Clinical Neurophysiology Practice最新文献

{"title":"Prognostic models for seizures and epilepsy after stroke, tumors and traumatic brain injury","authors":"Kai Michael Schubert,&nbsp;Anton Schmick,&nbsp;Miranda Stattmann,&nbsp;Marian Galovic","doi":"10.1016/j.cnp.2025.02.008","DOIUrl":"10.1016/j.cnp.2025.02.008","url":null,"abstract":"<div><div>Epilepsy is a frequent consequence of acute brain injuries, such as stroke, brain tumors, and traumatic brain injury (TBI). Accurate prediction of epilepsy is essential for early intervention and improved patient outcomes. This review evaluates the best-established prognostic models, including the SeLECT and CAVE scores, which estimate the risk of developing seizures and epilepsy following these injuries. The review highlights their clinical applicability, predictive accuracy, and limitations for different etiologies. In addition to providing practical tables for risk estimation, we also offer user-friendly online calculators for these models at <span><span>www.predictepilepsy.com</span><svg><path></path></svg></span> to facilitate clinical implementation. These tools help identify high-risk patients and support decision-making for follow-up and treatment. Furthermore, we discuss the potential of integrating electrophysiological data, including EEG biomarkers, to further enhance prediction accuracy and patient care. These insights highlight the need for further refinement and validation of predictive models, enabling more personalized treatment strategies and better patient care.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 116-128"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628171","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":"Comments on “Asymptomatic tarsal tunnel syndrome in rheumatoid arthritis: an electrophysiological perspective with insights into clinical and laboratory correlates”","authors":"Peyman Roomizadeh ,&nbsp;Ayushi Chugh","doi":"10.1016/j.cnp.2025.08.004","DOIUrl":"10.1016/j.cnp.2025.08.004","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Page 346"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894787","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":"The optimal montage to mark interictal epileptiform discharges and high-frequency oscillations in intraoperative electrocorticography","authors":"Ziyi Wang ,&nbsp;Jiaojiao Guo ,&nbsp;Eline Schaft ,&nbsp;Sem Hoogteijling ,&nbsp;Cyrille H. Ferrier ,&nbsp;Gerhard H. Visser ,&nbsp;Dongqing Sun ,&nbsp;Friso Hoefnagels ,&nbsp;Taku Inada ,&nbsp;Sandra van der Salm ,&nbsp;Geertjan Huiskamp ,&nbsp;Nicole van Klink ,&nbsp;Maryse van’t Klooster ,&nbsp;Maeike Zijlmans ,&nbsp;On behalf of the RESPect database study group","doi":"10.1016/j.cnp.2025.06.007","DOIUrl":"10.1016/j.cnp.2025.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>In intraoperative electrocorticography (ioECoG), interictal epileptiform discharges (IEDs) and high-frequency oscillations (HFOs; ripples 80–250 Hz, fast ripples (FRs) 250–500 Hz) can be identified in <em>average</em> or <em>bipolar</em> montage. We studied how montage choice affects event identification.</div></div><div><h3>Methods</h3><div>Two reviewers independently marked IEDs and HFOs across three montages (<em>average,</em> horizontal- and vertical-<em>bipolar</em>) from 13 patients who were seizure-free after ioECoG-guided surgery. We analyzed the number of channels-with-events, total events count, events morphology (maximum-amplitude, duration, frequency), number of instances with overlapping events across multiple channels (event_instance), concordance of event_instances over montages, and percentage of channels-with-events in the resected-area.</div></div><div><h3>Results</h3><div><em>Bipolar</em> montages yielded more channels-with-events, higher counts, and greater maximum-amplitude of IEDs and ripples compared to <em>average</em> montages. <em>Average</em> and horizontal<em>-bipolar</em> montages yielded more IED_instances than vertical<em>-bipolar</em> montages. <em>Average</em> montages detected the highest percentage of event_instances occurring only in this montage. Event duration, frequency, and percentage of channels-with-events in the resected-area did not differ across montages.</div></div><div><h3>Conclusions</h3><div>All three ioECoG montages are clinically useful to find epileptic events. The <em>bipolar</em> montage detects more events with greater amplitude, while the <em>average</em> montage uncovers a wider variety of unique events. Combining montages provides complementary information.</div></div><div><h3>Significance</h3><div>This study quantitatively revealed how different montages capture epileptiform events.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 246-255"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562782","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":"Muscle excitability testing: Age and sex dependency of normative data","authors":"Matthias Thomas Exl ,&nbsp;Belén Rodriguez ,&nbsp;Karl Ng ,&nbsp;Stella Veronica Tan ,&nbsp;James Howells ,&nbsp;Hugh Bostock ,&nbsp;Hatice Tankisi ,&nbsp;Werner J. Z’Graggen","doi":"10.1016/j.cnp.2025.03.002","DOIUrl":"10.1016/j.cnp.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>To establish normative data for muscle excitability testing in the tibialis anterior muscle of a healthy population, and to determine their dependence on age and sex.</div></div><div><h3>Methods</h3><div>Parameters of muscle velocity recovery cycle recordings with 1, 2 and 5 conditioning stimuli of 197 healthy subjects and frequency ramp recordings of 151 healthy subjects were retrospectively analysed for age and sex differences.</div></div><div><h3>Results</h3><div>There were no differences by sex and only small age differences were found in healthy subjects older than 60 years for the muscle excitability parameters muscle relative refractory period, early supernormality and latency to the first response in a train at 15 Hz and 30 Hz.</div></div><div><h3>Conclusions</h3><div>In this study, based on a large sample of muscle velocity recovery cycle and frequency ramp recordings, we have provided normative data and shown that muscle excitability testing is not influenced by sex, and that age only has an influence from the age of 60 years onwards on parameters reflecting muscle membrane potential.</div></div><div><h3>Significance</h3><div>Our results suggest that future studies no longer need to control for sex when using a healthy control group.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 129-133"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681141","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":"Presence of interictal epileptiform EEG discharges implies increased risk of recurrence after the first unprovoked seizure: Report of the International League Against Epilepsy and International Federation of Clinical Neurophysiology","authors":"Betül Baykan ,&nbsp;John Dunne ,&nbsp;Samuel Wiebe ,&nbsp;Louis Maillard ,&nbsp;Sandor Beniczky ,&nbsp;Michalis Koutroumanidis ,&nbsp;Margitta Seeck","doi":"10.1016/j.cnp.2025.07.007","DOIUrl":"10.1016/j.cnp.2025.07.007","url":null,"abstract":"<div><h3>Objective</h3><div>A joint International Federation of Clinical Neurophysiology — International League Against Epilepsy (IFCN-ILAE) Taskforce was created to explore the published evidence for initial EEGs in the evaluation of patients who experienced their first unprovoked seizure, and to determine the diagnostic value of EEG in supporting the diagnosis of epilepsy.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review, with two independent authors screening each study. We extracted seizure recurrence data among patients with EEG showing interictal epileptiform discharges (IEDs) versus those with normal or nonspecific-abnormal EEG results. Random-effects meta-analyses of seizure recurrence in relation to IEDs was conducted in the included studies, calculating odds ratios (OR) with confidence intervals (CI) and diagnostic accuracy.</div></div><div><h3>Results</h3><div>A total of 4847 patients from 22 studies with variable follow-up durations were analysed. The random-effects pooled binary estimate of seizure recurrence was 47 % (95 % CI 40 %–55 %). The overall proportion with seizure recurrence was higher in patients with IEDs (60 %; 95 % CI 53 %–68 %) compared to those without (40 %; 95 % CI 33 %–48 %, p &lt; 0.001). Random-effects meta-analysis showed that the presence of IEDs was associated with seizure recurrence (OR: 2.32, 95 % CI 1.69–3.17, p &lt; 0.001). Subgroup analyses of adults and children showed that this difference remained significant in both groups: OR in children of 3.24 (95 % CI 2.19–4.79) and in adults of 1.55 (95 % CI 1.08–2.21). In eight studies (n = 1209, 923 children) patients remained untreated before the second seizure; the pooled probability of seizure recurrence in those with IED in these studies was no different than in studies in which some patients were treated.</div></div><div><h3>Significance</h3><div>In conclusion, the presence of IEDs in EEG recordings obtained after the first unprovoked seizure can help clinicians to confirm the clinical diagnosis of epilepsy after a first unprovoked seizure, according to the revised ILAE definition. These results support the relevance of IED detection on EEG as a predictor of seizure recurrence after a first unprovoked seizure. However, its prognostic value is influenced by age and other clinical factors.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 380-391"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060317","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":"Multimodal tele-epileptology: Challenges on the way to interoperable medical data","authors":"Sigrid Mues ,&nbsp;Arndt Ebert ,&nbsp;Marc Kämmerer ,&nbsp;Marcus Kremers ,&nbsp;Ulrich Sliwka ,&nbsp;Rüdiger Hilker-Roggendorf ,&nbsp;Dirk Woitalla ,&nbsp;Iris Adelt ,&nbsp;Thomas Günnewig ,&nbsp;Ana Miron ,&nbsp;Sulev Haldre ,&nbsp;Tipakorn Tumnark ,&nbsp;Kanjana Unnwongse ,&nbsp;Wenke Grönheit ,&nbsp;Tim Wehner ,&nbsp;Vanessa Behrens ,&nbsp;Jörg Wellmer","doi":"10.1016/j.cnp.2025.02.004","DOIUrl":"10.1016/j.cnp.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>To realize multi-modal data exchange for telemedicine in epilepsy.</div></div><div><h3>Methods</h3><div>TE Ruhr is a multicenter, prospective pilot study. Primary endpoint of the study was the technical implementation of a platform between an epilepsy center and regional neurological departments and international cooperating epilepsy centers, respectively. A multi-professional board was established to develop technical workflows. After completion of the study a survey was conducted among users of the regional arm.</div></div><div><h3>Results</h3><div>Two workflows were developed, 1) a combination of web-application and use of an established teleradiology network, and 2) a web-application only data exchange. Technical workflow 1 comprised local EEG conversion into to a standard format (.besa) and its shipping as DICOM RAW object. Technically, both workflows could be implemented. Yet, workflow 1 was not realisable in peripheral hospitals. Via workflow 2, 149 consults for 144 patients were completed. Users of the regional arm were satisfied (1.6 on a grading scale of 1–6 (1-very good, 6- very bad)).</div></div><div><h3>Conclusion</h3><div>Technical feasibility alone does not determine the actual use of telemedicine. Web applications enables multimodal data exchange, but usability is limited due to lack of interoperability.</div></div><div><h3>Significance</h3><div>Genuine interoperability of medical data remains the desired goal for multi modal data exchange.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 56-62"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552404","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":"Controversies: Periodic discharges in critically ill patients –” urgent treatment is essential”","authors":"M. Brandon Westover,&nbsp;Peter W. Kaplan,&nbsp;Aatif M. Husain","doi":"10.1016/j.cnp.2025.06.010","DOIUrl":"10.1016/j.cnp.2025.06.010","url":null,"abstract":"","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 286-291"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633447","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":"Rapid recovery after four months of near-tetraplegia: A case report of pan-neurofascin nodopathy and a brief review of emerging questions","authors":"Dániel Milanovich,&nbsp;Zsolt Mezei,&nbsp;Anna Katalin Iljicsov,&nbsp;János Bíró,&nbsp;Zsuzsanna Arányi,&nbsp;Magdolna Simó","doi":"10.1016/j.cnp.2025.09.005","DOIUrl":"10.1016/j.cnp.2025.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>Pan-neurofascin nodopathy is a rare form of dysimmune neuropathies, mediated by antibodies against the common epitope of the 140, 155 and 186 neurofascin isoforms. These autoantibodies cause the defect of saltatory action potential spreading, disorganization of the nodal-paranodal ultrastructure, and axonal loss of variable degree.</div></div><div><h3>Methods</h3><div>A 32-year old male presented with the typical symptom of acute onset severe tetraparesis. Electrophysiological findings indicated severe conduction failure, but no appreciable axonal loss. High-resolution ultrasound showed diffuse, but patchy pathology, including mild enlargement and abnormal fascicular structure in proximal arm nerves and the brachial plexus. Symptoms worsened despite plasma exchange, and showed only mild and transient improvement upon repeated intravenous immunoglobulin treatment.</div></div><div><h3>Results</h3><div>After the verification of pan-neurofascin antibodies, rituximab treatment was applied and we observed rapid improvement within weeks, leading to complete remission at 6 weeks.</div></div><div><h3>Conclusions</h3><div>A young male with pan-neurofascin nodopathy presenting as acute-onset symptoms resembling Guillain–Barré syndrome, became asymptomatic following 4 months of near-tetraplegia as a result of rituximab therapy.</div></div><div><h3>Significance</h3><div>In pan-neurofascin nodopathy, rituximab treatment can lead to complete reversal of symptoms, even in cases characterized by prolonged and severe clinical manifestations. We also provide one of the first ultrasound descriptions of a pan-neurofascin case.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 433-439"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218894","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":"Neurophysiology and muscle histopathology in ICU-acquired muscle weakness: Lessons learned from COVID-19","authors":"Eva K. Hejbøl ,&nbsp;Atle V. Lomstein ,&nbsp;Henrik D. Schrøder ,&nbsp;Benjamin Khan ,&nbsp;Thomas Harbo ,&nbsp;Hatice Tankisi","doi":"10.1016/j.cnp.2025.05.001","DOIUrl":"10.1016/j.cnp.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>To describe different electrophysiological, histopathological, and ultrastructural patterns of muscle pathology in COVID-19-associated intensive care unit acquired weakness (ICUAW) and raise the question of whether COVID-19-associated critical illness myopathy (CIM) is a distinct entity or is similar to CIM of other causes.</div></div><div><h3>Methods</h3><div>A series of three patients with COVID-19-associated ICUAW were presented.</div><div>Clinical examination, electrophysiological testing, and muscle pathology with light and electron microscopy were reported systematically.</div></div><div><h3>Results</h3><div>All three patients were clinically affected with severe proximal and distal weakness of upper and lower extremities, increased plasma levels of muscle enzymes, and had myopathic electromyography. Furthermore, in two patients, electrophysiological signs of inflammatory myopathy with profuse denervation activity were present. Muscle pathologies were prominent but very diverse. One patient had signs of CIM, another showed severe inflammatory myopathy, and the main finding in the third patient was mitochondrial changes.</div></div><div><h3>Conclusion</h3><div>Although the three cases showed similar clinical and electrophysiological patterns, muscle pathology revealed distinct underlying features. This spectrum of muscle disease among patients with severe COVID-19 includes CIM, autoimmune response to the COVID-19 infection, and mitochondrial dysfunction.</div></div><div><h3>Significance</h3><div>Electrophysiology and histopathology complement each other and are important for determining the etiology, as well as guiding treatment and prognosis.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 172-180"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068562","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":"Impact of clinical neurophysiological assessment on diagnosis and management of tremor disorders","authors":"Katherine Longardner ,&nbsp;Yasoda Satpathy ,&nbsp;Irene Litvan ,&nbsp;Dietrich Haubenberger","doi":"10.1016/j.cnp.2025.05.003","DOIUrl":"10.1016/j.cnp.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the clinical utility of a standardized, non-invasive electrodiagnostic testing protocol in refining the diagnosis and management of patients referred for tremor evaluation.</div></div><div><h3>Methods</h3><div>In this prospective observational study, patients with tremulous limb movements with indeterminate clinical diagnoses involving tremor as a cardinal symptom were referred by movement disorders neurologists. Participants underwent standardized phenotyping and electrodiagnostic studies for tremor analysis including four-channel surface electromyography polygraphy and two-channel accelerometry.</div></div><div><h3>Results</h3><div>Clinical and electrophysiological data from 31 consecutive individuals were analyzed. Electrodiagnostic testing refined the differential diagnosis in 25/31 (80.6 %) participants and changed therapy in 14/29 (48.3 %). Changes included adjusting pharmacotherapy (n = 10), undergoing deep brain stimulation surgery (n = 2), or avoiding invasive procedures (n = 2).</div></div><div><h3>Conclusions</h3><div>We propose that electrodiagnostic testing is a clinically valuable tool that can narrow the differential diagnosis and impact treatment of tremor.</div></div><div><h3>Significance</h3><div>Clinical evaluation alone may be insensitive in diagnosing the tremor type when findings are subtle or when multiple movement disorders coexist. This may lead to inaccurate diagnosis and management, increasing cost and patient burden, and prolonging or preventing a successful journey towards adequate treatment. Clinical neurophysiology is a useful diagnostic procedure that can detect and quantify movements that may be otherwise indistinguishable by visual observation.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 188-201"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307951","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}