Clinical Neurophysiology Practice最新文献

{"title":"A practical framework for interpreting intraoperative electrophysiological signals in acoustic neuroma surgery","authors":"Juan Li,&nbsp;Qing Liu,&nbsp;Xianrui Yuan,&nbsp;Jian Yuan","doi":"10.1016/j.cnp.2026.09.006","DOIUrl":"10.1016/j.cnp.2026.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a practical, stepwise framework for interpreting intraoperative neurophysiological signals to predict facial nerve outcomes after acoustic neuroma surgery.</div></div><div><h3>Methods</h3><div>This methodological report synthesizes evidence from three IONM modalities: facial motor evoked potentials (FMEPs), direct electrical stimulation (DES), and free-running electromyography (EMG). Key predictive parameters, threshold values, sensitivity, specificity, and technical limitations were extracted from published meta-analyses, systematic reviews, and prospective cohort studies. These parameters were then organized chronologically into a stepwise interpretation framework according to their typical intraoperative use.</div></div><div><h3>Results</h3><div>An end-of-surgery FMEP amplitude reduction &gt;50% predicts poor long-term (≥1 year) facial function with 93% specificity. A DES threshold ≤0.05 mA at the brainstem stump predicts good long-term function (73% sensitivity, 74% specificity). A cumulative A-train duration &gt;10 s on free-running EMG signals high risk for severe immediate palsy (66.7% sensitivity, 88.0% specificity). The 2026 CNS guidelines confirm that electrophysiological parameters predict long-term outcomes better than clinical information alone.</div></div><div><h3>Conclusions</h3><div>This report provides a clinically usable, stepwise framework that integrates FMEP, DES, and free-running EMG thresholds for intraoperative prediction of facial nerve function.</div></div><div><h3>Significance</h3><div>Despite routine use of intraoperative neurophysiological monitoring, no standardized framework has existed to translate real-time signals into postoperative facial nerve predictions. This framework fills that gap by offering surgeons and monitoring teams a clear, evidence-based, and chronologically ordered decision aid, potentially improving early recognition of poor outcomes and facilitating timely referral for facial reanimation.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 867-873"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149153369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragm ‘atonia’ during ictal and post-ictal apnoea: A case report.","authors":"Margherita Burani,&nbsp;Giada Giovannini,&nbsp;Niccolò Orlandi,&nbsp;Matteo Pugnaghi,&nbsp;Lisa Taruffi,&nbsp;Sofia Angeloni,&nbsp;Stefano Meletti","doi":"10.1016/j.cnp.2026.10.004","DOIUrl":"10.1016/j.cnp.2026.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>Ictal and post ictal central apnoea (ICA and PCA) are driven by suppression of brainstem respiratory drive and represent an electroclinical biomarker of sudden unexpected death in epilepsy (SUDEP). While animal models have demonstrated a true ‘atonic diaphragm’ underlying seizure-related apnoea, no human polygraphic study has yet confirmed respiratory muscle ‘atonia’ with direct EMG recording.</div></div><div><h3>Methods</h3><div>In this case report, we present a 26-year-old female with meningoencephalocele-associated temporal lobe epilepsy who underwent a video-EEG polygraphy integrated with surface EMG from intercostals muscles and the diaphragm.</div></div><div><h3>Results</h3><div>We recorded a left frontotemporal seizure with ICA and four consecutives PCA events, all accompanied by surface electromyographic silence of the diaphragm and the intercostal muscles.</div></div><div><h3>Conclusions</h3><div>This case provide a human polygraphic evidence of diaphragm and intercostal muscles silence during ICA and PCA, confirming the cascade of respiratory inhibition through brainstem respiratory centres down to respiratory muscles themselves. Notably, muscles relaxation occurred despite the patient was awake and able to follow commands.</div></div><div><h3>Significance</h3><div>These findings support the importance of cardiorespiratory polygraphy during presurgical video-EEG evaluation, especially for temporal lobe seizures, to identify patients at higher SUDEP risk.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 874-877"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149211073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic discordance between referral impressions, clinical assessment, and final electrodiagnostic findings","authors":"Lauren L. Walkon,&nbsp;Daniel Menkes","doi":"10.1016/j.cnp.2026.09.008","DOIUrl":"10.1016/j.cnp.2026.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluated concordance between referral impressions, structured pre-test assessment, and electrodiagnostic findings (EDX), compared the concordance of an electrodiagnostic consultant's (EC) pre-test assessment and the referring clinician's impression with the final EDX diagnosis.</div></div><div><h3>Methods</h3><div>A single-center, prospective observational study enrolled 104 participants over 9 months; 101 completed testing. The EC recorded a diagnostic impression before nerve conduction studies and needle electromyography (EMG). Final diagnoses were categorized using an ICD-10 root-based schema. Referral, pre-test, and final diagnoses were compared using exact agreement between the first-listed primary ICD-10 diagnosis codes.</div></div><div><h3>Results</h3><div>Among 101 patients (mean age 59 years; 59.4% female), referral-final concordance was 34.7% (35/101), compared with 71.3% (72/101) for EC pre-test-final concordance (matched OR, 6.29; 95% CI, 2.81–16.54; <em>p</em> &lt; 0.001). EDX produced a clinically meaningful diagnostic change in 67 patients (66.3%) and modified management in 53 (52.5%); subsequent implementation was not assessed. The EC pre-test diagnosis differed from the final EDX diagnosis in 29 cases (28.7%).</div></div><div><h3>Conclusions</h3><div>EDX frequently identified diagnoses that differed from referral impressions and sometimes differed from the consultant's pre-test assessment. The higher pre-test-final concordance reflects within-clinician agreement after a focused history and examination; it does not establish that the electrodiagnostic consultant is more diagnostically accurate than referring clinicians.</div></div><div><h3>Significance</h3><div>This single-center exploratory study supports the clinical value of a focused pre-test assessment and of EDX as a diagnostic consultation. Larger, multicenter studies using independent assessment are needed.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 888-893"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149211075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microstates and connectivity states reveal task-related network reorganization in Alzheimer's disease patients","authors":"Ji-Won Kim,&nbsp;Azamat Yeldesbay,&nbsp;Christina Kehm,&nbsp;Ronja V. Fassbender,&nbsp;Oezguer A. Onur,&nbsp;Nils Rosjat,&nbsp;Gereon R. Fink,&nbsp;Silvia Daun","doi":"10.1016/j.cnp.2026.07.016","DOIUrl":"10.1016/j.cnp.2026.07.016","url":null,"abstract":"<div><h3>Objective</h3><div>Microstates derived from EEG amplitude and connectivity states from EEG phase examine distinct aspects of the brain's dynamic organization. However, it is unclear how sensitive they are to changes in functional connectivity in Alzheimer's disease (AD). We examined pre- and post-task alterations of brain activity in AD patients to compare the ability of microstates and connectivity states to capture disease-related network dysfunction.</div></div><div><h3>Methods</h3><div>Resting-state EEG (RS-EEG) was recorded before and after a memory task in fifteen patients with AD and fifteen healthy controls. During the memory task, either low-intensity repetitive transcranial magnetic stimulation (rTMS) over the parieto-occipital region or sham stimulation was applied. We quantified microstates and phase-based connectivity states in the alpha frequency range from the RS-EEG.</div></div><div><h3>Results</h3><div>While microstates showed task-related alterations in healthy controls only, connectivity states were more sensitive to alterations in the AD group. rTMS appeared to reduce these task-related alterations in connectivity states. Connectivity states indicated a shift towards lower, more diffuse connectivity in AD patients. Connectivity states were correlated with memory task performance and amyloid-beta levels in the AD group.</div></div><div><h3>Conclusions</h3><div>Connectivity states indicated decreased task-related network stability in AD patients, which correlated with memory task performance. The findings support the neural efficiency hypothesis, which states that more efficient brain network optimization during tasks is linked to better performance.</div></div><div><h3>Significance</h3><div>Given the progressive decline of alpha power in AD patients, phase-based connectivity states provide valuable complementary information to microstates and may serve as a biomarker for assessing large-scale network alterations in relation to disease progression.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 664-676"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The frequency-dependent effects of primary hand motor cortex stimulation on volitional finger movement","authors":"Léon Taquet ,&nbsp;Brian J. Conway ,&nbsp;Timothy F. Boerger ,&nbsp;Kaitlin Goetschel ,&nbsp;Sarah C. Young ,&nbsp;Nada E. Botros ,&nbsp;Manoj Raghavan ,&nbsp;Brian D. Schmit ,&nbsp;Max O. Krucoff","doi":"10.1016/j.cnp.2026.03.001","DOIUrl":"10.1016/j.cnp.2026.03.001","url":null,"abstract":"<div><h3>Objective</h3><div>We conducted a prospective study in human patients undergoing awake craniotomies to examine whether the effects of cortical stimulation in hand primary motor cortex (M1) can be (1) frequency dependent and (2) inhibitory.</div></div><div><h3>Methods</h3><div>In 11 participants undergoing clinically indicated awake craniotomies, we delivered bursts of 1–333 Hz stimulation during a finger-flexion task. Synchronized electrocorticography (ECoG), finger joint kinematics, electromyography (EMG), and video were recorded.</div></div><div><h3>Results</h3><div>Inability to flex the index finger during subthreshold stimulation was noted in 3 participants at frequencies &gt;250 Hz when the electrodes were in locations that induced extension of the forefinger at higher amplitudes. Other than these trials, all stimulation events either induced muscle contractions or had no measurable effect.</div></div><div><h3>Conclusion</h3><div>Data presented here represent the first evidence of (1) movement inhibition of the human hand caused by electrical stimulation of M1, as well as (2) the frequency-dependence of net downstream effects of hand M1 stimulation during task. Our findings support the hypothesis that the mechanism of movement inhibition may be activation of indirect, net-inhibitory mechanisms, as opposed to direct inhibition of the stimulated motor neurons.</div></div><div><h3>Significance</h3><div>There is growing interest in using continuous electrical stimulation of the brain to remap anatomical-functional relationships away from invasive lesions. Achieving this type of neuroplasticity requires a better understanding of the direct and indirect effects of cortical stimulation. Here we demonstrate the frequency-dependent effects of cortical M1 stimulation on volitional finger movement.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 252-261"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147600113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mills–Nithi algorithm for navigated transcranial magnetic stimulation motor mapping in healthy subjects and brain tumor patients","authors":"Evangelia Chatzikyriakou,&nbsp;Ioannis Vlachos,&nbsp;Konstantinos Pastiadis,&nbsp;Nikolaos Foroglou,&nbsp;Konstantinos Kouskouras,&nbsp;Georgios Feretos,&nbsp;Christos Frantzidis,&nbsp;Ioannis Patsalas,&nbsp;Vasilios Papaliagkas,&nbsp;Dimitris Kugiumtzis,&nbsp;Vasilios K. Kimiskidis","doi":"10.1016/j.cnp.2026.08.006","DOIUrl":"10.1016/j.cnp.2026.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>Navigated TMS (nTMS) motor mapping is typically performed at a fixed percentage of the resting motor threshold (rMT), most commonly 110%. The Mills–Nithi algorithm's upper threshold (UT), the minimal stimulation intensity evoking MEPs with 100% probability, has been proposed as an alternative. This study compared motor mapping at 110% rMT with the Mills–Nithi method in healthy subjects and patients with brain tumors.</div></div><div><h3>Methods</h3><div>11 healthy controls and 14 patients with supratentorial tumors underwent FDI motor mapping using both UT of the Mills-Nithi algorithm, and 110% rMT estimated with an adaptive threshold-hunting algorithm. Outcomes included the number of pulses, hotspot localization, map area, volume, centers of gravity, and DTI parameters (i.e., fiber count, FA, ADC, fiber length). Personalized sigmoid curves were fitted to estimate response probabilities. An independent control group of 12 healthy subjects underwent two nTMS mapping sessions at 110% rMT to establish baseline Earth Movers Distance (EMD) values.</div></div><div><h3>Results</h3><div>Motor map characteristics and DTI metrics did not differ significantly between methods in either group. In healthy subjects, UT-based motor mapping required fewer stimuli than 110% rMT (110%: 256 ± 95 stimuli; UT: 227 ± 97; <em>p</em> = 0.03) and was more likely to elicit responses (<em>p</em> = 0.0375), with markedly reduced inter-individual variability (<em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Motor mapping based on UT produces results comparable to 110% rMT, while improving procedural efficiency and response consistency in healthy subjects.</div></div><div><h3>Significance</h3><div>Our findings support the Mills-Nithi algorithm as a practical alternative for clinical nTMS motor mapping.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 738-748"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148853916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tactile perception and tolerability thresholds of TMS characterized by intensity across locations and frequencies","authors":"Neketa Nesmith,&nbsp;Megan Senda,&nbsp;Yang Hou,&nbsp;Kirthin Dev,&nbsp;Austin M. Spitz,&nbsp;F. Andrew Kozel,&nbsp;Kevin A. Johnson","doi":"10.1016/j.cnp.2026.07.010","DOIUrl":"10.1016/j.cnp.2026.07.010","url":null,"abstract":"<div><h3>Objective</h3><div>Transcranial Magnetic Stimulation (TMS) involves pulsed magnetic fields that pass through the scalp to stimulate the brain, with incidental stimulation to superficial nerves and muscles. This study characterizes the scalp sensations of TMS by location (over modified BeamF3 prefrontal, THREE-D prefrontal, right orbitofrontal, medial prefrontal, motor, and parietal cortical targets, as well as the knee) and by frequency (1 Hz, 10 Hz, or iTBS), with increasing levels of stimulation intensity.</div></div><div><h3>Methods</h3><div>Study participants (<em>n</em> = 18) each provided ratings for 7 locations, with 3 frequencies per location. We adapted quantitative sensory testing method of limits, where participants identified the sensory threshold, the annoyance threshold, and the tolerability threshold, for each trial as TMS intensity increased.</div></div><div><h3>Results</h3><div>For location, sites distal to the facial nerves and muscle (Knee, P3, M1, mPFC) were more tolerable, followed by BeamF3, with the THREE-D and AF8 locations as least tolerable. For frequency, we found that 1 Hz was significantly more tolerable than 10 Hz and iTBS. iTBS was more annoying than 10 Hz but only marginally different in tolerability.</div></div><div><h3>Conclusions</h3><div>The sensation and tolerability of TMS is dependent on stimulation location, and frequency, with increasing stimulation intensity.</div></div><div><h3>Significance</h3><div>From a research perspective, the tactile sensations can be a problematic confound, particularly when stimulation approaches an unpleasant or painful level. Clinically, providers need data on adjustments to stimulation parameters to improve tolerability and efficacy. This study provides TMS researchers and clinicians with empirical data to inform respective endeavors.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 727-737"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148853917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct cortical stimulation–evoked symptoms in the human temporal pole: a cohort study","authors":"Yulia Novitskaya,&nbsp;Andreas Schulze-Bonhage","doi":"10.1016/j.cnp.2026.05.004","DOIUrl":"10.1016/j.cnp.2026.05.004","url":null,"abstract":"<div><h3>Objective</h3><div>The temporal pole is a part of temporolimbic networks and may contribute to seizure generation in temporal lobe epilepsy. Direct cortical stimulation (DCS) during invasive presurgical evaluation in epilepsy patients provides information about its functional organization.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed DCS data from epilepsy patients at a tertiary center between 2012 and 2025. Patients with at least one temporopolar DCS session were included. Stimulation-induced symptoms were categorized by modality and frequency.</div></div><div><h3>Results</h3><div>Fifty patients (58% male, median age 33 years) underwent temporopolar DCS, comprising 157 stimulation trials. Overall, 66% of patients reported at least one symptom across a broad range of modalities. Sensory and motor manifestations were most frequent (75%). Although much less common (24%), cognitive, emotional, and visceral symptoms were significantly more likely to resemble patients' habitual seizure semiology (GLMM, OR = 13.0, 95% CI 2.42–69.7, <em>p</em> = 0.003). Thirteen patients reported ipsilateral painful facial sensations, likely reflecting activation of trigeminal sensory pathways due to current spread near the skull base.</div></div><div><h3>Conclusions</h3><div>Temporopolar DCS elicits heterogeneous symptoms, supporting its role as an integrative network node rather than a region with distinct stimulation-induced semiology.</div></div><div><h3>Significance</h3><div>The findings limit the localizing value of temporopolar DCS responses in presurgical evaluation.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 374-380"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148167568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the diagnostic yield of myasthenia gravis using 7-Hz repetitive nerve stimulation: an 11-year retrospective study","authors":"Cheng Chi Hsieh ,&nbsp;Yuan Ting Sun","doi":"10.1016/j.cnp.2026.05.006","DOIUrl":"10.1016/j.cnp.2026.05.006","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the diagnostic utility of augmenting the conventional 3-Hz repetitive nerve stimulation test (RNST) with a 7-Hz protocol in patients with myasthenia gravis (MG).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 11 years of RNST data (2013−2023) from patients at a tertiary medical center. The diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of the conventional 3-Hz protocol was compared against a combined 3-Hz plus 7-Hz protocol.</div></div><div><h3>Results</h3><div>Among 311 MG patients (208 generalized MG [gMG]; 103 ocular MG [oMG]), adding 7-Hz stimulation significantly improved the sensitivity for gMG from 69.0% to 82.1% without compromising specificity (91.7%). Multivariable regression confirmed that the combined protocol was independently associated with higher diagnostic yield in gMG (OR = 2.28, <em>p</em> = 0.019). Using a within-group paired analysis, 7-Hz RNST showed superior sensitivity compared to 3-Hz RNST. This increased diagnostic yield was predominantly observed in the gMG subgroup. Notably, 15% of MG patients were positive exclusively at 7 Hz, with the highest rescue rate observed in proximal muscles.</div></div><div><h3>Conclusion</h3><div>Incorporating 7-Hz RNST into standard diagnostic algorithms substantially enhances the detection of gMG, particularly when conventional 3-Hz testing yields negative results in proximal muscles.</div></div><div><h3>Significance</h3><div>RNST protocol selection may be tailored by clinical phenotype to maximize sensitivity by adding 7 Hz RNST.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 403-408"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temperature effects on TMS-Derived measures of cortical excitability: a systematic review and implications for a warming climate","authors":"Giulio Peroni ,&nbsp;Charlotte Ravenscroft ,&nbsp;Simona Balestrini ,&nbsp;Sanjay M. Sisodiya","doi":"10.1016/j.cnp.2026.05.010","DOIUrl":"10.1016/j.cnp.2026.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review evidence on the effects of temperature manipulation on transcranial magnetic stimulation (TMS)-derived measures of cortical excitability in healthy individuals and temperature-sensitive neurological conditions.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we searched PubMed, Cochrane Library, EMBASE, and MEDLINE through November–December 2025. Studies reporting quantitative TMS-EMG or TMS-EEG outcomes after experimentally induced, non-noxious temperature changes were included. Parallel searches examined healthy populations and six temperature-sensitive neurological conditions.</div></div><div><h3>Results</h3><div>Twenty-one studies in healthy individuals (<em>n</em> = 360, mean age 30.9 ± 5.7 years) and one study in multiple sclerosis (MS) met inclusion criteria. Temperature manipulations included whole-body (core changes −2.4 °C to +1.5 °C) and focal interventions (−22 °C to +18 °C). Most studies reported no significant effects on motor evoked potential (MEP) amplitude (73.3%), latency (71.4%), cortical silent period (85.7%), or paired-pulse measures (100%). Effect directions were inconsistent in studies reporting significant findings. The single MS study demonstrated heat-induced impairment, with increased motor threshold and decreased MEP amplitude, not observed in controls.</div></div><div><h3>Conclusions</h3><div>Experimental TMS studies largely show null effects of temperature on cortical excitability in healthy individuals, contrasting with epidemiological evidence of temperature-related neurological vulnerability. This discrepancy likely reflects modest brain temperature changes, peripheral confounds, and limited ecological validity of current paradigms.</div></div><div><h3>Significance</h3><div>There is a critical need for climate-relevant experimental designs incorporating sustained thermal exposure and direct cortical readouts (e.g., TMS-EEG) in temperature-sensitive populations to elucidate mechanisms of thermal vulnerability.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"11 ","pages":"Pages 416-425"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}