Journal Of Clinical Neurophysiology[JOURNAL]
Sun
200 papers
Surface EEG to Identify Cognitive Motor Dissociation After Acute Brain Injury.
Egawa S, Casson N, Neves Briard J … +15 more , Shen Q, Kansara V, Niesvizky-Kogan I, Carroll E, Carmona JC, Song YL, Klein AJ, Velazquez A, Andres W, Ghoshal S, Roh D, Agarwal S, Park S, Connolly ES, Claassen J
J Clin Neurophysiol · 2026 Jul · PMID 42397011 · Publisher ↗
PURPOSE: Cognitive motor dissociation (CMD) is associated with long-term recovery in acute brain injury, but CMD testing is only available in few centers. Our objective was to identify surface EEG patterns with high sens...
PURPOSE: Cognitive motor dissociation (CMD) is associated with long-term recovery in acute brain injury, but CMD testing is only available in few centers. Our objective was to identify surface EEG patterns with high sensitivity or positive predictive value (PPV) for CMD in patients with acute disorders of consciousness to refine allocation of this resource-intensive test. METHODS: In this observational cohort study, we enrolled clinically unresponsive, acutely brain injured patients who underwent continuous surface EEG and CMD assessments. CMD was detected by applying a machine learning algorithm to EEG acquired during a motor command paradigm presentation. Electroencephalographers blinded to CMD test results applied standardized ACNS criteria to the EEGs acquired during CMD assessments. We calculated accuracy measures of surface EEG findings for CMD test results using generalized estimating equations, with an exchangeable matrix and accounting for repeated measures per patient. RESULTS: We included 185 patients (mean age: 62 ± 17; 85 [46%] female) and 282 CMD assessments. CMD testing was positive in 39 (14%) assessments. Sensitivity and PPV of normal background voltage, symmetry, and continuity were, respectively, 77% (95% CI: 60%-88%) and 19% (95% CI: 13%-26%), 74% (95% CI: 58%-86%) and 14% (95% CI: 10%-20%), and 74% (95% CI: 58%-86%) and 14% (95% CI: 9%-19%). All EEGs with burst suppression, suppression, sporadic epileptiform discharges, lateralized periodic discharges, bilateral independent periodic discharges, electrographic seizures, and brief potentially ictal rhythmic discharges had negative CMD tests. CONCLUSIONS: Surface EEG findings are not reliable to screen for CMD or to identify patterns conferring higher CMD pretest probability.
The Physics and Physiology of Electrical Stimulation of the Brain.
Conrad EC, Sinha SR
J Clin Neurophysiol · 2025 Dec · PMID 42360072 · Full text
Electrical brain stimulation plays an important role in surgical planning and in the treatment of epilepsy, movement disorders, and psychiatric disease. Safe and effective application of stimulation and interpretation of...
Electrical brain stimulation plays an important role in surgical planning and in the treatment of epilepsy, movement disorders, and psychiatric disease. Safe and effective application of stimulation and interpretation of results require an understanding of the underlying physics and physiology. This review synthesizes key principles that govern how electrical stimuli interact with brain tissue and how these interactions shape electrophysiological and clinical responses. This includes an introduction to the core physical concepts that support simple models of stimulation-induced electrical fields. This is followed by a description of how the physiology of neural tissues modifies these predictions, complicating the impact of stimulation on the brain. These physical and physiological principles form the basis of interpretation of commonly studied stimulation responses, including functional responses, afterdischarges, seizures, and cortico-cortical evoked potentials. The goal is to clarify how physics and physiology inform stimulation safety and utility while highlighting important limitations in our current understanding of stimulation responses.
Neurophysiology in Postanoxic Encephalopathy: Pathophysiology, Prognosis, and Treatment.
van Putten MJAM
J Clin Neurophysiol · 2026 Jul · PMID 42359669 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Review on the Functional Connectivity of the Human Opercular Cortex.
Oane I, Barborica A, Mindruta I
J Clin Neurophysiol · 2026 Apr · PMID 42359667 · Publisher ↗
The opercular cortex is the part of the brain that overlies the insula and is the prolongation of the frontal, parietal, and temporal lobes in the lateral fissure. Over the years, this region has undergone multiple parce...
The opercular cortex is the part of the brain that overlies the insula and is the prolongation of the frontal, parietal, and temporal lobes in the lateral fissure. Over the years, this region has undergone multiple parcellations, and updated, multimodal, large-scale brain atlases highlight up to 16 subregions organized within the frontal, parietal, and temporal opercula. Using complementary methods for brain mapping-such as functional neuroimaging, source connectivity on scalp EEG or magnetoencephalography signals, and effective connectivity measures based on intracranial EEG recordings and cortico-cortical evoked potentials-several connectivity patterns have been identified. The main bidirectional opercular connections are with the insular cortex. The anterior insula is preferentially connected with the temporal and frontal operculum (OpF), whereas the posterior insula is connected to all opercular subdivisions. All three opercular subdivisions are interconnected. The OpF is functionally connected to the cingulate cortex consistent with a role in salience processing and to the temporal basal, temporal neocortex, premotor, and primary sensorimotor regions implicated in language processing. The parietal operculum is functionally connected with the premotor-motor and parietal regions for sensorimotor and vestibular processing. Finally, the temporal operculum is functionally connected with the temporal basal, temporal pole, mesial temporal structures, and parietal cortex supporting auditory, vestibular, and language processing.
Surgical Aspects of Opercular Epilepsies.
Hsu J, Bingaman W, Serletis D
J Clin Neurophysiol · 2026 Mar · PMID 42359665 · Publisher ↗
Operculoinsular epilepsy presents diagnostic and surgical challenges due to the complex anatomy of the opercula, the underlying insula, and their intimate relationships with major vascular and subcortical white matter tr...
Operculoinsular epilepsy presents diagnostic and surgical challenges due to the complex anatomy of the opercula, the underlying insula, and their intimate relationships with major vascular and subcortical white matter tracts. Comprehensive evaluation relies on detailed seizure semiology, high-resolution structural and functional neuroimaging, and invasive monitoring (namely, stereoelectroencephalography) to distinguish opercular from insular seizure onset and identify suitable surgical candidates. Advances in invasive recording capabilities, intraoperative mapping, microneurosurgical techniques, and laser ablative technologies have expanded access to epileptogenic networks in this region, improving the safety and precision of operative approaches for the treatment of epilepsy. This review outlines the relevant surgical anatomy of the frontal, parietal, and temporal opercula and deeply-situated insula, emphasizing the need for meticulous preoperative planning and accurate intraoperative recognition of anatomical landmarks. We describe resective strategies (including transsylvian and transopercular approaches), tailored to epileptogenic localization while minimizing risk to critical vasculature and eloquent cortex. Intraoperative electrocorticography, functional mapping, and neurophysiological monitoring further refine surgical margins and help mitigate postoperative deficits. We also highlight stereotactic laser interstitial thermal therapy as a minimally invasive alternative for well-defined epileptogenic zones, particularly in the dominant hemisphere or deep opercular tissue, offering reduced morbidity and shorter hospitalization. Reported seizure-freedom rates following resective operculoinsular epilepsy surgery are 60% to 70%, and around 50% with laser interstitial thermal therapy, with relatively safe complication profiles. Ultimately, a thorough understanding of anatomy, careful patient selection, and judicious use of adjunctive mapping technologies are essential to achieving optimal seizure outcomes in the safe surgical management of operculoinsular epilepsy.
Cost-Effectiveness of EEG Monitoring in Hypoxic-Ischemic Brain Injury After Cardiac Arrest.
Bhat N, Amorim E
J Clin Neurophysiol · 2026 Jul · PMID 42359664 · Publisher ↗
OBJECTIVE: To evaluate and synthesize current evidence on the cost-effectiveness of EEG monitoring in postcardiac arrest care, with a focus on its utility in neuroprognostication and clinical decision making. METHODS: A...
OBJECTIVE: To evaluate and synthesize current evidence on the cost-effectiveness of EEG monitoring in postcardiac arrest care, with a focus on its utility in neuroprognostication and clinical decision making. METHODS: A narrative review was conducted to summarize the recent literature on EEG utilization, guidelines, and cost-effectiveness analyses. Studies examining continuous EEG, routine EEG, and point-of-care EEG using cost-utility frameworks, quality-adjusted life year modeling, and health system variability were analyzed. RESULTS: Despite class I recommendations from the AHA and ACNS, EEG remains underused in postcardiac arrest management. Although continuous EEG provides superior temporal resolution and facilitates prognostic assessment, it comes with significant costs associated with equipment, personnel, and EEG interpretation. Cost-effectiveness analysis shows that small improvements in prognostic specificity of 1% to 4% may render EEG monitoring cost-effective in a closed health care system. Routine EEG and point-of-care-EEG systems offer new strategies for expanding access and reducing costs. However, studies are predominantly retrospective, single-center, and heterogeneous in their analytic methodology, which limits generalizability. CONCLUSIONS: EEG monitoring after cardiac arrest may be cost-effective if modest gains in prognostic accuracy are achieved. Further data from prospective, multicenter studies and long-term financial and outcome data using standardized statistical metrics will be needed for broader use. By doing so, more robust use guidelines and cost-effectiveness thresholds can be created for postcardiac arrest EEG monitoring.
Pathophysiology and Prognostic Significance of Myoclonus in Hypoxic-Ischemic Encephalopathy.
Leitinger M, Beretta S
J Clin Neurophysiol · 2026 Jul · PMID 42359663 · Full text
Cerebral hypoxia due to cardiac arrest is frequently complicated by myoclonus manifesting hours to days after the return of spontaneous circulation. However, myoclonus per se-without further characterization-lacks suffic...
Cerebral hypoxia due to cardiac arrest is frequently complicated by myoclonus manifesting hours to days after the return of spontaneous circulation. However, myoclonus per se-without further characterization-lacks sufficient biological specificity and does not allow for reliable prognostic interpretation. Accumulating evidence underscores the critical role of EEG monitoring in the assessment of postanoxic patients, particularly with regard to background continuity and the presence of status epilepticus, as defined by the American Clinical Neurophysiology Society. These parameters have emerged as key determinants in prognostication. A structured research framework for the classification of postanoxic myoclonus has been proposed to mitigate the risk of false-positive predictions of poor neurological outcome and to prevent unwarranted withdrawal of life-sustaining therapy in selected patient subgroups. These subgroups are defined by continuous, nearly continuous, or discontinuous EEG background activity, particularly in the absence of concomitant status epilepticus. This framework constitutes a robust foundation for the systematic acquisition of relevant clinical and paraclinical data. In addition, a standardized communication tool may facilitate precise information exchange among physicians and efficient interprofessional patient management.
Rhythmic and Periodic Patterns and Seizures in Hypoxic-Ischemic Encephalopathy.
De Stefano P, Gaspard N
J Clin Neurophysiol · 2026 Jul · PMID 42359661 · Full text
Cardiac arrest is a major cause of hypoxic-ischemic brain injury, often resulting in coma even after the return of spontaneous circulation. In this severely ill population, accurate neurologic prognostication is essentia...
Cardiac arrest is a major cause of hypoxic-ischemic brain injury, often resulting in coma even after the return of spontaneous circulation. In this severely ill population, accurate neurologic prognostication is essential for guiding treatment decisions. Continuous electroencephalography (EEG) has become a cornerstone of postcardiac arrest care, offering real-time monitoring of cerebral activity and facilitating early detection of electrographic seizures and other pathologic patterns. This narrative review focuses on the standardized interpretation of EEG findings using the 2021 American Clinical Neurophysiology Society Critical Care EEG terminology. Key EEG patterns-such as generalized periodic discharges, suppression-burst, and status epilepticus (SE)-are discussed in the context of their prognostic significance and therapeutic implications. Particular attention is given to the progressive restoration of background EEG continuity and amplitude over the first 24 hours after the arrest, which is increasingly recognized as a marker of the extent of neuronal damage and potential for recovery. Seizure and SE management remains complex in comatose postcardiac arrest patients, with recent studies highlighting variable outcomes and the potential risks of both under- and overtreatment. We underscore the importance of individualized treatment strategies informed by EEG characteristics and integrated with clinical examination, neuroimaging, and serum biomarkers. Multimodal prognostication helps identify patients with a potential for meaningful recovery while avoiding unnecessary interventions in those with poor neurologic prognosis. EEG-guided care is crucial in optimizing outcomes after cardiac arrest and enhancing the precision of neurocritical care.
Neuroprotective Treatment of Postanoxic Encephalopathy: Review of the Literature and Ongoing Trials.
Lee JW, Hofmeijer J
J Clin Neurophysiol · 2026 Jul · PMID 42359658 · Publisher ↗
Postanoxic encephalopathy is a common consequence of cardiac arrest, characterized by varying degrees of global cerebral hypoxic-ischemic injury. Despite advances in resuscitation science and critical care, neurologic ou...
Postanoxic encephalopathy is a common consequence of cardiac arrest, characterized by varying degrees of global cerebral hypoxic-ischemic injury. Despite advances in resuscitation science and critical care, neurologic outcome is essentially unchanged over the past decades. Although various treatment approaches to mitigate brain injury have been proposed, none of these has been unequivocally associated with improved neurologic outcome. This review provides an overview of the evidence from previous studies and ongoing clinical trials. Based on successes and limitations in recent research, we recommend EEG-based patient stratification and sufficiently powered subgroups for future trials. We also recommend outcome measures that provide more granularity than the current ordinal outcome scales, such as screening instruments for cognitive and emotional functioning. Adaptive randomized trial designs using a single master protocol and Bayesian statistics can provide an efficient platform for testing multiple treatments against a common control group, simultaneously. Treatments based on active stimulation of neuro- and synaptogenesis instead of prevention of secondary injury are promising.
EEG Revisited-Neuronal, Glial, and Network Mechanisms Across Scales.
Kudlacek J, Lisgaras CP, Jefferys JGR … +3 more , de Curtis M, Suffczynski P, Jiruska P
J Clin Neurophysiol · 2026 Apr · PMID 42359657 · Publisher ↗
Electroencephalography (EEG) has been providing a window into human brain activity for nearly a century, yet its interpretation often remains empirical rather than mechanistic. This review revisits the cellular and bioph...
Electroencephalography (EEG) has been providing a window into human brain activity for nearly a century, yet its interpretation often remains empirical rather than mechanistic. This review revisits the cellular and biophysical foundations of EEG through a modern perspective, integrating advances from neurophysiology, computational modeling, and cellular neuroscience. We examine the fundamental physics of EEG generation, from transmembrane currents and dipole formation to the spatial summation. Electroencephalography results from coordinated cellular and network activity, reflecting the integrated contributions of excitatory and inhibitory synaptic events, intrinsic conductances, and tissue geometry, with pyramidal neurons acting as dominant generators, while interneurons play a role in rhythmogenesis and oscillatory coupling. Expanding beyond traditional Berger frequencies, we highlight the significance of high-frequency oscillations and the underlying cellular and network mechanisms that generate the high-frequency component of the EEG signal. Conversely, infra-slow fluctuations and direct current shifts reveal the roles of glial networks, ionic homeostasis, and spreading depolarizations in health and disease. Across these domains, EEG uniquely captures neural activity from submillisecond events to long-term state changes spanning days or years, offering an unparalleled temporal range for studying the human brain. Clinically, this multiscale capacity underpins the emergence of EEG-based biomarkers for epilepsy, psychiatric disorders, and disorders of consciousness, while guiding development of closed-loop neuromodulation and precision medicine strategies. With technological advances and the expanding field of machine learning, the role of EEG will continue to expand as we will gain deeper insights into its underlying mechanisms.
Neurophysiologic Mechanisms of Cerebral Ischemia and the EEG.
van Putten MJAM, Hofmeijer J
J Clin Neurophysiol · 2026 Jul · PMID 42359656 · Publisher ↗
Cerebral ischemia rapidly disturbs neuronal function through failure of synaptic transmission and, with ongoing energy deprivation, loss of ion gradients. Adenosine-mediated inhibition of presynaptic release leads to an...
Cerebral ischemia rapidly disturbs neuronal function through failure of synaptic transmission and, with ongoing energy deprivation, loss of ion gradients. Adenosine-mediated inhibition of presynaptic release leads to an early and reversible loss of synaptic transmission, reflected in the EEG by slowing and eventual suppression of rhythmic activity. With more severe or prolonged energy failure, Na + /K + -ATPase failure results in membrane depolarization, cytotoxic swelling, and irreversible injury. Secondary injury mechanisms include spreading depolarizations, inflammation, and oxidative stress. The EEG primarily reflects extracellular currents resulting from synaptic input on pyramidal neurons, providing a real-time readout of cerebral function. Recovery of continuous background activity with physiologic rhythms within 12 to 24 hours indicates preserved and reversible synaptic function, whereas persistent suppression or burst suppression with identical bursts beyond 24 hours is consistently associated with extensive structural injury and poor neurologic outcome.
Role of Neurophysiologic Testing in Prognostication of Hypoxic-Ischemic Encephalopathy.
Westhall E, Admiraal M
J Clin Neurophysiol · 2026 Jul · PMID 42359655 · Full text
Electroencephalography (EEG) and somatosensory evoked potentials (SSEP) are important components of multimodal prognostication in comatose patients after cardiac arrest (CA). The EEG changes considerably during the first...
Electroencephalography (EEG) and somatosensory evoked potentials (SSEP) are important components of multimodal prognostication in comatose patients after cardiac arrest (CA). The EEG changes considerably during the first days after CA. The prognostic value of some EEG patterns is time-dependent, whereas that of others is not. Persistence of burst-suppression with heterogeneous (variable) bursts and generalized suppression (<10 µV) ≥24 hours after CA strongly predicts poor outcome. Burst-suppression with identical or highly epileptiform bursts and periodic discharges on a suppressed background strongly predict poor outcome, also within the first 24 hours during ongoing sedation and temperature management. These synchronous patterns are best assessed with early continuous EEG-monitoring (cEEG), because their prevalence gradually decreases. Early (<12 hours) return of a continuous normal-voltage background activity on cEEG is a strong predictor of good outcome. A reactive and continuous background on a late routine-EEG also indicates a good prognosis. Full-montage or simplified cEEG provides early prognostic information and improves sensitivity for both poor and good outcome prediction compared with a single late routine-EEG. Bilateral absence of cortical potentials (N20) on median nerve SSEP is one of the most reliable tools for predicting poor outcome, including during ongoing sedation. Sensitivity is limited, but specificity is near 100% if recordings are of sufficient quality, with clearly discernible peripheral potentials and low noise levels. Currently not included in guidelines, very low cortical SSEP amplitudes (approximately 0.5 µV or less) are strongly predictive of poor outcome. However, further research is needed to establish consensus criteria.
Principles of Management of Postcardiac Arrest Patients in the ICU.
Sandroni C, Cronberg T, Nolan JP
J Clin Neurophysiol · 2026 Jul · PMID 42359654 · Publisher ↗
Postcardiac arrest (CA) care in the intensive care unit is pivotal to mitigating hypoxic-ischemic brain injury (HIBI), the leading cause of death and disability in resuscitated patients. This narrative review synthesizes...
Postcardiac arrest (CA) care in the intensive care unit is pivotal to mitigating hypoxic-ischemic brain injury (HIBI), the leading cause of death and disability in resuscitated patients. This narrative review synthesizes current evidence and guideline recommendations on key domains of post-CA management, including diagnostic evaluation, hemodynamic optimization, oxygenation and ventilation strategies, temperature control, and sedation. Immediate coronary angiography is indicated in patients with ST-segment elevation, while a selective approach is warranted in others, guided by clinical findings. Whole-body computed tomography facilitates early identification of extracardiac causes and resuscitation-related injuries. Current consensus supports maintaining mean arterial pressure above 60 to 65 mm Hg, normoxemia (PaO 2 75-100 mm Hg), and normocapnia (PaCO 2 35-45 mm Hg). Lung-protective ventilation and head-up positioning are standard practices. Recent high-quality trials have challenged the neuroprotective role of therapeutic hypothermia; current guidelines recommend active fever prevention targeting a temperature of ≤37.5° C for at least 72 hours after CA. Sedation should be tailored to facilitate neurologic assessment, with short-acting intravenous agents preferred.
Direct Electrical Stimulation of the Opercula.
Zhang B, Zhou W
J Clin Neurophysiol · 2026 May · PMID 42359653 · Publisher ↗
Direct electrical stimulation (DES) has long been used in patients undergoing epilepsy surgery for two key purposes: functional brain mapping and seizure triggering. In this review, the findings from DES applications to...
Direct electrical stimulation (DES) has long been used in patients undergoing epilepsy surgery for two key purposes: functional brain mapping and seizure triggering. In this review, the findings from DES applications to the opercula are synthesized, with the aim of mapping opercular functions and investigating seizure induction. Clinical responses to opercular DES are frequent and diverse, showing a partial segregation with spatial overlap, and exhibiting topographical differences: Emotion is evoked in the most anterior part of frontal operculum, expressive aphasia is the mid-posterior part, followed by oropharyngeal, dysarthria, and gustatory in the central opercula, somatosensory and vestibular in the posterior opercula, and auditory (or rarely visual) in the temporal opercula. No studies have specifically looked at DES-induced seizures from the opercula. Only a small number of studies about insulo-opercular epilepsy have mentioned that DES of the opercula induced seizures. Overall, opercular DES studies converge on the view that the opercula comprise a complex multimodal cortex integrating especially sensorial perception. Each subdivision had a different dominant response to DES, whose organization helps understand the different subgroups of opercular epilepsy.
SEEG Implantation for Opercular Epilepsies.
Robin A, Kahane P, Nguyen DK
J Clin Neurophysiol · 2026 Apr · PMID 42359652 · Publisher ↗
Insulo-opercular epilepsies are rare, and pure opercular epilepsies are even rarer in the field of epilepsy surgery. They represent a complex form of focal epilepsy, often associated with noninformative MRI findings and,...
Insulo-opercular epilepsies are rare, and pure opercular epilepsies are even rarer in the field of epilepsy surgery. They represent a complex form of focal epilepsy, often associated with noninformative MRI findings and, in some cases, extensive epileptogenic networks. In this context, stereoelectroencephalography (SEEG) is a critical tool for precise characterization of the epileptogenic zone (EZ) and for guiding surgical treatment; in selected cases, it may also serve as a therapeutic intervention through radiofrequency thermocoagulation (RFTC). The insulo-opercular region exhibits intricate intra- and extraregional structural and functional connectivity, requiring individualized implantation strategies. SEEG implantation combining orthogonal electrodes sampling different opercular areas with oblique electrodes targeting the insula enables comprehensive coverage of the epileptogenic network. Hypothesis-driven, patient-specific SEEG implantation-integrating detailed anatomical, functional, and semiological considerations-is essential for the evaluation and treatment of pure opercular and insulo-opercular epilepsies. Strategically tailored coverage not only enhances diagnostic accuracy but also enables targeted therapeutic interventions, ultimately improving surgical outcomes while minimizing postoperative risks.
What Do the Intracerebral Electrodes See and Do Not See?
Fratello M, Pizzo F, Badier JM … +2 more , Bénar CG, López-Madrona VJ
J Clin Neurophysiol · 2025 Dec · PMID 42359649 · Publisher ↗
Stereoelectroencephalography (SEEG) is a powerful technique for delineating the epileptogenic zone network in patients with drug-resistant epilepsy, providing direct access to both superficial and deep brain structures....
Stereoelectroencephalography (SEEG) is a powerful technique for delineating the epileptogenic zone network in patients with drug-resistant epilepsy, providing direct access to both superficial and deep brain structures. However, its clinical value depends critically on the accurate interpretation of the recorded signals-which requires clear understanding of what we are actually recording, and what we are not. In this review, we examine the fundamental biophysical principles underlying SEEG signal generation, mainly the anatomical organization of brain structures and their distance from SEEG contacts. We address the types of epileptic patterns that SEEG can detect and how their interpretation depends on the referencing montage. Building on these concepts, we discuss the types of activity that may be missed or misrepresented. Finally, we explore emerging strategies to extend the field of view of SEEG electrodes. This review is intended both as an introduction for newcomers to the origin of SEEG signals and as an update for experienced users, reaffirming key concepts and presenting new methodological perspectives.
Quantitative EEG Analyses for Outcome Prediction in Comatose Patients After Cardiac Arrest.
van Putten MJAM, Tjepkema-Cloostermans MC
J Clin Neurophysiol · 2026 Jul · PMID 42359645 · Publisher ↗
Conventional visual interpretation of EEG has several limitations, including inter- and intraobserver variability, a substantial review burden, and the need to reduce a continuously evolving spatiotemporal signal to cate...
Conventional visual interpretation of EEG has several limitations, including inter- and intraobserver variability, a substantial review burden, and the need to reduce a continuously evolving spatiotemporal signal to categorical descriptions. Quantitative analysis of the EEG may help overcome some of these limitations by capturing signal characteristics and temporal dynamics that are difficult to summarize consistently in words alone. In this review, we briefly summarize the main approaches that have been used to support EEG-based outcome prediction in comatose patients after cardiac arrest. These range from explicit feature-based indices, such as the Cerebral Recovery Index, to machine-learning classifiers using larger EEG feature sets, and, more recently, to deep learning models trained directly on raw EEG. Importantly, these methods are relevant not only for the early identification of patients with a poor prognosis but also for identifying patients with a realistic chance of good neurologic recovery. Furthermore, qEEG increases objectivity, reducing dependence on categorical wording and supporting continuous bedside assessment of neurologic recovery. These approaches can reach sensitivities of 50% to 60% at specificities of > 99% for poor and > 95% for good neurologic outcome, respectively, particularly for early EEG (recorded < 24 hour after cardiac arrest). Within a multimodal prognostic framework, qEEG can serve as a valuable decision-support tool to assist final assessment by a trained electroencephalographer.
Anatomy and Structural Connectivity of the Opercula.
Charbonneau L, Mrichi S, Champagne PO … +3 more , Theaud G, Bojanowski MW, Obaid S
J Clin Neurophysiol · 2026 Jun · PMID 42328755 · Publisher ↗
The cerebral operculum comprises the cortical folds of the frontal, central, parietal, and temporal lobes that overlie the insula. Although historically described as a simple anatomical "cover," the operculum is now reco...
The cerebral operculum comprises the cortical folds of the frontal, central, parietal, and temporal lobes that overlie the insula. Although historically described as a simple anatomical "cover," the operculum is now recognized as a morphologically complex periSylvian region embedded within multiple cortico-cortical and cortico-subcortical networks. In this review, a comprehensive synthesis of opercular organization is provided, integrating topographic anatomy, structural connectivity, and vascular supply. The topographic anatomy of the operculum is described in relation to periSylvian sulcal landmarks that define four opercular subregions-the frontal, rolandic (i.e., central), parietal, and temporal opercula-and to the outer Sylvian membrane, which separates the superficial from the medial operculum. Structural connectivity involves well-defined major white matter tracts-including the superior longitudinal, arcuate, inferior fronto-occipital, uncinate, and middle longitudinal fasciculi-alongside operculum-specific associative connections, commissural pathways, and projection fibers. Within this structural framework, the operculum emerges as a critical hub in language, auditory, visual, and gustatory networks, supporting multimodal integration and higher-order processing. Cortical and white matter vascularization of the opercular region is dominated by centripetal branches arising from the M2 to M4 segments of the middle cerebral artery, which supply both superficial and deeper opercular layers. Collectively, the complex morphology, dense structural connectivity, and complex vascular organization of the operculum provide a structural basis for its functional importance and help explain the clinical heterogeneity of opercular epilepsy, including the challenges associated with its diagnosis and surgical management.
Sleep Microarchitecture, Epileptic Spikes, and Memory in Epilepsy: Implications for Developmental and Epileptic Encephalopathies.
Kwon H, Merricks EM, Yi S … +2 more , Kramer MA, Chu CJ
J Clin Neurophysiol · 2026 Jun · PMID 42328741 · Publisher ↗
Healthy sleep is electrographically defined by oscillations that drive alternating up- and down-states that regulate neuronal excitability. Slow oscillations-the hallmark rhythm of deep nonrapid eye movement sleep, tempo...
Healthy sleep is electrographically defined by oscillations that drive alternating up- and down-states that regulate neuronal excitability. Slow oscillations-the hallmark rhythm of deep nonrapid eye movement sleep, temporally organize faster, more focal rhythms, including thalamocortical sleep spindles and hippocampal sharp-wave ripples. These cascading rhythms have been implicated as a critical activity-dependent mechanism that binds coordinated neuronal activity to support systems-level consolidation of previous experience into long-term memory. Epilepsy is a disease characterized by sporadic pathologic neuronal activity, including interictal epileptiform discharges and seizures. Epileptic activity is frequently potentiated during sleep, but the interactions with specific graphoelements that comprise sleep microarchitecture are complex. Critically, the diverse ways in which epileptic activity interdigitates with sleep microstructure imply that epileptiform activity can distort and disrupt the same sleep rhythms that normally support memory consolidation. Cognitive comorbidities are common in epilepsy, and impairments in memory consolidation are increasingly recognized. In this review, we synthesize leading evidence on the complex interactions between sleep microarchitecture and interictal epileptiform discharges. We first summarize electrophysiologic data on how slow oscillations interact with spindles and interictal epileptiform discharges and then assemble these findings into a unifying framework for interictal epileptiform discharge-slow oscillation-spindle dynamics. Finally, we review evidence on how disruption of these sleep oscillations can contribute to cognitive dysfunction in epilepsy and highlight implications for developmental and epileptic encephalopathies.
Active and Passive Knitting Rhythm on EEG.
Nathan CL, Gerard EE
J Clin Neurophysiol · 2026 Jun · PMID 42328719 · Publisher ↗
Abstract loading — click title to view on PubMed.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe