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1.

Objective

To develop an automated algorithm for detecting fasciculations and other movements in muscle ultrasound videos. Fasciculation detection in muscle ultrasound is routinely performed online by observing the live videos. However, human observation limits the objective information gained. Automated detection of movement is expected to improved sensitivity and specificity and increase reliability.

Methods

We used 42 ultrasound videos from 11 neuromuscular patients for an iterative learning process between human observers and automated computer analysis, to identify muscle ultrasound movements. Two different datasets were selected from this, one to develop the algorithm and one to validate it. The outcome was compared to manual movement identification by clinicians. The algorithm also quantifies specific parameters of different movement types, to enable automated differentiation of events.

Results

The algorithm reliably detected fasciculations. With algorithm guidance, observers found more fasciculations compared to visual analysis alone, and prescreening the videos with the algorithm saved clinicians significant time compared to reviewing full video sequences. All videos also contained other movements, especially contraction pseudotremor, which confused human interpretation in some.

Conclusions

Automated movement detection is a feasible and attractive method to screen for fasciculations in muscle ultrasound videos.

Significance

Our findings affirm the potential clinical usefulness of automated movement analysis in muscle ultrasound.  相似文献   

2.

Objective

To test the diagnostic accuracy of a new automatic algorithm for ictal onset source localization (IOSL) during routine presurgical epilepsy evaluation following STARD (Standards for Reporting of Diagnostic Accuracy) criteria.

Methods

We included 28 consecutive patients with refractory focal epilepsy (25 patients with temporal lobe epilepsy (TLE) and 3 with extratemporal epilepsy) who underwent resective epilepsy surgery. Ictal EEG patterns were analyzed with a novel automatic IOSL algorithm. IOSL source localizations on a sublobar level were validated by comparison with actual resection sites and seizure free outcome 2?years after surgery.

Results

Sensitivity of IOSL was 92.3% (TLE: 92.3%); specificity 60% (TLE: 50%); positive predictive value 66.7% (TLE: 66.7%); and negative predictive value 90% (TLE: 85.7%). The likelihood ratio was more than ten times higher for concordant IOSL results as compared to discordant results (p?=?0.013).

Conclusions

We demonstrated the clinical feasibility of our IOSL approach yielding reasonable high performance measures on a sublobar level.

Significance

Our IOSL method may contribute to a correct localization of the seizure onset zone in temporal lobe epilepsy and can readily be used in standard epilepsy monitoring settings. Further studies are needed for validation in extratemporal epilepsy.  相似文献   

3.

Objective

To test the utility of a novel semi-automated method for detecting, validating, and quantifying high-frequency oscillations (HFOs): ripples (80–200?Hz) and fast ripples (200–600?Hz) in intra-operative electrocorticography (ECoG) recordings.

Methods

Sixteen adult patients with temporal lobe epilepsy (TLE) had intra-operative ECoG recordings at the time of resection. The computer-annotated ECoG recordings were visually inspected and false positive detections were removed. We retrospectively determined the sensitivity, specificity, positive and negative predictive value (PPV/NPV) of HFO detections in unresected regions for determining post-operative seizure outcome.

Results

Visual validation revealed that 2.81% of ripple and 43.68% of fast ripple detections were false positive. Inter-reader agreement for false positive fast ripple on spike classification was good (ICC?=?0.713, 95% CI: 0.632–0.779). After removing false positive detections, the PPV of a single fast ripple on spike in an unresected electrode site for post-operative non-seizure free outcome was 85.7 [50–100%]. Including false positive detections reduced the PPV to 64.2 [57.8–69.83%].

Conclusions

Applying automated HFO methods to intraoperative electrocorticography recordings results in false positive fast ripple detections. True fast ripples on spikes are rare, but predict non-seizure free post-operative outcome if found in an unresected site.

Significance

Semi-automated HFO detection methods are required to accurately identify fast ripple events in intra-operative ECoG recordings.  相似文献   

4.

Objective

This study aimed to investigate the association between mismatch negativity (MMN) and volumes of several brain regions measured using a semi-automated method in patients with schizophrenia and healthy controls.

Methods

MMN in response to duration deviants and magnetic resonance imaging were acquired from 36 schizophrenia patients and 14 healthy controls. FreeSurfer was used for volumetric analysis. MMN amplitudes, brain volumes and their association were compared between schizophrenia and controls. Correlation analysis and multiple linear regression analysis were used to examine the correlated variables of MMN.

Results

MMN amplitude was significantly lower in the schizophrenia group. In schizophrenia, MMN was positively correlated with age and negatively correlated with left hippocampal and right pars opercularis volumes. The association between left hippocampal volume and MMN in schizophrenia remained significant after controlling for potential confounders.

Conclusions

Smaller hippocampal volume may play a role in the abnormal manifestation of MMN in schizophrenia.

Significance

The significant association between MMN and left hippocampal volume may suggest unique neurobiological contribution of hippocampus in auditory processing in schizophrenia.  相似文献   

5.

Objective

To evaluate the performance of a recently proposed motor unit action potential (MUAP) averaging method based on a sliding window, and compare it with relevant published methods in normal and pathological muscles.

Methods

Three versions of the method (with different window lengths) were compared to three relevant published methods in terms of signal analysis-based merit figures and MUAP waveform parameters used in the clinical practice. 218 MUAP trains recorded from normal, myopathic, subacute neurogenic and chronic neurogenic muscles were analysed. Percentage scores of the cases in which the methods obtained the best performance or a performance not significantly worse than the best were computed.

Results

For signal processing figures of merit, the three versions of the new method performed better (with scores of 100, 86.6 and 66.7%) than the other three methods (66.7, 25 and 0%, respectively). In terms of MUAP waveform parameters, the new method also performed better (100, 95.8 and 91.7%) than the other methods (83.3, 37.5 and 25%).

Conclusions

For the types of normal and pathological muscle studied, the sliding window approach extracted more accurate and reliable MUAP curves than other existing methods.

Significance

The new method can be of service in quantitative EMG.  相似文献   

6.

Objective

Tinnitus is an auditory phantom sensation experienced in the absence of a sound source. Cognitive dysfunctions, especially in working memory and attention, are frequently reported to be associated with tinnitus. The aim of this study was to investigate attentional functioning in a group of subjects with chronic tinnitus using ERPs, and in particular the P300 components.

Methods

We studied 20 patients with chronic tinnitus and 20 healthy subjects that performed a P300 Novelty task.

Results

P3a amplitude was significantly lower in tinnitus subjects than in controls. P3a latency was comparable in patients and controls. The P3b parameters were similar in the two groups. N1 latency for all the stimuli was significantly longer in tinnitus subjects than in controls.

Conclusion

These results point to a general slowing in early stimulus perception in tinnitus subjects. Moreover, a specific difficulty emerged in attentional switching to unexpected events during an orienting response, probably owing to a dysfunction in the ventral attention network.

Significance

Psychophysiological approach reveals selective attentional impairment and could provide useful data for rehabilitative strategies in chronic tinnitus.  相似文献   

7.

Objective

Interictal regional paroxysmal fast activity (RPFA) on scalp EEG is common in patients with focal cortical dysplasia (FCD). Little data exists regarding the presence of RPFA in other etiologies.

Methods

We studied the association between RPFA and etiology on MRI in patients with drug resistant focal epilepsy undergoing presurgical evaluation in 2011. RPFA was defined as ≥3 consecutive spikes with a frequency of ≥10?Hz lasting ≥300?ms but <4?s.

Results

626 patients fulfilled the inclusion criteria. Of these, 138 (22%) patients had RPFA while rest had other interictal epileptiform discharges (IEDs). RPFA was located at posterior head region in 52.2% patients, frontal regions in 24.6% patients and over temporal regions in 17.4% patients. Focal gliosis (61, 44%) and FCD (27, 19%) were common etiologies in patients with RPFA. Compared to patients with other IEDs, patients with RPFA were more likely to have focal gliosis (61/138 vs. 39/488; p?<?0.0001) or FCD (27/138 vs 37/488; p?<?0.001) as the etiology of epilepsy.

Conclusion

In developing countries, focal gliosis is more common than FCD as the underlying etiology in patients with RPFA on scalp EEG.

Significance

Focal gliosis should be considered as one of the common substrate for RPFA on scalp EEG.  相似文献   

8.

Objective

The introduction of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy calls for reevaluation of the prognostic role of somatosensory evoked potentials (SEPs).

Methods

Among 80 consecutive neonates undergoing hypothermia for hypoxic-ischemic encephalopathy, 58 performed SEPs and MRI at 4–14?days of life and were recruited in this multicenter study. SEPs were scored as: 0 (bilaterally/unilaterally recorded N20) or 1 (bilaterally absent N20). The severity of brain injury was scored using MRI.

Results

Bilaterally absent N20 was observed in 10/58 neonates (17%); all had moderate/severe MRI abnormalities; 36/48 neonates (75%) with score 0 at SEPs had normal MRI. The positive predictive value of SEPs on MRI outcome was of 1.00, while the negative predictive value 0.72, sensitivity 0.48, specificity 1.00, with an accuracy of 0.78 (p?<?.001).

Conclusions

Bilateral absence of cortical SEPs predicts moderate/severe MRI pattern of injury.

Significance

Therapeutic hypothermia does not seem to significantly affect prognostic reliability of SEPs.  相似文献   

9.

Objective

Single-pulse electrical stimulation (SPES) of intracranial electrodes evokes responses that may help identify the seizure onset zone (SOZ); however, lack of automation and response variability has limited clinical adoption of this technique. We evaluated whether automated delivery of low-current SPES could evoke delayed high-frequency suppression (DHFS) of ongoing electrocorticography (ECoG) signals that, when combined with objective analytic techniques, may provide a reliable marker of this zone.

Methods

Low-current SPES (1-ms, 3.5-mA biphasic pulses) was delivered to 652 electrodes across 10 patients undergoing ECoG for seizure focus localization. DHFS was measured by calculating the normalized trial-averaged time-frequency power (70–250?Hz) 0.4–1?sec post-stimulation. Electrodes that evoked suppression when stimulated or recorded suppression when stimulation was nearby were used to estimate the SOZ.

Results

The estimated SOZ significantly identified the clinical SOZ in 6 of 10 patients (5 of 7 temporal foci) with a false-positive rate of 0–0.06. Stimulation required <2?h, was undetectable by patients, and did not induce seizures or after-discharges.

Conclusions

We show that DHFS provides accurate estimates of the clinical SOZ in patients with refractory epilepsy.

Significance

This approach may increase the safety, speed, and reproducibility of SOZ identification while reducing cost, subjectivity, and patient discomfort.  相似文献   

10.

Objective

This study tested the hypothesis that markers of functional cortical source connectivity of resting state eyes-closed electroencephalographic (rsEEG) rhythms may be abnormal in subjects with mild cognitive impairment due to Alzheimer’s (ADMCI) and Parkinson’s (PDMCI) diseases compared to healthy elderly subjects (Nold).

Methods

rsEEG data had been collected in ADMCI, PDMCI, and Nold subjects (N?=?75 for any group). eLORETA freeware estimated functional lagged linear connectivity (LLC) from rsEEG cortical sources. Area under receiver operating characteristic (AUROC) curve indexed the accuracy in the classification of Nold and MCI individuals.

Results

Posterior interhemispheric and widespread intrahemispheric alpha LLC solutions were abnormally lower in both MCI groups compared to the Nold group. At the individual level, AUROC curves of LLC solutions in posterior alpha sources exhibited moderate accuracies (0.70–0.72) in the discrimination of Nold vs. ADMCI-PDMCI individuals. No differences in the LLC solutions were found between the two MCI groups.

Conclusions

These findings unveil similar abnormalities in functional cortical connectivity estimated in widespread alpha sources in ADMCI and PDMCI. This was true at both group and individual levels.

Significance

The similar abnormality of alpha source connectivity in ADMCI and PDMCI subjects might reflect common cholinergic impairment.  相似文献   

11.

Objectives

To evaluate whether the task-specific neural coupling mechanism during the performance of cooperative hand movements is preserved in tetraplegic subjects.

Methods

Recordings of ipsilateral and contralateral electromyographic reflex responses in activated forearm muscles and bilateral somatosensory potentials (SSEP) to unilateral ulnar nerve stimulations during rest, cooperative and non-cooperative hand movements.

Results

Contralateral reflex responses were present in almost all patients during cooperative hand movements but small in amplitude when hand function was severely impaired. Ipsilateral SSEP potentials were enhanced during both cooperative and, in contrast to healthy subjects, also non-cooperative bimanual movements.

Conclusions

Both results indicate a strong involvement of ipsilateral non-damaged cervical tracts and hemispheres in the control of bimanual hand movements in tetraplegic subjects.

Significance

This study on the neural control of bimanual movements in patients suffering a cervical injury allows designing therapeutic approaches for the improvement of hand function that are based on physiological insights.  相似文献   

12.

Objective

The aim was to compare muscle fiber diameters obtained from standard muscle biopsy and from computer simulations based on recorded motor unit potentials (MUPs).

Methods

Electromyography (EMG) and muscle biopsy were performed in 14 patients with a suspicion of a neuromuscular disorder. Histograms of the simulated muscle fiber diameters (SMFDs) were compared with those from the biopsy

Results

The values of the SMFDs were similar to those in the muscle biopsy for the same patient (p?=?0.05) in all 14 cases.

Conclusions

Comprehensive evaluation of EMG and biopsy findings supported by computer simulations may help resolve the discrepancy between the assessment of muscle by EMG and biopsy by explaining different results obtained with these two methods.

Significance

Evaluation of the SMFDs that are comparable to biopsy findings extends the amount of information available from EMG.  相似文献   

13.

Objective

Sodium-potassium pump dysfunction in peripheral nerve is usually assessed by determining axonal hyperpolarization following maximal voluntary contraction (MVC) or maximal electrical nerve stimulation. As MVC may be unreliable and maximal electrical stimulation too painful, we assessed if hyperpolarization can also be induced by submaximal electrical nerve stimulation.

Methods

In 8 healthy volunteers different submaximal electrical stimulus trains were given to the median nerve at the wrist, followed by 5 min assessment of thresholds for compound muscle action potentials of 20%, 40% or 60% of maximal.

Results

Threshold increase after submaximal electrical nerve stimulation was most prominent after an 8?Hz train of at least 5 min duration evoking submaximal CMAPs of 60%. It induced minimal discomfort and was not painful. Threshold increase after MVC was not significantly higher than this stimulus train.

Conclusions

Submaximal electrical stimulation evokes activity dependent hyperpolarization in healthy test subjects without causing significant discomfort.

Significance

Sodium-potassium pump function may be assessed using submaximal electrical stimulation.  相似文献   

14.

Objective

Altered brain connectivity has been theorized as a key neural underpinning of autism spectrum disorder (ASD), but recent investigations have revealed conflicting patterns of connectivity, particularly hyper-connectivity and hypo-connectivity across age groups. The application of graph theory to neuroimaging data has become an effective approach for characterizing topographical patterns of large-scale functional networks. We used a graph approach to investigate alteration of functional networks in childhood ASD.

Method

Magnetoencephalographic signals were quantified using graph-theoretic metrics with a phase lag index (PLI) for specific bands in 24 children with autism spectrum disorder and 24 typically developing controls.

Results

No significant group difference of PLI was found. Regarding topological organization, enhanced and reduced small-worldness, representing the efficiency of information processing, were observed respectively in ASD children, particularly in the gamma band and delta band.

Conclusions

Analyses revealed frequency-dependent atypical neural network topologies in ASD children.

Significance

Our findings underscore the recently proposed atypical neural network theory of ASD during childhood. Graph theory with PLI applied to magnetoencephalographic signals might be a useful approach for characterizing the frequency-specific neurophysiological bases of ASD.  相似文献   

15.

Objective

Evaluation of the diagnostic utility of the oxyneurography (ONG) in diagnosing carpal tunnel syndrome (CTS).

Methods

ONG examination of the median nerve was performed in 260 patients. The results were compared with nerve conduction studies and clinical provocative tests.

Results

ONG index greater than or equal to 62% was found in 95.18% of the patients with no or minimal Nerve Conduction Study (NCS) changes (1–2 according to the Padua classification) but only in 1.69% of the patients with advanced NCS changes (Padua 3–6). The sensitivity and specificity of the ONG study i.e. 95.18% and 98.31%, respectively, were compared with standard clinical tests: Tinel sign (61.45% and 14.69%), Phalen test (34.94% and 45.20%), reverse Phalen test (81.93% and 34.46%) and carpal compression test (91.57% and 72.32%).

Conclusions

ONG index lower than 62% was indicative of CTS. ONG has higher sensitivity and specificity then other clinical tests and it is an accurate and reliable method for the diagnosis of CTS.

Significance

Oxyneurography is a non-invasive, fast and safe study which may play role in the diagnosis of carpal tunnel syndrome.  相似文献   

16.

Objective

To investigate the use of a sonographic median-to-ulnar cross-sectional area ratio (MUR) in diagnosis of carpal tunnel syndrome (CTS); and to compare the MUR with currently used sonographic parameters, and electrophysiology.

Methods

Subjects with CTS and healthy volunteers underwent ultrasound studies of the median and ulnar nerves in the wrist and forearm. Various sonographic parameters and ratios were calculated, and compared between CTS patients and controls. The sensitivity and specificity of the different parameters were compared by plotting receiver operator characteristic curves. Correlations of sonographic results with electrophysiologic studies were calculated.

Results

The MUR was increased in patients with CTS, in comparison with controls. A cut-point of >2.09 yielded a sensitivity of 86% and specificity of 84%. This was comparable to the currently used ultrasound metrics for CTS. The MUR also correlated with electrophysiologic severity.

Conclusions

The MUR is an effective means of diagnosing CTS and correlates with electrophysiologic severity.

Significance

This report provides support for the use of the MUR in the sonographic diagnosis of CTS.  相似文献   

17.

Objective

To explore brain activity in AD with depression (D-AD) based on fractional amplitude of low-frequency fluctuation (fALFF).

Methods

Twenty-two D-AD and 21 AD without depression patients (nD-AD) were examined by magnetic resonance imaging during resting state. Neuropsychiatric Inventory and Hamilton Depression Rating Scale were employed to assess the severity of depression. We analysed the characteristics of fALFF in D-AD differing from nD-AD. We also examined the correlation between fALFF and the depression severity.

Results

D-AD patients had higher fALFF in right fusiform gyrus, left caudate nucleus, and right middle temporal gyrus (MTG), meanwhile lower fALFF in supplementary motor area (SMA) than nD-AD patients.

Conclusions

Abnormal fALFF changes in fusiform gyrus, caudate nucleus, MTG and SMA may be important neuropathophysiologic characteristics of depression in AD.

Significance

We have clarified the potential neuropathological changes of depression in AD based on fALFF method, which is crucial for effective intervention.  相似文献   

18.

Objective

The restless legs syndrome (RLS) is characterized by sensory-motor symptoms which usually occur predominantly at rest in the evening and at night. It is assumed that this circadian rhythm is caused by low dopamine levels in the evening. Yet, it has never been investigated whether RLS patients show diurnal variations in cognitive functions modulated by dopamine and what neurophysiological and functional neuroanatomical processes underlie such modulations.

Methods

We used a Simon task combined with EEG and source localization to investigate whether top-down response selection and/or automatic visuo-motor priming are subject to diurnal changes in RLS patients, as compared to matched healthy controls.

Results

We found that RLS patients showed better task performance due to reduced visuo-motor priming in the evening, as reflected by smaller early lateralized readiness potential (e-LRP) amplitudes and decreased activation of the superior parietal cortex and premotor cortex. Top-down response selection and early attentional processing were unaffected by RLS.

Conclusions

Counterintuitively, RLS patients show enhanced task performance in the evening, i.e. when experiencing dopaminergic deficiency. Yet, this may be explained by deficits in visuo-motor priming that lead to reduced false response tendencies.

Significance

This study reveals a counterintuitive circadian variation of cognitive functions in RLS patients.  相似文献   

19.

Objective

To investigate whether Posterior Dominant Rhythm (PDR) can be reliably assessed in sleep-EEG recordings and to investigate the diagnostic yield of standard-wake and sleep-recordings.

Methods

EEG recordings of 303 consecutive patients aged 18–88?years were analyzed. All patients had both standard-wake and sleep-recordings, including patients who had abnormal standard recordings. Melatonin was used in 6% of sleep EEGs, and sleep deprivation in 94%. The mean duration of sleep was 41?min. We measured the PDR frequency in standard and sleep-recordings, both before and after sleep. We compared the diagnostic yield of standard-wake and sleep EEG recordings.

Results

Compared to standard EEG, sleep-recordings showed a significantly lower PDR frequency, both when measured before and after sleep (p?<?0.001). One-hundred-fifty-six patients (51%) had normal standard recordings, and 35 of them (22%) had abnormal findings in the sleep-recording. One-hundred-forty-seven patients had abnormal standard recordings and in 16 of them (11%) these abnormalities were not present in sleep-recording.

Conclusions

PDR is significantly slower in the wake periods of sleep-recordings, compared to standard wake recordings.

Significance

Sleep and standard wake recordings are complementary.  相似文献   

20.

Objective

To assess electroencephalography (EEG) changes during tilt table testing in syncope and other orthostatic syndromes.

Methods

We retrospectively reviewed consecutive tilt table studies with simultaneous EEG from April 2014 to May 2016 at our center. All patients had video EEG during tilt table. All patients had at least 10?min of head up tilt unless they had syncope or did not tolerate the study. Video EEG was interpreted by epileptologists.

Results

Eighty-seven patients met the inclusion criteria. Mean age was 45?years, and 55 were women. Seven patients (~8%) had syncope during tilt table, 11 patients (~12%) had significant neurogenic orthostatic hypotension and a separate group of 11 patients (~12%) had significant orthostatic tachycardia. Valsalva responses were abnormal in 7 of the 11 patients with orthostatic hypotension, suggesting an underlying neurogenic orthostatic hypotension. Visually discernable EEG changes were seen in only 3 patients (~43%) who had syncope and in 1 patient (~9%) with orthostatic tachycardia.

Conclusions

Qualitative EEG analysis based on visual inspection during tilt table study revealed abnormalities in less than half the patients with syncope and a very small fraction with orthostatic tachycardia.

Significance

Routine qualitative EEG recording might not be clinically useful during tilt table studies.  相似文献   

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