Journal of Clinical Neurophysiology最新文献

{"title":"Clinical Significance of Positive Spike Wave Discharges in the Pediatric Population: Insights Beyond Neonates.","authors":"Shishir Duble, Anita N Datta","doi":"10.1097/WNP.0000000000001203","DOIUrl":"10.1097/WNP.0000000000001203","url":null,"abstract":"<p><strong>Introduction: </strong>Positive spike wave (PSW) discharges on EEG are well-documented in neonates, but data regarding their significance in other populations are limited. This study aimed to assess the clinical significance of PSW in children aged 1 month to 19 years at a single tertiary care center over approximately three decades.</p><p><strong>Methods: </strong>Clinical information of children with focal PSW ( n = 326) was compared with control patients with focal negative interictal epileptiform discharges ( n = 898).</p><p><strong>Results: </strong>From 77,500 pediatric EEGs in our laboratory from 1992 to 2020, PSW were identified in 445 (0.57%) children, of which 326 met inclusion criteria. Positive spike waves were located in the following brain regions: occipital (139), central (65), frontal (63), temporal (43), parietal (9), and centro-temporal (7). Positive spike wave patients had a younger median age of seizure onset than control patients (1.1 years [0.30, 4.00] versus 4 years [1.3, 7.5], P < 0.001).Logistic regression analysis confirmed that PSW were associated with high odds of seizures [odds ratios (OR) 3.78; CI: 2.14-2.14; P < 0.005], epilepsy [OR 2.05; CI: 1.39-1.39; P < 0.005], and drug-resistant epilepsy, [OR 3.51; CI: 2.67-2.67; P < 0.005]. Furthermore, PSW correlated with a greater odd of developmental delay [OR 3.69; CI: 2.77-2.77; P < 0.005], school difficulties [OR 2.85; CI: 2.07-2.07; P < 0.005], abnormal neurologic exam [OR 2.8; CI: 2.15-2.15; P < <0.005], and structural brain abnormalities [OR 1.74; CI: 1.32-1.32; P < 0.005], such as malformation of cortical development, compared with control patients.</p><p><strong>Conclusions: </strong>Positive spike waves on pediatric EEG are associated with congenital or acquired brain abnormalities and less favorable seizure and neurodevelopmental outcomes.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"245-252"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hardware Technology for Point-of-Care EEG: A Comprehensive Review.","authors":"Susan T Herman","doi":"10.1097/WNP.0000000000001240","DOIUrl":"10.1097/WNP.0000000000001240","url":null,"abstract":"<p><strong>Summary: </strong>Rapid or point-of-care (POC) EEG devices, bolstered by advancements in portability, ease of use, wireless technology, and artificial intelligence, are transforming the EEG field. Increasing demand for immediate neurophysiologic diagnosis, previously limited by the operational complexities and specialized personnel required for traditional EEG, has driven these critical shifts. These innovations extend EEG's reach beyond traditional neurophysiology labs to diverse clinical settings, including emergency departments, intensive care units, remote locations, and homes. POC EEG is particularly valuable for diagnosing acute neurologic emergencies such as nonconvulsive status epilepticus and nonconvulsive seizures, traumatic brain injury, and stroke, enabling faster seizure detection, improved triage, and timely treatment. POC EEG systems facilitate rapid acquisition of clinically acceptable EEG by nonexperts, including physicians and other health care providers, emergency personnel, nurses, and in some cases, remote caregivers and patients. Bedside interpretation is augmented by real-time artificial intelligence algorithms. POC EEG hardware, including its sensors, headsets, amplifiers, connectivity, form factor, and power, diverges significantly from conventional EEG systems. These modifications are explicitly engineered to optimize rapid deployment, patient comfort, and operational simplicity in resource-constrained or time-sensitive scenarios. The adaptations, however, may necessitate trade-offs in signal quality, flexibility, channel count, reliability, and cost compared with laboratory-grade systems. Understanding these inherent differences and how hardware designs address them is critical for selecting the optimal POC EEG technology for a specific use.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"191-203"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid-EEG Software Architecture's Clinical Impact: Advantages and Limitations.","authors":"Urs Fisch, Jong Woo Lee","doi":"10.1097/WNP.0000000000001188","DOIUrl":"10.1097/WNP.0000000000001188","url":null,"abstract":"<p><strong>Summary: </strong>Rapid electroencephalography (EEG) devices are portable, easy-to-use systems that provide automated EEG interpretation to guide clinical decisions at the bedside. The scope of this review outlines the principles of automatic EEG analysis methods and the impact of recent developments in artificial intelligence and machine learning on these techniques in the context of seizure detection. The first generation of rapid EEG devices, primarily developed for anesthesia management, were tested for seizure detection; although raw EEG traces and power density arrays from these devices were helpful in seizure monitoring, their proprietary algorithms were not reliable for this purpose. The next generation of rapid EEG devices were principally aimed at seizure detection. In several large retrospective research studies, deep learning algorithms have demonstrated equal or superior proficiency as compared with human experts. Recent guidelines from the US Food and Drug Administration describe several guiding principles for this class of algorithms to be incorporated into medical devices. However, the \"black box\" nature of proprietary algorithms remains a concern because it hinders understanding of the device's limitations and potential pitfalls. We advocate for transparent reporting of essential software features to foster a constructive interaction between clinical users and rapid EEG device developers. This transparency is crucial for the continuous improvement of these devices, their acceptance among users, and ultimately, better patient care.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"204-210"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Usefulness of the H-Reflex for Intraoperative Monitoring of Thoracoabdominal Aneurysms.","authors":"Guillermo Martín-Palomeque, Jaime R López","doi":"10.1097/WNP.0000000000001200","DOIUrl":"10.1097/WNP.0000000000001200","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"276-277"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resection After Responsive Neurostimulation for Bilateral Mesial Temporal Epilepsy: Why Continuing Neurostimulation After Resection Matters.","authors":"Lia de Leon Ernst, Ahmed M Raslan, Christopher Zimmerman, Marissa Kellogg, William Brewster Smith","doi":"10.1097/WNP.0000000000001224","DOIUrl":"10.1097/WNP.0000000000001224","url":null,"abstract":"<p><strong>Purpose: </strong>Prior research has suggested that select patients with refractory bilateral mesial temporal lobe epilepsy (MTLE) treated with responsive neurostimulation (RNS) may benefit from eventual resection of the more active side. However, there is little guidance regarding the role for continuing RNS therapy after unilateral resection. Our series aims to help define the utility of continued RNS therapy after resection and offer guiding principles for neurostimulation in this context.</p><p><strong>Methods: </strong>Retrospective chart review was performed for patients who underwent RNS implant surgery for bilateral MTLE at our institution between the years 2015-2024.</p><p><strong>Results: </strong>Five patients with RNS treating bilateral hippocampi ultimately underwent selective mesial temporal lobe resection on the primary side. After resection, 4/5 became seizure-free immediately; patient 4 had a 70% seizure reduction, with reemergence of seizures on the less active side. After reprogramming RNS to increase total number of daily stimulations, patient 4 became seizure-free. All patients continued RNS therapy after resection with the ipsilateral electrode used for monitoring, while the contralateral electrode monitored and delivered stimulation. Two patients had transient interruptions of RNS stimulation after resection associated with seizure relapse, followed by return to seizure freedom once stimulation was restored.</p><p><strong>Conclusions: </strong>This series suggests that (1) unilateral remission in patients with bilateral MTLE being treated with RNS may be stimulation dependent; thus, stimulation should continue after unilateral resection; (2) unilateral seizure remission may depend on a particular threshold of number of stimulations per day.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"278-281"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"H-reflex Monitoring During Thoracoabdominal Aneurysm Surgery: Optimizing Clinical Application.","authors":"Jongsuk Choi, Kieob Kim","doi":"10.1097/WNP.0000000000001199","DOIUrl":"10.1097/WNP.0000000000001199","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"276"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-Rater Reliability of EEG-Based Encephalopathy Grading.","authors":"Ryan A Tesh, Anika Zahoor, Jayme Banks, Kaileigh Gallagher, Christine A Eckhardt, Haoqi Sun, Ioannis Karakis, Roohi Katyal, Jonathan Williams, Chetan Nayak, Aline Herlopian, Marcus C Ng, Adam S Greenblatt, Emma Meyers, Mike Westmeijer, Daniel S Harrison, Wolfgang Ganglberger, Galina Gheihman, Tracey Fan, Aaron F Struck, Irfan S Sheikh, Fábio A Nascimento, M Brandon Westover","doi":"10.1097/WNP.0000000000001185","DOIUrl":"10.1097/WNP.0000000000001185","url":null,"abstract":"<p><strong>Purpose: </strong>Visual EEG Confusion Assessment Method-Severity (VE-CAM-S) quantifies encephalopathy severity based on electroencephalography features. This study evaluated inter-rater reliability among experts using the VE-CAM-S scale.</p><p><strong>Methods: </strong>Nine experts from six institutions independently reviewed 32 15-second electroencephalography samples in an online test, assessing 29 features (16 in the VE-CAM-S and 13 additional, or \"VE-CAM-S+\"). A consensus of three experts served as the gold standard. Performance was measured by the median Matthews correlation coefficient between expert and gold-standard VE-CAM-S+ scores, along with average sensitivity and specificity. Qualitative analysis identified common feature-recognition errors affecting scores.</p><p><strong>Results: </strong>Experts achieved a median Matthews correlation coefficient of 0.82 [95% CI: 0.74-0.99]. Specificity exceeded 90% for most features except background β (87%) and generalized delta (71%). Sensitivity was ≥65% except for burst suppression with epileptiform activity (61%), extreme delta brush (EDB; 61%), posterior dominant rhythm (50%), background α (59%) and β (42%). Common errors included missing subtle findings, confusing features, and misidentifying extreme delta brush.</p><p><strong>Conclusions: </strong>This pilot study offers some initial support for the reliability of VE-CAM-S+ scoring. The largest errors occurred when experts missed or falsely identified features with higher weight in the VE-CAM-S. Encephalopathy grading through VE-CAM-S may be improved by breaking high-stakes features into smaller parts, creating a \"cheat sheet\" with scored examples, and designing teaching materials.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"237-244"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid EEG Monitoring in Clinical Practice.","authors":"Kapil Gururangan, Santiago Philibert-Rosas, Thanujaa Subramaniam","doi":"10.1097/WNP.0000000000001192","DOIUrl":"10.1097/WNP.0000000000001192","url":null,"abstract":"<p><strong>Summary: </strong>Rapid electroencephalography (EEG) devices have emerged in response to the growing awareness of seizures and highly epileptiform patterns in critically ill patients and limitations associated with conventional EEG infrastructure. In this review, we describe rapid EEG utilization patterns, clinical workflows, implementation challenges, and financial considerations using a narrative review supplemented by a multi-institutional survey of 20 centers affiliated within the Critical Care EEG Monitoring Research Consortium. We identified that rapid EEG was perceived to expedite diagnosis and treatment decisions and enhance clinical triage, and most respondents perceived the cost of rapid EEG sessions to be low. However, commonly cited limitations included lower spatial resolution and unsuitability for replacing conventional EEG for prolonged monitoring. Prior cohort studies and clinical trials of rapid EEG devices display site-by-site variability in practical workflows regarding specificity of clinical indications for monitoring and designated personnel for device setup and EEG review, however, rapid EEG was reported to consistently augment EEG monitoring capabilities even at centers with access to conventional EEG. Because rapid EEG devices are increasingly adopted, and paired with artificial intelligence tools, it will be vital for institutions to develop protocols and guidelines with multidisciplinary input to steer their responsible, effective, and sustainable use.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"222-227"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid-EEG Technologies in Comprehensive Neuromonitoring.","authors":"Mariel Kalkach-Aparicio, Aaron F Struck","doi":"10.1097/WNP.0000000000001245","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001245","url":null,"abstract":"","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"189-190"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344537","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-Resolution Ultrasonography for Detecting Peripheral Neuropathy in Leprosy: A Systematic Review and Meta-Analysis.","authors":"Sara Ahmed Metwally, Shahd Al Haj Ali, Mostafa Tantawy, Nehal Ataky, Karim Mohamed Eltaib, Mohamed Emam Elatrosh, Horiah Amer Al-Ghorbany, Alamin Awadallah Mohamed Magzoub, Baraah Abd-Alqader Ibraheem Mdalal, Ahmed Medhat Helmy Hussein, Khaled Ashraf Mohamed, Mohamed A Bedewi, Ezzat M Awad","doi":"10.1097/WNP.0000000000001229","DOIUrl":"10.1097/WNP.0000000000001229","url":null,"abstract":"<p><strong>Background: </strong>Leprosy is a chronic granulomatous disease that commonly affects the peripheral nervous system, often leading to significant disability. High-resolution ultrasonography has emerged as a promising tool for the noninvasive assessment of nerve involvement in leprosy.</p><p><strong>Objective: </strong>To figure out the diagnostic value of HRUS in assessing peripheral nerve involvement in leprosy, with a focus on measuring the cross-sectional area (CSA) of major nerves.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted up to 2024. Seventeen studies were included, and quality assessment was performed using NIH and NOS tools. Meta-analyses compared CSA of the ulnar, median, posterior tibial, and common fibular nerves between patients with leprosy and healthy controls. Heterogeneity was evaluated using the I2 statistic and sensitivity analyses were performed.</p><p><strong>Results: </strong>Patients with leprosy showed significantly increased CSA in all examined nerves compared with controls. Single-arm analysis of CSA in patients with leprosy showed consistent nerve enlargement, particularly in the ulnar nerve.</p><p><strong>Conclusions: </strong>Our review shows the usefulness of HRUS as a sensitive, noninvasive imaging modality for evaluating peripheral nerve involvement in leprosy.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":"43 3","pages":"228-236"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344532","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}