Clinical Neurophysiology Practice最新文献

{"title":"Nerve ultrasound: Unravelling the different patterns of nerve enlargement in CIDP subtypes","authors":"Cheng-Yin Tan, Mingsheng Liu, Nortina Shahrizaila","doi":"10.1016/j.cnp.2023.11.003","DOIUrl":"https://doi.org/10.1016/j.cnp.2023.11.003","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 226-227"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2467981X2300029X/pdfft?md5=592814db10991fb45387fd23c1bd3a67&pid=1-s2.0-S2467981X2300029X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557586","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":"Rapid response EEG with needle electrodes in an intensive care unit with limited resources","authors":"Karine J. Abou Khaled ,&nbsp;Mei Bou Nasif ,&nbsp;Claudia Freiji ,&nbsp;Lawrence J. Hirsch ,&nbsp;Michael W.K. Fong","doi":"10.1016/j.cnp.2023.02.002","DOIUrl":"10.1016/j.cnp.2023.02.002","url":null,"abstract":"<div><h3>Objective</h3><p>Continuous EEG (cEEG) is the gold standard for detecting seizures and rhythmic and periodic patterns (RPPs) in critically ill patients but is often not available in health systems with limited resources. The current study aims to determine the feasibility and utility of low-cost, practical, limited montage, sub-dermal needle electrode EEG in a setting where otherwise no EEG would be available.</p></div><div><h3>Methods</h3><p>The study included all adult patients admitted to the intensive care unit of a single center over a 24-month period. Members of the existing ICU care team, mostly nurses, were trained to place 8 sub-dermal needle EEG electrodes to achieve rapid, limited montage-EEG recording. Clinical outcomes were recorded, including any reported major complications; and the EEG findings documented, including background characterization, RPPs, and seizures.</p></div><div><h3>Results</h3><p>One hundred twenty-three patients, mean age 68 years, underwent an average of 15.6 min of EEG recording. There were no complications of electrode placement. Overall, 13.0% had seizures (8.1% qualifying as status epilepticus [SE]), 18.7 % had generalized periodic discharges (GPDs), 4.9% had lateralized periodic discharges (LPDs), and 11.4 % sporadic epileptiform discharges (sEDs). Greater mortality was observed in patients with worse background EEGs, seizures, LPDs, or sEDs.</p></div><div><h3>Conclusions</h3><p>Rapid, limited montage EEG could be achieved safely and inexpensively in a broad population of critically ill patients following minimal training of existing care teams.</p></div><div><h3>Significance</h3><p>For resource poor centers or centers outside of major metropolitan areas who otherwise have no access to EEG, this may prove a useful method for screening for non-convulsive seizures and status epilepticus.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 44-48"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/90/main.PMC10025002.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9174569","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":"Median nerve ultrasound cross sectional area and wrist-to-forearm ratio in relation to carpal tunnel syndrome related axonal damage and patient age","authors":"Henri Grönfors ,&nbsp;Sari-Leena Himanen ,&nbsp;Lauri Martikkala ,&nbsp;Mika Kallio ,&nbsp;Katri Mäkelä","doi":"10.1016/j.cnp.2023.02.003","DOIUrl":"10.1016/j.cnp.2023.02.003","url":null,"abstract":"<div><h3>Objective</h3><p>Primary objective was to retrospectively examine the effects of patient age and carpal tunnel syndrome (CTS) related axon loss on median nerve (MN) high resolution ultrasound (HRUS) in younger and older patients. HRUS parameters evaluated in this study were MN cross sectional area at the wrist (CSA) and wrist-to-forearm ratio (WFR).</p></div><div><h3>Methods</h3><p>The material comprised 467 wrists of 329 patients. The patients were categorized into younger (&lt;65 years) and older (≥65 years) groups. Patients with moderate to extreme CTS were included in the study. Axon loss of the MN was assessed by needle EMG and graded by the interference pattern (IP) density. The association between axon loss and CSA and WFR was studied.</p></div><div><h3>Results</h3><p>The older patients had smaller mean CSA and WFR values compared to the younger patients. CSA correlated positively to the CTS severity only in the younger group. However, WFR correlated positively to CTS severity in both groups. In both age groups, CSA and WFR correlated positively with IP reduction.</p></div><div><h3>Conclusions</h3><p>Our study complemented recent findings on the effects of patient age on the CSA of the MN. However, although the MN CSA did not correlate with the CTS severity in older patients, the CSA increased in respect to the amount of axon loss. Also, as a new result, we presented the positive association of WFR with CTS severity among older patients.</p></div><div><h3>Significance</h3><p>Our study supports the recently speculated need for different MN CSA and WFR cut-off values for younger and older patients in assessing the severity of CTS. With older patients, WFR may be a more reliable parameter to assess the CTS severity than the CSA. CTS related axonal damage of the MN is associated to additional nerve enlargement at the carpal tunnel intel site.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 81-87"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/31/ad/main.PMC10196766.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557872","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":"EEG-Delta brushes in DPPX encephalitis – Welcome to the club","authors":"Christine Heuer ,&nbsp;Leah Disse ,&nbsp;Debora Ledergerber ,&nbsp;Ilijas Jelcic ,&nbsp;Lukas L. Imbach","doi":"10.1016/j.cnp.2022.11.003","DOIUrl":"10.1016/j.cnp.2022.11.003","url":null,"abstract":"<div><h3>Background</h3><p>Extreme Delta Brushes are a rare interictal EEG pattern that was first described in NMDA-R encephalitis and has been considered a pathognomonic pattern for this subtype of autoimmune encephalitis. Recently, extreme delta brushes have been described as a rare EEG phenomenon in other forms of encephalitis.</p></div><div><h3>Case report</h3><p>We describe to our knowledge the first occurrence of EEG Delta brushes in DPPX encephalitis. In this article, we present a comprehensive case report and discuss clinical differential diagnosis with special emphasis on the diagnostic value of the EEG, leading the way to the correct diagnosis. We also present current diagnostic criteria and clinical screening scales for initial evaluation for patients with suspected autoimmune encephalitis.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 12-15"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/41/main.PMC9792293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460053","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":"Utility of nerve ultrasound in the management of primary neurolymphomatosis: Case report and review of the literature","authors":"Arena Wada ,&nbsp;Yudai Uchida ,&nbsp;Keiichi Hokkoku ,&nbsp;Amuro Kondo ,&nbsp;Yuki Fujii ,&nbsp;Takashi Chiba ,&nbsp;Takuji Matsuo ,&nbsp;Hiroshi Tsukamoto ,&nbsp;Yuki Hatanaka ,&nbsp;Shunsuke Kobayashi ,&nbsp;Masahiro Sonoo","doi":"10.1016/j.cnp.2023.04.003","DOIUrl":"10.1016/j.cnp.2023.04.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Primary neurolymphomatosis (NL) is a critical differential diagnosis of asymmetric multiple mononeuropathy and radiculoplexopathy. Its diagnosis is often challenging due to the lack of typical clinical signs of systemic lymphoma. We report a case of primary NL where nerve ultrasound (NUS) played an important role in the diagnosis and follow-up of the disease.</p></div><div><h3>Case presentation</h3><p>A 52-year-old man developed asymmetric painful multiple mononeuropathy in the right upper limb with cranial nerve involvement. After being referred to our department, the patient underwent NUS, which revealed marked enlargement and increased vascularity in the right upper limb nerves, brachial plexus, and cervical nerve roots. Furthermore, an epineural hypoechoic mass, a characteristic finding of NL, was seen in the right median nerve. These NUS findings prompted us to perform 18F-fluorodeoxyglucose positron emission tomography/computed tomography and a subsequent biopsy on the right axillary lymph node, confirming NL. Notably, the NUS abnormalities dramatically subsided, demonstrating the effectiveness of chemotherapy.</p></div><div><h3>Discussion</h3><p>The diagnostic utility of NUS for NL has been documented by many recent reports. Additionally, NUS can work as a quick follow-up tool for NL, as seen in our case.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 92-96"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5e/e4/main.PMC10225816.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9924283","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":"Repetitive transcranial magnetic stimulation for early-onset Alzheimer’s disease – A case report","authors":"Ali Elahi,&nbsp;Tiffany Frechette","doi":"10.1016/j.cnp.2023.07.003","DOIUrl":"10.1016/j.cnp.2023.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Early-onset Alzheimer’s Disease (AD) is a rare form of AD defined as exhibiting signs and symptoms before age 65. Several studies have shown high frequency repetitive transcranial magnetic stimulation (rTMS) to be an effective treatment for individuals with mild cognitive impairment (MCI) and AD when applied to the left and/or right dorsolateral prefrontal cortex (DLPFC) with clear improvements found on standardized assessments of cognitive function.</p></div><div><h3>Case report</h3><p>Here, we present a case report of a 44-year-old patient with clinical and laboratory characteristics of definite early-onset AD.</p></div><div><h3>Findings</h3><p>rTMS led to marked cognitive improvements. We hope to inspire more clinical interest in exploring rTMS for treatment of dementia.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 161-163"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/bf/main.PMC10425613.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10010667","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":"Sonomorphology of median nerve in relation to function: Important lessons from carpal tunnel but still complex","authors":"H. Stephan Goedee","doi":"10.1016/j.cnp.2023.04.001","DOIUrl":"10.1016/j.cnp.2023.04.001","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 79-80"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45346095","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":"EEG biomarker candidates for the identification of epilepsy","authors":"Stefano Gallotto,&nbsp;Margitta Seeck","doi":"10.1016/j.cnp.2022.11.004","DOIUrl":"10.1016/j.cnp.2022.11.004","url":null,"abstract":"<div><p>Electroencephalography (EEG) is one of the main pillars used for the diagnosis and study of epilepsy, readily employed after a possible first seizure has occurred. The most established biomarker of epilepsy, in case seizures are not recorded, are interictal epileptiform discharges (IEDs). In clinical practice, however, IEDs are not always present and the EEG may appear completely normal despite an underlying epileptic disorder, often leading to difficulties in the diagnosis of the disease. Thus, finding other biomarkers that reliably predict whether an individual suffers from epilepsy even in the absence of evident epileptic activity would be extremely helpful, since they could allow shortening the period of diagnostic uncertainty and consequently decreasing the risk of seizure. To date only a few EEG features other than IEDs seem to be promising candidates able to distinguish between epilepsy, i.e. &gt; 60 % risk of recurrent seizures, or other (pathological) conditions. The aim of this narrative review is to provide an overview of the EEG-based biomarker candidates for epilepsy and the techniques employed for their identification.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 32-41"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9088718","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":"Additional overnight video EEG for the diagnosis of epilepsy: Experiences from Western Kenya","authors":"Nshimiyimana Jules Fidele","doi":"10.1016/j.cnp.2023.07.004","DOIUrl":"10.1016/j.cnp.2023.07.004","url":null,"abstract":"<div><h3>Objective</h3><p>The prolonged video EEG monitoring is widely used for the diagnosis and management of epilepsy, especially during the presurgical evaluation. The routine practice in neurology is to order a prolonged recording like an overnight EEG when the initial routine EEG is normal or unrevealing. Only few studies have evaluated this sequential approach and we aimed in this study to evaluate the added diagnostic value of a relatively brief video EEG monitoring especially in developing nations where the history of seizure semiology may be harder to obtain, and the video EEG monitoring technology is scarce.</p></div><div><h3>Methods</h3><p>This study analyzed retrospectively 167 overnight video EEG records in one of the secondary healthcare facilities in Western Kenya between March 2018 and March 2021. The indications were mainly further diagnosis and seizure classification. All the patients had an unrevealing routine EEG and 162 of them were normal.</p></div><div><h3>Results</h3><p>Additional epileptiform discharges were recorded in 91 of those 162 with initial normal routine EEG. Further classification of seizure was achieved in 67 patients among 112 with initially unclassified seizure before the overnight recording. The improvement of 68% (97 out of 143 patients without a prior epilepsy diagnosis) for the diagnosis of epilepsy in those patients without initial final diagnosis is comparable to other similar studies but mostly with a longer duration of recording. The diagnosis was changed or at least improved in 142 (85%) patients out of the 167 patients who underwent the overnight video EEG. The treatment modification was immediately considered in 116 after the prolonged recording.</p></div><div><h3>Conclusions</h3><p>Adding an overnight video EEG to an unrevealing routine EEG can significantly increase the likelihood of detecting additional epileptiform discharges in patients with epilepsy, thereby improving diagnostic yield and aiding in treatment adjustment for all patients suspected of having epilepsy.</p></div><div><h3>Significance</h3><p>The sequential approach of adding a prolonged video EEG monitoring even as brief as an overnight video EEG to an unrevealing routine EEG has a very significant impact in further classification of seizure and diagnosis of epilepsy especially in a resource limited set up.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 164-168"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/4d/main.PMC10462784.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125508","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":"On-demand EEG education through competition – A novel, app-based approach to learning to identify interictal epileptiform discharges","authors":"Jaden D. Barfuss ,&nbsp;Fábio A. Nascimento ,&nbsp;Erik Duhaime ,&nbsp;Srishti Kapur ,&nbsp;Ioannis Karakis ,&nbsp;Marcus Ng ,&nbsp;Aline Herlopian ,&nbsp;Alice Lam ,&nbsp;Douglas Maus ,&nbsp;Jonathan J. Halford ,&nbsp;Sydney Cash ,&nbsp;M. Brandon Westover ,&nbsp;Jin Jing","doi":"10.1016/j.cnp.2023.08.003","DOIUrl":"10.1016/j.cnp.2023.08.003","url":null,"abstract":"<div><h3>Objective</h3><p>Misinterpretation of EEGs harms patients, yet few resources exist to help trainees practice interpreting EEGs. We therefore sought to evaluate a novel educational tool to teach trainees how to identify interictal epileptiform discharges (IEDs) on EEG.</p></div><div><h3>Methods</h3><p>We created a public EEG test within the iOS app DiagnosUs using a pool of 13,262 candidate IEDs. Users were shown a candidate IED on EEG and asked to rate it as epileptiform (IED) or not (non-IED). They were given immediate feedback based on a gold standard. Learning was analyzed using a parametric model. We additionally analyzed IED features that best correlated with expert ratings.</p></div><div><h3>Results</h3><p>Our analysis included 901 participants. Users achieved a mean improvement of 13% over 1,000 questions and an ending accuracy of 81%. Users and experts appeared to rely on a similar set of IED morphologic features when analyzing candidate IEDs. We additionally identified particular types of candidate EEGs that remained challenging for most users even after substantial practice.</p></div><div><h3>Conclusions</h3><p>Users improved in their ability to properly classify candidate IEDs through repeated exposure and immediate feedback.</p></div><div><h3>Significance</h3><p>This app-based learning activity has great potential to be an effective supplemental tool to teach neurology trainees how to accurately identify IEDs on EEG.</p></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"8 ","pages":"Pages 177-186"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10557012","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}