatric) for seizure activation, (3) performing electrical cortical stimulation at the end of SEEG evaluation after spontaneous seizures are captured (84% adult and 88% pediatric), and (4) daily head-wrap inspection (76% adult and 80% pediatric). Significant intercenter variabilities were noted in the other aspects of SEEG workflow.</p><p><strong>Conclusions: </strong>Results showed significant variability in SEEG workflow across polled centers. Prospective, multicenter protocols will help the future development and harmonization of optimal practice patterns.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"41 5","pages":"415-422"},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468440","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}
引用次数: 0
In Search of a Common Language: The Standardized Electrode Nomenclature for Stereoelectroencephalography Applications. 寻找共同语言:立体脑电图应用的标准化电极术语。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-07-01 DOI: 10.1097/WNP.0000000000001032
Michelle Y Chiu, Jeffrey Bolton, Jeffrey S Raskin, Daniel J Curry, Howard L Weiner, Phillip L Pearl, Scellig Stone
{"title":"In Search of a Common Language: The Standardized Electrode Nomenclature for Stereoelectroencephalography Applications.","authors":"Michelle Y Chiu, Jeffrey Bolton, Jeffrey S Raskin, Daniel J Curry, Howard L Weiner, Phillip L Pearl, Scellig Stone","doi":"10.1097/WNP.0000000000001032","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001032","url":null,"abstract":"<p><strong>Purpose: </strong>Stereoelectroencephalography (SEEG) is widely performed on individuals with medically refractory epilepsy for whom invasive seizure localization is desired. Despite increasing adoption in many centers across the world, no standardized electrode naming convention exists, generating confusion among both clinical and research teams.</p><p><strong>Methods: </strong>We have developed a novel nomenclature, named the Standardized Electrode Nomenclature for SEEG Applications system. Concise, unique, informative, and unambiguous labels provide information about entry point, deep targets, and relationships between electrodes. Inter-rater agreement was evaluated by comparing original electrode names from 10 randomly sampled cases (including 136 electrodes) with those prospectively assigned by four additional blinded raters.</p><p><strong>Results: </strong>The Standardized Electrode Nomenclature for SEEG Application system was prospectively implemented in 40 consecutive patients undergoing SEEG monitoring at our institution, creating unique electrode names in all cases, and facilitating implantation design, SEEG recording and mapping interpretation, and treatment planning among neurosurgeons, neurologists, and neurophysiologists. The inter-rater percent agreement for electrode names among two neurosurgeons, two epilepsy neurologists, and one neurosurgical fellow was 97.5%.</p><p><strong>Conclusions: </strong>This standardized naming convention, Standardized Electrode Nomenclature for SEEG Application, provides a simple, concise, reproducible, and informative method for specifying the target(s) and relative position of each SEEG electrode in each patient, allowing for successful sharing of information in both the clinical and research settings. General adoption of this nomenclature could pave the way for improved communication and collaboration between institutions.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"41 5","pages":"405-409"},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468445","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}
引用次数: 0
A Proposed Stereoelectroencephalography Electrode Nomenclature and Call for Standardization. 拟议的立体脑电图电极命名法和标准化呼吁。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-06-27 DOI: 10.1097/WNP.0000000000001103
Clifford S Calley, Winson Ho, Abbas Babajani-Feremi, Carla Bodden, Elizabeth Tyler-Kabara, Dave F Clarke
{"title":"A Proposed Stereoelectroencephalography Electrode Nomenclature and Call for Standardization.","authors":"Clifford S Calley, Winson Ho, Abbas Babajani-Feremi, Carla Bodden, Elizabeth Tyler-Kabara, Dave F Clarke","doi":"10.1097/WNP.0000000000001103","DOIUrl":"10.1097/WNP.0000000000001103","url":null,"abstract":"<p><strong>Introduction: </strong>Between 20 and 40% of patients with epilepsy are considered pharmacoresistant. Stereoelectroencephalography (sEEG) is frequently used as an invasive method for localizing seizures in patients with pharmacoresistant epilepsy who are surgical candidates; however, electrode nomenclature varies widely across institutions. This lack of standardization can have many downstream consequences, including difficulty with intercenter or intracenter interpretation, communication, and reliability.</p><p><strong>Methods: </strong>The authors propose a novel sEEG nomenclature that is both intuitive and comprehensive. Considerations include clear/precise entry and target anatomical locations, laterality, distinction of superficial and deep structures, functional mapping, and relative labeling of electrodes in close proximity if needed. Special consideration was also given to electrodes approximating radiographically distinct lesions. The accuracy of electrode identification and the use of correct entry-target labels were assessed by neurosurgeons and epileptologists, not directly involved in each case.</p><p><strong>Results: </strong>The authors' nomenclature was used in 41 consecutive sEEG cases (497 electrodes total) within their institution. After reconstruction was complete, the accuracy of electrode identification was 100%, and the correct use of entry-target labels was 98%. The last 30 sEEG cases had 100% correct use of entry-target labels.</p><p><strong>Conclusions: </strong>The proposed sEEG nomenclature demonstrated both high accuracy in electrode identification and consistent use of entry-target labeling. The authors submit this nomenclature as a model for standardization across epilepsy surgery centers. They intend to improve practicability, ease of use, and specificity of this nomenclature through collaboration with other surgical epilepsy centers.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457175","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}
引用次数: 0
Electrocorticographic Patterns in Frontal Epilepsy and Long-Term Outcomes [RETRACTED]. 额叶癫痫的皮层电图模式与长期疗效
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-06-25 DOI: 10.1097/WNP.0000000000001085
{"title":"Electrocorticographic Patterns in Frontal Epilepsy and Long-Term Outcomes [RETRACTED].","authors":"","doi":"10.1097/WNP.0000000000001085","DOIUrl":"10.1097/WNP.0000000000001085","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446287","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}
引用次数: 0
Direct (D)-Wave Monitoring Enhancement With Subdural Electrode Placement: A Case Series. 硬膜下电极置入可增强直接 (D) 波监测:病例系列。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-06-25 DOI: 10.1097/WNP.0000000000001100
Harshal A Shah, Adrian Chen, Ross Green, Roee Ber, Randy S D'Amico, Daniel M Sciubba, Sheng-Fu Larry Lo, Justin W Silverstein
{"title":"Direct (D)-Wave Monitoring Enhancement With Subdural Electrode Placement: A Case Series.","authors":"Harshal A Shah, Adrian Chen, Ross Green, Roee Ber, Randy S D'Amico, Daniel M Sciubba, Sheng-Fu Larry Lo, Justin W Silverstein","doi":"10.1097/WNP.0000000000001100","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001100","url":null,"abstract":"<p><strong>Purpose: </strong>Direct-wave (D-wave) neuromonitoring is a direct measure of corticospinal tract integrity that detects potential injury during spinal cord surgery. Epidural placement of electrodes used for D-wave measurements can result in high electrical impedances resulting in substantial signal noise that can compromise signal interpretation. Subdural electrode placement may offer a solution.</p><p><strong>Methods: </strong>Medical records for consecutive patients with epidural and subdural D-wave monitoring were reviewed. Demographic and clinical information including preoperative and postoperative motor strength were recorded. Neuromonitoring charts were reviewed to characterize impedances and signal amplitudes of D-waves recorded epidurally (before durotomy) and subdurally (following durotomy). Nonparametric statistics were used to compare epidural and subdural D-waves.</p><p><strong>Results: </strong>Ten patients (50% women, median age 50.5 years) were analyzed, of which five patients (50%) were functionally independent (modified McCormick grade ≤ II) preoperatively. D-waves were successfully acquired by subdural electrodes in eight cases and by epidural electrodes in three cases. Subdural electrode placement was associated with lower impedance values ( P = 0.011) and a higher baseline D-wave amplitude ( P = 0.007) relative to epidural placement. No association was observed between D-wave obtainability and functional status, and no adverse events relating to subdural electrode placement were encountered.</p><p><strong>Conclusions: </strong>Subdural electrode placement allows successful D-wave acquisition with accurate monitoring, clearer waveforms, and a more optimal signal-to-noise ratio relative to epidural placement. For spinal surgeries where access to the subdural compartment is technically safe and feasible, surgeons should consider subdural placement when monitoring D-waves to optimize clinical interpretation.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446285","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}
引用次数: 0
Survey of Continuous EEG Monitoring Practices in the United States. 美国连续脑电图监测实践调查。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-06-25 DOI: 10.1097/WNP.0000000000001099
Gina Kayal, Kristen N Oliveira, Zulfi Haneef
{"title":"Survey of Continuous EEG Monitoring Practices in the United States.","authors":"Gina Kayal, Kristen N Oliveira, Zulfi Haneef","doi":"10.1097/WNP.0000000000001099","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001099","url":null,"abstract":"<p><strong>Objective: </strong>Continuous EEG (cEEG) practice has markedly changed over the last decade given its utility in improving critical care outcomes. However, there are limited data describing the current cEEG infrastructure in US hospitals.</p><p><strong>Methods: </strong>A web-based cEEG practice survey was sent to neurophysiologists at 123 ACGME-accredited epilepsy or clinical neurophysiology programs.</p><p><strong>Results: </strong>Neurophysiologists from 100 (81.3%) institutions completed the survey. Most institutions had 3 to 10 EEG faculty (80.0%), 1 to 5 fellows (74.8%), ≥6 technologists (84.9%), and provided coverage to neurology ICUs with >10 patients (71.0%) at a time. Round-the-clock EEG technologist coverage was available at most (90.0%) institutions with technologists mostly being in-house (68.0%). Most institutions without after-hours coverage (8 of 10) attributed this to insufficient technologists. The typical monitoring duration was 24 to 48 hours (23.0 and 40.0%), most commonly for subclinical seizures (68.4%) and spell characterization (11.2%). Larger neurology ICUs had more EEG technologists ( p = 0.02), fellows ( p = 0.001), and quantitative EEG use ( p = 0.001).</p><p><strong>Conclusions: </strong>This survey explores current cEEG practice patterns in the United States. Larger centers had more technologists and fellows. Overall technologist numbers are stable over time, but with a move toward more in-hospital compared with home-based coverage. Reduced availability of EEG technologists was a major factor limiting cEEG availability at some centers.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446291","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}
引用次数: 0
Intraoperative Neurophysiological Monitoring in Tethered Cord Syndrome Surgery: Predictive Values and Clinical Outcome. 系索综合征手术的术中神经电生理监测:预测值和临床结果。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-06-25 DOI: 10.1097/WNP.0000000000001096
Giovanna Squintani, Federica Basaldella, Andrea Badari, Andrea Rasera, Vincenzo Tramontano, Giampietro Pinna, Fabio Moscolo, Christian Soda, Umberto Ricci, Giorgio Ravenna, Francesco Sala
{"title":"Intraoperative Neurophysiological Monitoring in Tethered Cord Syndrome Surgery: Predictive Values and Clinical Outcome.","authors":"Giovanna Squintani, Federica Basaldella, Andrea Badari, Andrea Rasera, Vincenzo Tramontano, Giampietro Pinna, Fabio Moscolo, Christian Soda, Umberto Ricci, Giorgio Ravenna, Francesco Sala","doi":"10.1097/WNP.0000000000001096","DOIUrl":"10.1097/WNP.0000000000001096","url":null,"abstract":"<p><strong>Introduction: </strong>\"Tethered cord syndrome\" (TCS) refers to a congenital abnormality associated with neurological signs and symptoms. The aim of surgery is to prevent or arrest their progression. This study reports a retrospective case series of tethered cord syndrome surgeries, supported by intraoperative neurophysiological monitoring.</p><p><strong>Methods: </strong>The case series comprises 50 surgeries for tethered cord syndrome in which multimodal intraoperative neurophysiological monitoring was performed using motor evoked potentials (transcranial motor evoked potentials [TcMEPs]), tibial nerve somatosensory evoked potentials (TNSEPs), and pudendal-anal reflex (PAR). The intraoperative neurophysiological monitoring results are reported and correlated with clinical outcomes.</p><p><strong>Results: </strong>Sensitivity, specificity, and negative predictive value were high for TcMEPs and TNSEPs, while PAR exhibited low sensitivity and positive predictive value but high specificity and negative predictive value. Fisher's exact test revealed a significant correlation between changes in TcMEPs, TNSEPs, and clinical outcome ( P < 0.000 and P = 0.049 respectively), but no correlation was detected between PAR and urinary/anal function ( P = 0.497).</p><p><strong>Conclusions: </strong>While TcMEPs and TNSEPs were found to be reliable intraoperative neurophysiological monitoring parameters during tethered cord syndrome surgery, PAR had low sensitivity and positive predictive value probably because the reflex is not directly related to bladder function and because its multisynaptic pathway may be sensitive to anesthetics. New onset muscle weakness and sensory deficits were related to postoperative changes in TcMEPs and TNSEPs, whereas changes in PAR did not predict bladder/urinary impairment. Urinary deficits may be predicted and prevented with other neurophysiological techniques, such as the bladder-anal reflex.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436943","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}
引用次数: 0
Patient Handoff Practices at the Epilepsy Centers in the United States: A Survey of the Medical Directors. 美国癫痫中心的患者交接做法:对医务主任的调查。
IF 2.3 4区 医学
Journal of Clinical Neurophysiology Pub Date : 2024-06-25 DOI: 10.1097/WNP.0000000000001081
Olga Selioutski, Susan Herman, Eva Katharina Ritzl, Matthew Garlinghouse, Olga Taraschenko
{"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":"https://doi.org/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":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-25","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}
引用次数: 0
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