Journal Of Clinical Neurophysiology[JOURNAL]
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200 papers
Using Quantitative EEG to Stratify Epilepsy Risk After Neonatal Encephalopathy: A Comparison of Automatically Extracted Features.
Fulton N, Guerriero RM, Keene M … +6 more , Landre RL, Tomko SR, Vesoulis ZA, Zempel JM, Ching S, Keene JC
J Clin Neurophysiol · 2026 Jan · PMID 40059129 · Publisher ↗
PURPOSE: Neonatal encephalopathy (NE) is a commonly encountered, highly morbid condition with a pressing need for accurate epilepsy prognostication. We evaluated the use of automated EEG for prediction of early life epil...
PURPOSE: Neonatal encephalopathy (NE) is a commonly encountered, highly morbid condition with a pressing need for accurate epilepsy prognostication. We evaluated the use of automated EEG for prediction of early life epilepsy after NE treated with therapeutic hypothermia (TH). METHODS: We conducted retrospective analysis of neonates with moderate-to-severe NE who underwent TH at a single center. The first 24 hours of EEG data underwent automated artifact removal and quantitative EEG (qEEG) analysis with subsequent evaluation of qEEG feature accuracy at the 1st and 20th hour for epilepsy risk stratification. RESULTS: Of 144 neonates with NE, 67 completed at least 1 year of follow-up with a neurologist and were included. Twenty-three percent had seizures ( N = 18) in the NICU and 9% developed epilepsy ( N = 6). We found multiple automatically extracted qEEG features were predictive of epilepsy as early as the first hour of life, with improved risk stratification during the first day of life. In the 20th hour EEG, absolute spectral power best stratified epilepsy risk, with area under the curve ranging from 76% to 83% across spectral frequencies, followed by range EEG features including width, SD, upper and lower margin, and median. Clinical examination did not significantly predict epilepsy development. CONCLUSIONS AND SIGNIFICANCE: Quantitative EEG features significantly predicted early life epilepsy after NE. Automatically extracted qEEG may represent a practical tool for improving risk stratification for post-NE epilepsy development. Future work is needed to validate using automated EEG for prediction of epilepsy in a larger cohort.
A Quantitative Electroencephalographic Index for Stroke Detection in Adults.
Caffarelli M, Simmons R, Tolokh I … +6 more , Karukonda V, Guterman EL, Smith W, Fox CK, Westover MB, Amorim E
J Clin Neurophysiol · 2026 Jan · PMID 40048377 · Full text
PURPOSE: Electroencephalography (EEG) remains underutilized for stroke characterization. We sought to assess the performance of the EEG Correlate Of Injury to the Nervous system (COIN) index, a quantitative metric design...
PURPOSE: Electroencephalography (EEG) remains underutilized for stroke characterization. We sought to assess the performance of the EEG Correlate Of Injury to the Nervous system (COIN) index, a quantitative metric designed for stroke recognition in children, in discriminating large from small ischemic strokes in adults. METHODS: Retrospective, single-center cohort of adults with acute (within 7 days) ischemic stroke who underwent at least 8 hours of continuous EEG monitoring in hospital. Stroke size was categorized as large or small based on a threshold of 100 mL using the ABC/2 approach. EEG data were processed on MATLAB. COIN was independently calculated from consecutive 4-second EEG epochs. Student t-test and logistic regression were used to assess COIN performance in stroke size discrimination across the entire recording; random forest classification was used to determine COIN performance in limited EEG time windows ranging from 5 to 30 minutes in duration. RESULTS: Thirty-five patients with mean age 67 (SD ± 17) years were analyzed with mean 4.5 ± 1.3 hours of clean EEG per patient. Ten patients had large stroke and 25 had small stroke. Participants with large strokes had larger COIN values than those with small strokes (-53 vs. -16, P = 0.0001). Logistic regression for stroke size classification model showed accuracy 83% ± 8%, sensitivity 70%±15%, specificity 88%±8%, and area under the receiver operator curve 0.75±0.10. Random Forest Classification performance was similar using 5 or 30 minutes of EEG data with accuracy 81% to 82%, specificity 91% to 92%, and sensitivity 55% to 58%, respectively. CONCLUSIONS: COIN differentiated large from small acute ischemic strokes in this single-center cohort. Prospective evaluation in larger multicenter data sets is necessary to determine COIN utility as an aid for bedside detection of large ischemic strokes in contexts where neuroimaging cannot be easily obtained or when neurologic examination is limited by sedation or neuromuscular blockade.
The Effect of Playing Career on Chronic Neurophysiologic Changes in Retired Male Football Players: An Exploratory Study Using Transcranial Magnetic Stimulation.
Pearce AJ, Tallent J, Frazer AK … +2 more , Rist B, Kidgell DJ
J Clin Neurophysiol · 2026 Jan · PMID 40045467 · Publisher ↗
PURPOSE: Repetitive head impact exposure, from contact and collision sports, are increasingly being attributed to increased risk of neurodegenerative disease in aging athletes. This exploratory study investigated the ass...
PURPOSE: Repetitive head impact exposure, from contact and collision sports, are increasingly being attributed to increased risk of neurodegenerative disease in aging athletes. This exploratory study investigated the association of playing career in retired professional contact sport athletes with cortical neurophysiology via transcranial magnetic stimulation (TMS). METHODS: This study used a cross-correlation design without a control group. Male athletes between the ages of 28 and 68 years ( n = 113; mean age [SD] 48.8 [9.7]) who had been retired from professional sport for a minimum of 5 years were recruited. Cortical excitability was measured using single pulse TMS for motor evoked potentials and paired pulse for short-interval intracortical inhibition and long-interval intracortical inhibition. Associations were assessed between TMS measures and concussion history, clinical symptom scores, total career length (including junior to complete retirement), and professional career length (elite competition only). RESULTS: Correlations showed significant associations between motor evoked potentials and clinical symptom reporting ( rho : -0.21 to -0.38; P < 0.01) and motor evoked potentials and short-interval intracortical inhibition with total career length ( rho : 0.26 to -0.33; P < 0.01). No significant correlations were observed between single and paired-pulse TMS and professional career length ( rho : 0.16 to -0.15), nor the number of concussions ( rho : 0.17 to -0.17). CONCLUSIONS: This exploratory study is the first to report pathophysiologic outcomes in a cohort of retired professional athletes associated with total career exposure, rather than professional career exposure or concussion history. Without a control group comparison and cross-correlational design, these preliminary results should be viewed with caution; however, TMS assessment could be considered a viable biomarker in future studies of retired athletes classified with traumatic encephalopathy syndrome.
Expanding the Electroclinical Profile of CAPE.
Nordli DR, Chang J, Haider HA
J Clin Neurophysiol · 2025 May · PMID 40009504 · Publisher ↗
This case report presents two illustrative cases of cyclic alternating pattern of encephalopathy, showcasing its distinct quantitative EEG signature alongside observed correlations with cardiorespiratory fluctuations. Re...
This case report presents two illustrative cases of cyclic alternating pattern of encephalopathy, showcasing its distinct quantitative EEG signature alongside observed correlations with cardiorespiratory fluctuations. Recognizing cyclic alternating pattern encephalopathy patterns may provide clinicians with an actionable marker, guiding timely interventions and potentially improving outcomes in critically ill patients.
A Multicenter Training and Interrater Reliability Study of the BASED Score for Infantile Epileptic Spasms Syndrome.
Mytinger JR, Albert DVF, Aylward SC … +34 more , Beatty CW, Bhalla S, Bhatia S, Brock GN, Ciliberto MA, Choudhari PR, Clark DJ, Cohen JM, Czech TM, Fredwall MM, Gonzalez-Giraldo E, Harini C, Hunter SE, Sandoval Karamian AG, Katyayan A, Kistler I, Kulkarni N, Liu VB, McCabe C, Murray T, Neville K, Patel SH, Pavuluri S, Phillips DJ, Samanta D, Sirsi D, Spelbrink EM, Stafstrom CE, Steenari M, Takacs DS, Terrill T, Tran L, Vidaurre J, Shrey DW
J Clin Neurophysiol · 2025 Mar · PMID 40009427 · Full text
PURPOSE: The best possible outcomes in infantile epileptic spasms syndrome require electroclinical remission; however, determining electrographic remission is not straightforward. Although the determination of hypsarrhyt...
PURPOSE: The best possible outcomes in infantile epileptic spasms syndrome require electroclinical remission; however, determining electrographic remission is not straightforward. Although the determination of hypsarrhythmia has inadequate interrater reliability (IRR), the Burden of AmplitudeS and Epileptiform Discharges (BASED) score has shown promise for the reliable interictal assessment of infantile epileptic spasms syndrome. Our aim was to develop a BASED training program and assess the IRR among learners. We hypothesized moderate or better IRR for the final BASED score and the presence or absence of epileptic encephalopathy (+/-EE). METHODS: Using a web-based application, 31 learners assessed 12 unmarked EEGs (length 1-6 hours) from children with infantile epileptic spasms syndrome. RESULTS: For all readers, the IRR was good for the final BASED score (intraclass correlation coefficient 0.86) and +/-EE (Marginal Multirater Kappa 0.63). For all readers, the IRR was fair to good for all individual BASED score elements. CONCLUSIONS: These findings support the use of our training program to quickly learn the BASED scoring method. The BASED score may be a valuable clinical and research tool. Given that the IRR for the determination of epileptic encephalopathy is not perfect, clinical acumen remains paramount. Additional experience with the BASED scoring technique among learners and advances in collaborative EEG evaluation platforms may improve IRR.
Sleep Induction in Pediatric EEG Recordings: Chloral Hydrate Versus Melatonin and Hydoxyzine.
Güzin Y, Erdoğan I, Baykan M … +5 more , Taşkırdı ED, Yaman ÖA, Gençpınar P, Baydan F, Dündar NO
J Clin Neurophysiol · 2025 Mar · PMID 40009022 · Publisher ↗
PURPOSE: Electroencephalography (EEG) recording in pediatric patients is difficult because of patient compliance, and children who are unsuitable for behavioral training usually require sedation for EEG recordings. The a...
PURPOSE: Electroencephalography (EEG) recording in pediatric patients is difficult because of patient compliance, and children who are unsuitable for behavioral training usually require sedation for EEG recordings. The aim of this study was to examine the effects of agents commonly used in daily practice for sleep induction on sleep transition, sleep architecture, and frequency of movement artifacts on EEG recordings. METHODS: A retrospective analysis was made of the demographic data and sleep EEG recordings of patients who underwent sleep EEG because of suspected seizure between 2021 and 2022. The study included patients aged 4 to 18 years, and patients with a new or previous diagnosis of epilepsy were excluded from the study. RESULTS: Evaluation was made of 88 patients, comprising 35 (39.8%) girls and 53 (60.2%) boys with a mean age of 10.6 ± 4.3 years. In the analysis of the patients who did not sleep at all during the EEG recording, the drugs administered to the patients for sedation were observed to be hydroxyzine in 4 (14.8%) patients, chloral hydrate in 1 (2.8%) patient, and melatonin in 5 (20%) patients. Sleep duration was seen to be longer and the rates of motion artifacts and awakening during filming were lower in the patients treated with chloral hydrate. CONCLUSIONS: The results of this study showed that chloral hydrate was the most effective drug for inducing sleep. There is a need for further similar prospective studies to be performed on patients diagnosed with epilepsy and those aged <4 years. Possible complications should be considered before using each agent for sleep induction.
The Role of Intraoperative Neurophysiologic Monitoring on Surgical Decision Making and Neurologic Outcomes in Pediatric Patients With Intramedullary Spinal Cord Tumors.
Papadakis JE, Mosher A, Slingerland AL … +5 more , Albanese JS, Staffa SJ, Bose M, Toczylowlski M, Fehnel KP
J Clin Neurophysiol · 2026 Jan · PMID 40001277 · Publisher ↗
PURPOSE: Maximal safe resection is recommended for intramedullary spinal cord tumors (IMSCT). Tools to minimize surgical morbidity are, therefore, critical. We review intraoperative neurophysiologic monitoring (IONM) in...
PURPOSE: Maximal safe resection is recommended for intramedullary spinal cord tumors (IMSCT). Tools to minimize surgical morbidity are, therefore, critical. We review intraoperative neurophysiologic monitoring (IONM) in a large series of pediatric IMSCTs, focusing on its relationship with functional outcomes and surgical decision making. METHODS: A single-institution, retrospective review of all IMSCT resections with IONM from 2000 to 2022 was conducted. Univariate analysis evaluated IONM changes with clinical and functional outcomes across an extended follow-up period. RESULTS: Among the 59 IMSCT cases with IONM that met inclusion, somatosensory evoked potentials were used in 89.8%, motor evoked potentials in 86.4%, and Direct wave monitoring in 18.6%. Almost a third of patients experienced intraoperative changes in motor evoked potentials, somatosensory evoked potentials, and Direct waves, respectively, depending on the modality of IONM used. Monitoring alerts were more common in older patients (≥15 years) and those with larger tumors, and often led to longer hospital/intensive care unit stays and a higher rate of discharge to inpatient rehabilitation. Motor evoked potential and Direct wave alerts significantly affected the surgeon's decision to stop further resection ( p = 0.001 and p = 0.067). Marked somatosensory evoked potential changes were associated with worse immediate postoperative sensory deficits (<6-weeks, p < 0.05). At 1-year follow-up, most patients experienced improved functional outcomes, with favorable motor and sensory recovery. CONCLUSIONS: Multiple IONM modalities are technically feasible in pediatric IMSCTs and help guide surgical decision making. Intraoperative neurophysiologic monitoring alerts were more common in patients with larger tumors and older ages, significantly affecting the surgeon's decision to stop further resection. Although associated with longer hospital/intensive care unit stays and increased discharge rates to rehabilitation, IONM changes did not significantly affect long-term functional outcomes.
Subclinical Epileptiform Discharge in Patients With Alzheimer Dementia: A Systematic Review and Meta-Analysis.
Yeh WC, Yang YH, Li YS … +1 more , Hsu CY
J Clin Neurophysiol · 2026 Feb · PMID 39962503 · Publisher ↗
PURPOSE: Patients with Alzheimer's dementia (AD) who do not have a history of epilepsy have a higher frequency of subclinical epileptiform discharge (SED) than healthy individuals. This meta-analysis aims to investigate...
PURPOSE: Patients with Alzheimer's dementia (AD) who do not have a history of epilepsy have a higher frequency of subclinical epileptiform discharge (SED) than healthy individuals. This meta-analysis aims to investigate the frequency of SED in patients with AD using different EEG protocols and to compare SED rates between early- and late-onset AD. METHODS: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched various databases until January 2024 for studies reporting the frequency of SED in patients with AD who did not have a history of epilepsy. A meta-analysis was conducted using a random-effects model. RESULTS: Thirteen studies involving 1,373 patients with AD were analyzed. The patients had a mean age of 71.2 years, and 59.3% were women. The pooled SED rate was found to be 18.3%. The SED rate was higher with extended EEG protocols (26.7%) than with routine EEG protocols (12.1%). It was also observed that patients with early-onset AD had higher SED rates with routine EEG protocols (14.4%) and extended EEG protocols (43.9%) than those with late-onset AD (10.5 and 21.3%, respectively). Furthermore, patients with AD had a 3.55 relative risk ( P < 0.001) of SED compared with healthy controls. Specifically, patients with early-onset AD showed a significantly higher risk of developing SED than those with late-onset AD (relative risk, 4.48; P < 0.001). CONCLUSIONS: Subclinical epileptiform discharge frequency was high in patients with AD, particularly in those with early onset AD.
American Clinical Neurophysiology Society Technical Standards for Electrical Stimulation With Intracranial Electrodes for Functional Brain Mapping and Seizure Induction.
Arya R, Baumer FM, Chauvel P … +15 more , Frauscher B, Jayakar P, Kheder A, Lega B, Lesser RP, Miller KJ, Nuwer MR, Pedersen NP, Ritaccio AL, Sabsevitz DS, Sinha SR, So EL, Tatum WO, Templer JW, Schuele SU
J Clin Neurophysiol · 2025 Mar · PMID 39946166 · Publisher ↗
PURPOSE: These American Clinical Neurophysiology Society technical standards suggest best practices for electrical stimulation mapping (ESM) with subdural and stereotactic depth electrodes for seizure induction and mappi...
PURPOSE: These American Clinical Neurophysiology Society technical standards suggest best practices for electrical stimulation mapping (ESM) with subdural and stereotactic depth electrodes for seizure induction and mapping of brain function. METHODS: A working group was convened from American Clinical Neurophysiology Society membership with expertise in ESM. PubMed searches were performed to identify pertinent peer-reviewed literature. Recurrent meetings reviewed progress, built consensus by discussion, and developed evidence-based recommendations to the extent possible. RECOMMENDATIONS: Stimulators used for ESM should have sufficient dynamic range, ability to interrupt a stimulus train, and ictal disrupt mechanism(s). Charge density should be calculated for the specific electrodes and ESM settings, the maximum safe limits being 52 to 57 μC/cm 2 /phase for subdural electrodes and not established for stereotactic depth electrodes. Subdural ESM for functional mapping is typically performed at 50-Hz pulse frequency, 200- to 300-µs pulse width, 2- to 8-s train duration, and 1- to 20-mA current strength. Stereo ESM is commonly performed using 2 different pulse frequencies: 1 Hz (300-500 µs pulse width, train duration up to 30 s, and often a constant current of 3-5 mA), and 50 Hz (100-500 µs pulse width, train duration 2-8 s, and 0.5-10 mA current intensity). CONCLUSIONS: This guideline provides technical standards for the performance of ESM, which will likely evolve over time with advances in technology and additional evidence (also see Graphical Abstract).
Epilepsy Surgery Education: A Survey of US Epilepsy Fellowship Program Directors.
Katyal R, Sheikh IS, Gutierrez C … +7 more , Sinha SR, Day BK, Gavvala JR, Sheth SA, Wirrell E, Beniczky S, Nascimento FA
J Clin Neurophysiol · 2026 Jan · PMID 39934975 · Publisher ↗
PURPOSE: To understand the current state of epilepsy surgery education delivered to epilepsy fellows in the United States. METHODS: An online survey focused on characteristics of epilepsy surgery education was distribute...
PURPOSE: To understand the current state of epilepsy surgery education delivered to epilepsy fellows in the United States. METHODS: An online survey focused on characteristics of epilepsy surgery education was distributed to all 93 epilepsy fellowship program directors listed on the ACGME website (accessed in May 2022). Programs were stratified per the number of fellows currently enrolled: 0 to 3 (group A) and ≥4 (group B). RESULTS: Forty-one of 93 (44%) epilepsy fellowship programs were included in the study. The average number of resective surgeries, ablations, or corpus callosotomies per year was mostly 0 to 30 (54%) in group A and mostly >30 (80%) in group B ( P = 0.05). The average number of intracranial implantations per year was mostly 0 to 20 (58%) in group A and mostly >20 (80%) in group B ( P < 0.05). The average number of neurostimulation implantations per year was 15 (range 0-90; vagal nerve stimulation), 7 (range 0-25; responsive neurostimulation), and 4 (range 0-10; deep brain stimulation). In 78% of programs, fellows are not required to present a minimum number of epilepsy surgery cases in multidisciplinary conference before graduation. Roughly half of programs (51%) reported not using objective measures to assess fellow competency in epilepsy surgery. CONCLUSIONS: Our results suggest significant variability in epilepsy surgery volume and, consequently, fellow exposure to surgical cases and lack of standardized, objective measures in fellow teaching and assessment in the field of epilepsy surgery across programs in the United States. We advocate development of a core epilepsy surgery curriculum including minimum standards at the national level.
Reference Values of the Tube-Based Laryngeal Adductor Reflex of the Healthy Recurrent Laryngeal Nerve.
Téllez MJ, Escobar-Montalvo JM, Sinclair CF … +4 more , Rodriguez Morel PM, Torralba P, Ulkatan S, Urken ML
J Clin Neurophysiol · 2026 Jan · PMID 39924683 · Publisher ↗
PURPOSE: This study aimed to establish reference values for laryngeal adductor reflex latency and amplitude under general anesthesia using a noninvasive technique with commercially available electromyographic endotrachea...
PURPOSE: This study aimed to establish reference values for laryngeal adductor reflex latency and amplitude under general anesthesia using a noninvasive technique with commercially available electromyographic endotracheal tubes. METHODS: This retrospective observational study included 380 patients undergoing head and neck surgery. The inclusion criteria were recording the laryngeal adductor reflex from the nonsurgical side and the absence of pathology in the recurrent laryngeal nerve. Measurements were taken before incision and surgical completion. RESULTS: The R1 component medians for the latency and amplitude were 20 ms and 448 µV for the right and 22 ms and 425 µV for the left LARs, respectively. There were significant differences in the R1 latencies between the sides. Quantile regression models revealed that 95th percentile amplitudes exceeded 400 µV, whereas 5% of our data set surpassed 600 µV. The R2 component was present in 26% of patients initially but decreased to 8% at surgical conclusion. The percentage difference between the median R1 value at the end of the surgery, compared with the opening value, was up to 4% for latency and 10% for amplitude. CONCLUSIONS: The R1 component of the laryngeal adductor reflex remains a reliable tool for intraoperative neuromonitoring. This is the largest study to provide reference values for laryngeal adductor reflex, aiding future diagnostic applications in head and neck surgeries.
Accuracy of SEEG Source Localization: A Pilot Study Using Corticocortical Evoked Potentials.
Cox BC, Smith RJ, Mohamed I … +4 more , Donohue JV, Rostamihosseinkhani M, Szaflarski JP, Chatfield RJ
J Clin Neurophysiol · 2025 Nov · PMID 39899731 · Publisher ↗
INTRODUCTION: EEG source localization is an established technique for localizing scalp EEG in medically refractory epilepsy but has not been adequately studied with intracranial EEG (iEEG). Differences in sensor location...
INTRODUCTION: EEG source localization is an established technique for localizing scalp EEG in medically refractory epilepsy but has not been adequately studied with intracranial EEG (iEEG). Differences in sensor location and spatial sampling may affect the accuracy of EEG source localization with iEEG. Corticocortical evoked potentials can be used to evaluate EEG source localization algorithms for iEEG given the known source location. METHODS: We recorded 205 sets of corticocortical evoked potentials using low-frequency single-pulse electrical stimulation in four patients with iEEG. Averaged corticocortical evoked potentials were analyzed using 11 distributed source algorithms and compared using the Wilcoxon signed-rank test ( P < 0.05). We measured the localization error from stimulated electrodes and the spatial dispersion of each solution. RESULTS: Minimum norm, standard low-resolution electromagnetic tomography (sLORETA), LP Norm, sLORETA-weighted accurate minimum norm (SWARM), exact LORETA (eLORETA), standardized weighted LORETA (swLORETA), and standardized shrinking LORETA-FOCUSS (ssLOFO) had the least localization error (13.3-15.7 mm) and were superior to focal underdetermined system solver (FOCUSS), logistic autoregressive average (LAURA, and LORETA, 17.9-21.7, P < 0.001). The FOCUSS solution had the smallest spatial dispersion (7.4 mm), followed by minimum norm, L1 norm, LP norm, and SWARM (20.8-28.3 mm). Gray matter stimulations had less localization error than white matter (median differences 3.1-6.1 mm) across all algorithms except SWARM, LORETA, and logistic autoregressive average. A multivariate linear regression showed that distance from the source to sensors and gray/white matter stimulation had a significant effect on localization error for some algorithms but not SWARM, minimum norm, focal underdetermined system solver, logistic autoregressive average, and LORETA. CONCLUSIONS: Our study demonstrated that minimum norm, L1 norm, LP norm, and SWARM localize iEEG corticocortical evoked potentials well with lower localization error and spatial dispersion. Larger studies are needed to confirm these findings.
Revised Process for ACNS Guidelines Development.
Quraishi IH, Andrade E, Galloway G … +20 more , Hyslop A, Selioutski O, Sinha S, Arnold ST, Arya R, Bagić AI, Drislane F, Gloss D, Hani AJ, Kobayashi E, Marashly A, Nuwer MR, Park J, Sabau D, San-Juan D, Shahid A, Skjei K, Tatum WO, Vengrow M, Wusthoff CJ
J Clin Neurophysiol · 2025 Feb · PMID 39883486 · Publisher ↗
The development of clinical practice guidelines is an evolving field. In response to the need for consistent, evidence-based medical practice, the American Clinical Neurophysiology Society identified the need to update t...
The development of clinical practice guidelines is an evolving field. In response to the need for consistent, evidence-based medical practice, the American Clinical Neurophysiology Society identified the need to update the Society's guideline development process. The American Clinical Neurophysiology Society Guidelines Committee created an action plan with the goal of improving transparency and rigor for future guidelines and bringing existing guidelines to current standards. This article provides an overview of the new American Clinical Neurophysiology Society standards for the creation of clinical guidance documents, including clinical guidelines, technical standards, and consensus statements. This process is rooted in the importance of clinical guidance documents and their significance in the context of current behests for updated standards for practicing clinical neurophysiology. The need and rationale for updating the guideline development process from its prior state were described. The updated American Clinical Neurophysiology Society categories for clinical guidance and recommendations were defined and compared. Finally, the new process is summarized, focusing on methodologies, authorship, and conflicts of interest.
Language Mapping With rTMS in Healthy Pediatric Patients.
Vedala K, Kadis DS, Vannest J … +7 more , Sino S, Horn PS, Maue E, Williamson B, Mangano FT, Leach JL, Greiner HM
J Clin Neurophysiol · 2026 Jan · PMID 39876045 · Publisher ↗
PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) is a potentially effective, noninvasive tool for language mapping. However, there is a paucity of data in pediatric patients. In this study, we aimed to map la...
PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) is a potentially effective, noninvasive tool for language mapping. However, there is a paucity of data in pediatric patients. In this study, we aimed to map language sites in healthy pediatric participants with navigated rTMS. METHODS: Children aged 5 to 18 years underwent bilateral language mapping. Stimulation was delivered at 5 Hz during visual-naming and auditory verb-generation tasks in 1 to 2 second bursts. We targeted 33 standardized sites per hemisphere. In total, 34 participants completed the visual-naming task, and 27 participants completed the verb-generation task. Lateralization index (LI) and Wilcoxon signed-rank test were used to assess language lateralization. A difference of least squares means model was developed to determine the prevalence of visual-naming and verb-generation errors within lobar and hemispheric regions. RESULTS: Weak left lateralization was observed for visual naming (LI 0.14; p = 0.038), and no lateralization was observed for verb generation (LI 0.08; p = 0.269). Using multiple least squares regression, left hemisphere errors were more likely to occur than right hemisphere errors for visual naming (OR 1.23; 95% CI 1.06-1.44), but no lateralization effect was observed for verb-generation errors (OR 1.11; 95% CI 0.93-1.27). CONCLUSIONS: rTMS is likely to identify bilateral or weakly left-lateralized language sites in pediatric patients during language tasks. Although rTMS can be a useful noninvasive method for identifying potential language-positive sites, our results in healthy controls suggest that it cannot be used as a singular method for language mapping in the preoperative setting.
Journal of Clinical Neurophysiology is Going Digital.
Nordli DR, Schuele S
J Clin Neurophysiol · 2025 Mar · PMID 39849314 · Publisher ↗
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Electroencephalography in Clinical Practice: Neurology Professionals' Views on Optimal Standards of Care.
Nascimento FA, Katyal R, Kass NR … +4 more , Yuan D, Sirven JI, Westover MB, Beniczky S
J Clin Neurophysiol · 2025 Nov · PMID 39820182 · Publisher ↗
PURPOSE: Delivering optimal care to patients with seizures and epilepsy requires all EEGs to be interpreted accurately and reliably. This study investigated neurology professionals' opinions on the ideal standards for EE...
PURPOSE: Delivering optimal care to patients with seizures and epilepsy requires all EEGs to be interpreted accurately and reliably. This study investigated neurology professionals' opinions on the ideal standards for EEG in clinical care. METHODS: We developed an anonymous e-survey targeting practicing and trainee neurologists focused on participants' demographics, clinical practice characteristics, and views on optimal EEG standards of care-including whether an EEG certification test is needed and whether postresidency/fellowship training in EEG/epilepsy is necessary for neurologists who interpret outpatient/routine EEGs in practice. The survey was hosted by the Neurology Clinical Practice-Practice Current, and it was distributed online through the American Academy of Neurology, American Epilepsy Society, American Clinical Neurophysiology Society, and International League Against Epilepsy, and through social media. RESULTS: Two hundred eighty-three responses were included: 119 from EEG/epilepsy-trained neurologists, 83 from non-EEG/epilepsy-trained neurologists, 75 from trainees, and 6 from advanced care providers. Most participants (78%) agreed that "an objective certification test of ability to interpret EEGs is needed for all those who interpret EEGs in clinical practice." Most participants (71%) believed that outpatient/routine EEGs may be read only by neurologists with EEG/epilepsy training; this opinion was more prevalent among EEG/epilepsy-trained (83%) versus non-EEG/epilepsy-trained neurologists (55%). CONCLUSIONS: Our neurology community should discuss the need to develop and implement a certification test of ability for all neurologists who wish to interpret EEGs in clinical practice. In addition, it is imperative to improve in-residency EEG education to ensure that neurology graduates achieve EEG competence before entering the workforce.
Adherence to Recommendations and Yield of Critical Care EEG Monitoring: A Prospective Multicentric Study.
Bellante F, Santos SF, Gérard L … +7 more , Jacquet LM, Piagnerelli M, Taccone F, Thooft A, Wittebole X, Legros B, Gaspard N
J Clin Neurophysiol · 2025 Nov · PMID 39810297 · Publisher ↗
PURPOSE: The American Clinical Neurophysiology Society has provided a set of recommendations on the use of critical care EEG monitoring (CEEG). However, these recommendations have not been prospectively validated. We aim...
PURPOSE: The American Clinical Neurophysiology Society has provided a set of recommendations on the use of critical care EEG monitoring (CEEG). However, these recommendations have not been prospectively validated. We aimed to assess the adherence to the American Clinical Neurophysiology Society recommendations for obtaining CEEG for different indications and the yield of obtained CEEG according to these different indications. METHODS: This was a multicenter prospective observational study of critically ill adult patients between April 01, 2022, and June 22, 2022, in two academic medical centers and a large teaching hospital. Indications for CEEG, according to the American Clinical Neurophysiology Society recommendations, were determined based on clinical data at the time of discharge from the intensive care unit. The use of CEEG and detection of electrographic seizures were retrieved from the EEG databases. RESULTS: A total of 600 patients were enrolled in this study. The primary admission diagnoses were medical (49%), surgical (30%), or neurologic/neurosurgical (21%). Approximately 60% of patients had an altered mental status. A few (6%) patients had a preceding clinical seizure, and 1% had generalized convulsive status epilepticus. Indications were identified in 226 admissions. Of these patients, 88 (39%) underwent CEEG. In addition, 12 patients underwent CEEG without clear indications. Of the 100 patients, 33 (33%) had electrographic seizures. Adherence to recommendations and yields was highest for refractory status epilepticus, altered mental status after any clinical seizure, and acute brain injury. Adherence and yield varied the most and were inversely correlated in the group of patients without acute brain injury, suggesting that additional clinical factors may have contributed to patient selection. CONCLUSIONS: Patients meeting American Clinical Neurophysiology Society indications and receiving CEEG had a high seizure risk. Emerging CEEG programs should focus on epilepsy-related and neurologic diagnosis. Although recommendations effectively identify groups of patients with a high seizure risk, additional clinical factors might further help select candidates in the low-risk group.
Short-Latency Trigeminocervical Reflex Obtained Without Muscle Activation: Topographic Distribution and Methodological Approach.
Melo DLM, Comerlato EA, Tavares ES … +2 more , Pinheiro DS, Manzano GM
J Clin Neurophysiol · 2024 Nov · PMID 39792636 · Publisher ↗
PURPOSE: Electrical stimulation of trigeminal nerve branches elicits early and late reflex responses in the cervical muscles, known as the trigeminocervical reflex (TCR). This study aimed to evaluate the neurophysiologic...
PURPOSE: Electrical stimulation of trigeminal nerve branches elicits early and late reflex responses in the cervical muscles, known as the trigeminocervical reflex (TCR). This study aimed to evaluate the neurophysiological aspects, stimulation patterns, and topographic distribution of short-latency TCR components in humans in the absence of voluntary muscle activation. METHODS: This prospective observational study included 30 participants. Trigeminocervical reflex responses were simultaneously recorded from the bilateral sternocleidomastoid, trapezius, and splenius capitis muscles (without voluntary muscle activation), after electrical stimulation of the supraorbital and infraorbital nerves. Two different stimulation protocols were evaluated: a 3 Hz stimulation protocol (using averaging) and a single-pulse stimulation protocol. RESULTS: Using a 3 Hz stimulation protocol, short-latency TCR responses were recorded in the sternocleidomastoid, trapezius, and splenius capitis muscles, ipsilateral and/or contralateral, but with variable recordability depending on the recording site. The most reliable response was obtained in ipsilateral sternocleidomastoid muscle. To the best of our knowledge, this is the first study to demonstrate the elicitation of short-latency TCR components in the sternocleidomastoid muscle in the absence of voluntary muscle activation in humans without craniocervical junction disorders or lower brainstem abnormalities. CONCLUSIONS: The choice of an appropriate stimulation protocol is particularly relevant for recording short-latency TCR components, considering that the visualization of early or late responses seems to be facilitated by different stimulation methodologies.
Intraoperative Neurophysiologic Monitoring Improves Neurologic Outcomes in Eloquent Brain Areas and Aids in Increasing the Volume of Resected Glioma: Current Results Compared With Historical Controls.
Ilgaz Aydinlar E, Sari R, Yalinay Dikmen P … +1 more , Elmaci İ
J Clin Neurophysiol · 2025 May · PMID 39787472 · Publisher ↗
PURPOSE: This study aims to show the impact of multimodal intraoperative neurophysiologic monitoring (IOM) in glioma surgery in preventing severe neurologic injury and increasing tumor removal by comparing the historical...
PURPOSE: This study aims to show the impact of multimodal intraoperative neurophysiologic monitoring (IOM) in glioma surgery in preventing severe neurologic injury and increasing tumor removal by comparing the historical cases where IOM was not used. METHODS: Fifty-nine patients with glial tumors located nearby the eloquent area, operated by the same surgeon, were included in the study. Between 2008 and 2012, 21 patients were operated on without IOM (non-IOM); between 2018 and 2021, 38 patients were operated on with IOM. RESULTS: The preoperative Karnofsky performance status scale (KPSS) scores were not statistically significant between non-IOM and IOM groups ( P = 0.351). Postoperative KPSS (mean 97.9) scores were 15.7% higher than preoperative KPSS (mean 84.6) in the IOM group ( P < 0.001). Conversely, there was no significant difference between preoperative and postoperative KPSS scores (mean 78.5 and 81.5, respectively) in the non-IOM group ( P = 0.472). Moreover, postoperative KPSS scores were 20% higher in the IOM group than in the non-IOM group ( P < 0.001). Preoperative tumor sizes were double the size in the non-IOM group compared with those in the IOM group ( P = 0.007). Nevertheless, the postsurgery tumor residue volume was almost four times higher in the non-IOM group than that in the IOM group ( P = 0.035). A median of 93.35% of the tumor volume was resected in the IOM group, but only 77.26% of the tumor was removed in the non-IOM group ( P < 0.001). CONCLUSIONS: Intraoperative neurophysiologic monitoring helps in a more radical tumor resection in glial tumors located close to the eloquent area, improves postoperative neurologic outcomes, and maintains the patient's quality of life.
Comparison of EEG Signal Characteristics of Subdural and Depth Electrodes.
Alkawadri CI, Yan Q, Kocuglu Kinal AG … +2 more , Spencer DD, Alkawadri R
J Clin Neurophysiol · 2024 Dec · PMID 39787440 · Publisher ↗
OBJECTIVES: Our study aimed to compare signal characteristics of subdural electrodes (SDE) and depth stereo EEG placed within a 5-mm vicinity in patients with drug-resistant epilepsy. We report how electrode design and p...
OBJECTIVES: Our study aimed to compare signal characteristics of subdural electrodes (SDE) and depth stereo EEG placed within a 5-mm vicinity in patients with drug-resistant epilepsy. We report how electrode design and placement collectively affect signal content from a shared source between these electrode types. METHODS: In subjects undergoing invasive intracranial EEG evaluation at a surgical epilepsy center from 2012 to 2018, stereo EEG and SDE electrode contacts placed within a 5-mm vicinity were identified. Of these, 24 contacts (12 pairs) met our criteria for signal-to-noise ratio and data availability for final analysis. We used Welch method to analyze the correlation of power spectral densities of EEG segments, root mean square of 1-second windows, and fast-Fourier transform to calculate coherence across conventional frequency bands. RESULTS: We observed a median distance of 3.7 mm between the electrode contact pairs. Time-aware analysis highlighted the coherence's strength primarily in the high-gamma band, where the median ( r ) was 0.889. In addition, the median power ratios between the SDE and stereo EEG signal was 1.99. This ratio decreased from high-gamma to infra-low frequencies, with medians of 2.07 and 0.97, respectively. The power spectral densities for the stereo EEG and SDE electrodes demonstrated a strong correlation, with a median correlation coefficient ( r ) of 0.99 and an interquartile range from 0.915 to 0.996. CONCLUSIONS: Signals captured by standard subdural and depth (intracranial EEG) electrodes within a 5-mm radius exhibit band-specific coherence and are not identical. The association was most pronounced in the high-gamma band, with coherence decreasing with lower frequencies. Our findings underscore the combined effects of electrode size, design, placement, preferred bandwidth, and the nature of the activity source on signal recording. Particularly, SDE employed herein may offer advantages for high-frequency signals, but the impact of electrode size on recordings necessitates careful consideration in context-specific situations. SIGNIFICANCE: The findings relate to surgical epilepsy care and may inform the design of brain-computer interface.
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