Clinical Neurophysiology Practice最新文献_第2页

Cathodal tDCS in obsessive-compulsive disorder: cognitive and neurophysiological outcomes in a double-blind sham-controlled trial 强迫症的阴极tDCS：双盲假对照试验的认知和神经生理结果

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-09-02 DOI: 10.1016/j.cnp.2026.08.009

Rut Zaks-Ohayon, Talia Beit-On Hakmon, Hagit Cohen, Itay Besser, Zippi Frenkel, Jonathan Guez, Doron Todder

Objective

This preliminary study examined the efficacy of cathodal transcranial direct current stimulation (tDCS) targeting the medial prefrontal cortex (mPFC) in reducing symptom severity, enhancing cognitive flexibility, and modulating brain-derived neurotrophic factor (BDNF) levels in individuals with obsessive-compulsive disorder (OCD).

Methods

A double-blind, randomized, sham-controlled trial was conducted with 20 patients meeting DSM-V criteria for OCD, of whom 15 completed the intervention and were included in the final analysis. Participants received cathodal mPFC-tDCS (2 mA, 20 min, 10 sessions) or sham stimulation. Symptom severity (Y-BOCS), cognitive flexibility (task-switching), salivary BDNF, and frontal alpha activity (qEEG at Fz) were measured at baseline, post-treatment, and follow-up.

Results

The tDCS group exhibited greater reductions in Y-BOCS scores over time (F(2, 26) = 12.562, p < 0.001, partial η² = 0.425). Task-switching performance improved in the experimental group compared with controls (F(2, 26) = 20.351, p < 0.001, partial η² = 0.531). Salivary BDNF levels increased significantly in the tDCS group at follow-up (F(2, 16) = 6.086, p = 0.01, partial η² = 0.432). Trends toward normalization of frontal alpha activity were observed, but did not reach statistical significance.

Conclusions

Cathodal mPFC-tDCS was associated with reduced OCD symptom severity, improved cognitive flexibility, and increased salivary BDNF. These preliminary findings warrant replication in larger controlled samples.

Significance

This study extends previous tDCS research in OCD by integrating clinical outcomes with cognitive performance and a peripheral marker of neuroplasticity. It provides preliminary support for mPFC-targeted tDCS as a potential intervention for OCD.

目的探讨针对内侧前额叶皮质（mPFC）的阴极经颅直流电刺激（tDCS）在减轻强迫症（OCD）患者症状严重程度、增强认知灵活性和调节脑源性神经营养因子（BDNF）水平方面的疗效。方法采用双盲、随机、假对照试验，选取符合DSM-V标准的强迫症患者20例，其中15例完成干预并纳入最终分析。参与者接受mPFC-tDCS阴极刺激（2 mA， 20分钟，10次）或假刺激。在基线、治疗后和随访时测量症状严重程度（Y-BOCS）、认知灵活性（任务切换）、唾液BDNF和额叶α活动（Fz时的qEEG）。结果tDCS组Y-BOCS评分随时间降低幅度更大（F(2,26) = 12.562, p < 0.001，偏η2 = 0.425）。与对照组相比，实验组的任务切换性能有所改善（F(2,26) = 20.351, p < 0.001，偏η2 = 0.531）。随访时，tDCS组唾液BDNF水平显著升高（F(2,16) = 6.086, p = 0.01，偏η2 = 0.432）。观察到额叶α活动趋于正常化的趋势，但没有达到统计学意义。结论经侧mPFC-tDCS可减轻强迫症症状严重程度，改善认知灵活性，增加唾液BDNF。这些初步发现可以在更大的对照样本中复制。意义本研究通过将临床结果与认知表现和神经可塑性的外周标志物结合起来，扩展了之前在强迫症中的tDCS研究。它为mpfc靶向tDCS作为强迫症的潜在干预措施提供了初步支持。

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引用次数: 0

Diaphragm ‘atonia’ during ictal and post-ictal apnoea: A case report. 猝死和猝死后呼吸暂停时膈肌“张力失调”1例报告。

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-10-11 DOI: 10.1016/j.cnp.2026.10.004

Margherita Burani, Giada Giovannini, Niccolò Orlandi, Matteo Pugnaghi, Lisa Taruffi, Sofia Angeloni, Stefano Meletti

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Significance

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.

目的：发作期和发作后中枢呼吸暂停（ICA和PCA）是由脑干呼吸驱动抑制驱动的，是癫痫猝死（SUDEP）的电临床生物标志物。虽然动物模型已经证明了癫痫相关的呼吸暂停存在真正的“张力隔膜”，但尚未有人类测谎研究通过直接肌电图记录证实呼吸肌“张力失调”。方法在本病例报告中，我们报告了一名患有脑膜脑泡相关颞叶癫痫的26岁女性，她接受了视频脑电图多导图，结合肋间肌和膈肌的表面肌电图。结果我们记录了一个左额颞叶癫痫发作伴ICA和四个连续的PCA事件，所有这些事件都伴随着膈肌和肋间肌的表面肌电图沉默。结论本病例提供了在ICA和PCA期间膈肌和肋间肌沉默的人体多导图证据，证实了呼吸抑制的级联性，通过脑干呼吸中心向下至呼吸肌本身。值得注意的是，尽管患者是清醒的，能够遵循命令，但肌肉还是会放松。这些发现支持了术前视频脑电图评估中，特别是颞叶癫痫发作时，心肺多导图对识别SUDEP高风险患者的重要性。

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引用次数: 0

Diagnostic discordance between referral impressions, clinical assessment, and final electrodiagnostic findings 转诊印象、临床评估和最终电诊断结果之间的诊断不一致

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-10-12 DOI: 10.1016/j.cnp.2026.09.008

Lauren L. Walkon, Daniel Menkes

Objective

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.

Methods

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.

Results

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; p < 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%).

Conclusions

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.

Significance

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.

目的本研究评估转诊印象、结构化预测评估和电诊断结果（EDX）之间的一致性，比较电诊断咨询师（EC）预测评估和转诊临床医生印象与最终EDX诊断的一致性。方法一项单中心前瞻性观察研究，纳入104名参与者，时间超过9 个月；101个测试完成。在神经传导研究和针肌电图（EMG）之前，EC记录了诊断印象。最终诊断使用ICD-10基于根的模式进行分类。比较转诊、预测和最终诊断，使用ICD-10首次列出的主要诊断代码之间的精确一致性。结果101例患者（平均年龄59 岁，女性59.4%），转诊-终末一致性为34.7%(35/101)，而EC前-终末一致性为71.3%(72/101)（匹配OR为6.29；95% CI为2.81-16.54;p <； 0.001）。EDX在67例（66.3%）患者中产生了有临床意义的诊断改变，53例（52.5%）患者的治疗得到改善；随后的实施没有被评估。EC预测诊断与EDX最终诊断差异29例（28.7%）。结论sedx经常识别出与转诊印象不同的诊断，有时与会诊医生的测试前评估不同。较高的考前期末一致性反映了经过重点病史和检查后临床医生之间的一致性；这并不能证明电诊断咨询师比转诊临床医生在诊断上更准确。这项单中心探索性研究支持了集中的测试前评估和EDX作为诊断咨询的临床价值。需要使用独立评估进行更大规模的多中心研究。

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引用次数: 0

Emergent technologies in clinical neurophysiology to study the neuromuscular system: IFCN handbook chapter 临床神经生理学研究神经肌肉系统的新兴技术：IFCN手册章节

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-09-18 DOI: 10.1016/j.cnp.2026.09.003

H. Tankisi, H. Bostock, L.D. Hobson-Webb, D. Holder, J. Howells, H. Olausson, S.B. Rutkove, N. Shahrizaila, W. Z'Graggen, J. Valls-Sole, J. Cole

The present chapter of the new third series IFCN Handbook focuses on how peripheral neurophysiology may develop in the next five years or more. While some are clinical relevant, others are more experimental. The first three sections detail the possible futures of EMG, motor unit number estimation, surface EMG and movement. In a section on magnetoneurography, electrically induced signals are visualized in sensory nerves whilst that on magnetomyography shows how motor units may be identified in greater detail than with surface EMG. Electrical impedance methods for assessing nerve and muscle are considered, with the latter having been used clinically in several neurological conditions already. The section on microneurography describes how single nerve cells' response properties are related to RNA activity from dorsal root ganglion cells, leading to the identification of sixteen peripheral sensory nerve populations. Hyperexcitability syndromes can be difficult to diagnose, so nerve and muscle excitability testing, measuring membrane properties and ion channelopathies, shows clinical promise. The last section details ultrasound methods used in peripheral nerve and muscle disease and shows how ultrasound is becoming a necessary adjunct to nerve conduction studies and EMG. Common considerations between these methods' future include the greater use of artificial intelligence and that being non-invasive means they may be used for both diagnosis and long-term monitoring. Common barriers to wider availability include access to complex software and appropriate machines.

新的第三系列IFCN手册的本章侧重于周围神经生理学在未来五年或更长时间内的发展。有些是临床相关的，有些则是实验性的。前三个部分详细介绍了肌电图、运动单元数估计、表面肌电图和运动的可能未来。在磁神经图的一节中，电诱导信号在感觉神经中被可视化，而磁断层图显示了如何比表面肌电图更详细地识别运动单元。考虑电阻抗法评估神经和肌肉，后者已在临床上用于几种神经系统疾病。微神经摄影部分描述了单个神经细胞的反应特性如何与背根神经节细胞的RNA活性相关，从而确定了16个周围感觉神经群。高兴奋性综合征很难诊断，因此神经和肌肉兴奋性测试，测量膜特性和离子通道病变，显示出临床前景。最后一节详细介绍了周围神经和肌肉疾病中使用的超声方法，并展示了超声如何成为神经传导研究和肌电图的必要辅助手段。这些方法未来的共同考虑包括人工智能的更多使用，以及非侵入性意味着它们可以用于诊断和长期监测。扩大可用性的常见障碍包括获取复杂的软件和适当的机器。

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引用次数: 0

A practical framework for interpreting intraoperative electrophysiological signals in acoustic neuroma surgery 听神经瘤手术中解释术中电生理信号的实用框架

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-09-29 DOI: 10.1016/j.cnp.2026.09.006

Juan Li, Qing Liu, Xianrui Yuan, Jian Yuan

Objective

To develop a practical, stepwise framework for interpreting intraoperative neurophysiological signals to predict facial nerve outcomes after acoustic neuroma surgery.

Methods

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.

Results

An end-of-surgery FMEP amplitude reduction >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 >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.

Conclusions

This report provides a clinically usable, stepwise framework that integrates FMEP, DES, and free-running EMG thresholds for intraoperative prediction of facial nerve function.

Significance

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.

目的建立一个实用的、逐步的框架来解释术中神经生理信号，以预测听神经瘤术后面神经预后。方法本方法学报告综合了三种IONM模式的证据：面部运动诱发电位（FMEPs），直接电刺激（DES）和自由运行肌电图（EMG）。关键预测参数、阈值、敏感性、特异性和技术限制从已发表的荟萃分析、系统评价和前瞻性队列研究中提取。然后根据这些参数的典型术中使用情况，按时间顺序将其组织成逐步解释框架。ResultsAn end-of-surgery FMEP减少振幅在50%预测贫困长期(≥1年)面部功能特异性为93%。脑干残端DES阈值≤0.05 mA预示良好的长期功能（73%敏感性，74%特异性）。在自由运行的肌电图上，累计A列持续时间为10 s，表明严重即时瘫痪的风险较高（敏感性66.7%，特异性88.0%）。2026 CNS指南确认电生理参数比单独的临床信息更能预测长期预后。本报告提供了一个临床可用的、逐步整合FMEP、DES和自由运行肌电图阈值的框架，用于术中预测面神经功能。尽管术中常规使用神经生理监测，但没有标准化的框架将实时信号转化为术后面神经预测。该框架填补了这一空白，为外科医生和监测团队提供了一个明确的、以证据为基础的、按时间顺序排序的决策辅助，有可能提高对不良结果的早期识别，并促进及时转诊面部再生。

{"title":"A practical framework for interpreting intraoperative electrophysiological signals in acoustic neuroma surgery","authors":"Juan Li, Qing Liu, Xianrui Yuan, 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 >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 >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}

引用次数: 0

Microstates and connectivity states reveal task-related network reorganization in Alzheimer's disease patients 微观状态和连接状态揭示了阿尔茨海默病患者的任务相关网络重组

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-07-28 DOI: 10.1016/j.cnp.2026.07.016

Ji-Won Kim, Azamat Yeldesbay, Christina Kehm, Ronja V. Fassbender, Oezguer A. Onur, Nils Rosjat, Gereon R. Fink, Silvia Daun

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Significance

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.

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引用次数: 0

The frequency-dependent effects of primary hand motor cortex stimulation on volitional finger movement 初级手运动皮层刺激对手指意志运动的频率依赖性影响

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-03-20 DOI: 10.1016/j.cnp.2026.03.001

Léon Taquet , Brian J. Conway , Timothy F. Boerger , Kaitlin Goetschel , Sarah C. Young , Nada E. Botros , Manoj Raghavan , Brian D. Schmit , Max O. Krucoff

Objective

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.

Methods

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.

Results

Inability to flex the index finger during subthreshold stimulation was noted in 3 participants at frequencies >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.

Conclusion

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.

Significance

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.

目的：我们对接受清醒开颅手术的患者进行了一项前瞻性研究，以检验皮层刺激对手部初级运动皮层（M1）的影响是否具有(1)频率依赖性和(2)抑制性。方法在11名接受清醒开颅手术的参与者中，我们在手指屈曲任务中提供1-333 Hz的脉冲刺激。记录同步皮质电图（ECoG）、手指关节运动、肌电图（EMG）和视频。结果在250 Hz频率的阈下刺激下，当电极位于诱发食指以更高振幅伸展的位置时，3名参与者发现食指不能弯曲。除了这些试验之外，所有的刺激事件要么引起肌肉收缩，要么没有可测量的效果。本研究的数据首次证明了(1)M1电刺激对手部运动的抑制作用，以及(2)任务过程中手部M1电刺激的净下游效应的频率依赖性。我们的研究结果支持了运动抑制的机制可能是间接的、净抑制机制的激活的假设，而不是直接抑制受刺激的运动神经元。意义使用连续的脑电刺激来重新绘制远离侵入性病变的解剖-功能关系的兴趣越来越大。实现这种类型的神经可塑性需要更好地理解皮层刺激的直接和间接影响。在这里，我们证明了皮层M1刺激对手指意志运动的频率依赖效应。

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引用次数: 0

Mills–Nithi algorithm for navigated transcranial magnetic stimulation motor mapping in healthy subjects and brain tumor patients 健康受试者和脑肿瘤患者导航经颅磁刺激运动定位的Mills-Nithi算法

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-08-22 DOI: 10.1016/j.cnp.2026.08.006

Evangelia Chatzikyriakou, Ioannis Vlachos, Konstantinos Pastiadis, Nikolaos Foroglou, Konstantinos Kouskouras, Georgios Feretos, Christos Frantzidis, Ioannis Patsalas, Vasilios Papaliagkas, Dimitris Kugiumtzis, Vasilios K. Kimiskidis

Objective

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.

Methods

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.

Results

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; p = 0.03) and was more likely to elicit responses (p = 0.0375), with markedly reduced inter-individual variability (p < 0.0001).

Conclusions

Motor mapping based on UT produces results comparable to 110% rMT, while improving procedural efficiency and response consistency in healthy subjects.

Significance

Our findings support the Mills-Nithi algorithm as a practical alternative for clinical nTMS motor mapping.

目的导航经颅磁刺激（nTMS）运动定位通常在静息运动阈值（rMT）的固定百分比下进行，最常见的是110%。Mills-Nithi算法的上限阈值（UT），即100%概率触发mep的最小刺激强度，已被提出作为替代方案。本研究比较了健康受试者和脑肿瘤患者在110% rMT下与Mills-Nithi方法的运动测绘。方法11例健康对照和14例幕上肿瘤患者采用Mills-Nithi算法的UT和自适应阈值搜索算法估计的110% rMT进行FDI运动定位。结果包括脉冲数、热点定位、地图面积、体积、重心和DTI参数（即光纤数、FA、ADC、光纤长度）。拟合个性化的s型曲线来估计响应概率。独立对照组12名健康受试者在110% rMT下进行两次nTMS制图，以建立基线地球移动距离（EMD）值。结果两组患者的运动图特征和DTI指标无显著差异。在健康受试者中，UT-based运动映射所需的刺激少于110% rMT(110%: 256±95个刺激；UT: 227±97;p = 0.03)，更容易引起反应（p = 0.0375），个体间差异显著降低（p < 0.0001）。结论基于UT的运动映射的结果与110% rMT相当，同时提高了健康受试者的程序效率和反应一致性。我们的研究结果支持Mills-Nithi算法作为临床nTMS运动映射的实用替代方案。

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引用次数: 0

Tactile perception and tolerability thresholds of TMS characterized by intensity across locations and frequencies 经颅磁刺激的触觉感知和耐受阈值具有不同位置和频率的强度特征

IF 2.3 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-07-21 DOI: 10.1016/j.cnp.2026.07.010

Neketa Nesmith, Megan Senda, Yang Hou, Kirthin Dev, Austin M. Spitz, F. Andrew Kozel, Kevin A. Johnson

Objective

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.

Methods

Study participants (n = 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.

Results

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.

Conclusions

The sensation and tolerability of TMS is dependent on stimulation location, and frequency, with increasing stimulation intensity.

Significance

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.

目的经颅磁刺激（TMS）包括脉冲磁场通过头皮刺激大脑，附带刺激浅表神经和肌肉。该研究通过位置（改良的BeamF3前额叶、三维前额叶、右眶额叶、内侧前额叶、运动和顶叶皮质目标以及膝盖）和频率（1hz、10hz或iTBS）来表征TMS的头皮感觉，并增加刺激强度。方法研究参与者（n = 18）每人提供7个地点的评分，每个地点有3个频率。我们采用了定量感官极限测试方法，在每次试验中，随着TMS强度的增加，参与者确定了感觉阈值、烦恼阈值和耐受性阈值。结果面神经和肌肉远端部位（膝关节、P3、M1、mPFC）的耐受性较好，其次是BeamF3, 3d和AF8部位的耐受性最差。对于频率，我们发现1hz明显比10hz和iTBS更容易忍受。iTBS比10hz更令人讨厌，但在耐受性上只有微小的不同。结论经颅磁刺激的感觉和耐受性与刺激部位和频率有关，并随刺激强度的增加而增加。从研究的角度来看，触觉可能是一个有问题的混淆，特别是当刺激接近不愉快或痛苦的水平时。临床上，医生需要调整刺激参数的数据，以提高耐受性和疗效。本研究为经颅磁刺激研究人员和临床医生提供了经验数据，以指导各自的工作。

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引用次数: 0

Direct cortical stimulation–evoked symptoms in the human temporal pole: a cohort study 人类颞极直接皮层刺激诱发的症状：一项队列研究

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice

Pub Date : 2026-01-01 Epub Date: 2026-05-21 DOI: 10.1016/j.cnp.2026.05.004

Yulia Novitskaya, Andreas Schulze-Bonhage

Objective

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.

Methods

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.

Results

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, p = 0.003). Thirteen patients reported ipsilateral painful facial sensations, likely reflecting activation of trigeminal sensory pathways due to current spread near the skull base.

Conclusions

Temporopolar DCS elicits heterogeneous symptoms, supporting its role as an integrative network node rather than a region with distinct stimulation-induced semiology.

Significance

The findings limit the localizing value of temporopolar DCS responses in presurgical evaluation.

目的颞极是颞叶癫痫的一部分，可能与癫痫发作有关。直接皮质刺激（DCS）在有创性术前评估癫痫患者提供其功能组织的信息。方法回顾性分析2012 - 2025年某三级中心癫痫患者DCS数据。至少有一次颞极DCS会话的患者被纳入研究。刺激引起的症状按方式和频率分类。结果50例患者（58%男性，中位年龄33岁）接受了颞极DCS，包括157项刺激试验。总体而言，66%的患者报告至少有一种症状。感觉和运动表现最为常见（75%）。虽然不太常见（24%），但认知、情绪和内脏症状更有可能与患者的习惯性发作符码相似（GLMM, OR = 13.0, 95% CI 2.42-69.7, p = 0.003）。13例患者报告同侧面部疼痛感，可能反映了由于电流在颅底附近扩散而激活三叉神经感觉通路。结论孔极DCS引起的症状异质性，支持其作为一个综合网络节点的作用，而不是一个具有不同刺激诱导符号学的区域。意义本研究结果限制了颞极DCS反应在术前评估中的定位价值。

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引用次数: 0