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1.

Objectives

Somatosensory evoked potentials (SSEPs) have proven useful as an intraoperative modality to predict perioperative stroke during carotid endarterectomy (CEA). However, the predictive value of SSEPs for predicting stroke 30?days postoperatively remains unclear. The primary objective is to evaluate the efficacy of intraoperative SSEP change in predicting the risk of stroke in the postoperative period beyond 24?h but within 30?days. Our secondary aim is to evaluate the predictive value of each subcategory of SSEP change.

Methods

We performed a meta-analysis of 25 prospective/retrospective studies from PubMed, Web of Science, and Embase regarding SSEP monitoring for postoperative outcomes in symptomatic and asymptomatic CEA patients.

Results

A 8307-patient cohort composed the total sample population, of which 54.17% had symptomatic CS. For SSEP change and stroke greater than 24?h but within 30?days, the diagnostic odds ratio was 8.68. The diagnostic odds ratio was 3.88 for transient SSEP change and stroke; 49.29 for persistent SSEP change and stroke; 36.45 for transient SSEP loss and stroke; and 281.35 for persistent SSEP loss and stroke.

Conclusions

Patients with SSEP changes are at increased risk of perioperative stroke within the entire 30-day period. There is a noticeable step-wise increase in the predicted risk of stroke with the severity of SSEP changes.

Significance

SSEP changes can serve as a predictor for 30-day perioperative stroke during CEA.  相似文献   

2.

Objective

Deep brain stimulation (DBS) can provide insights into the workings of the basal ganglia (BG) by interfering with their function. In patients with Parkinson's disease (PD) treated with DBS of the subthalamic nucleus, we studied the effect of DBS on scanning eye movements.

Methods

In the visual memory task, subjects viewed images of various complexities for later recall. In visual search tasks, subjects looked for and fixated one odd target ring, embedded among 48 Landolt rings, which either stood out or not from the distractors. We compared the parameters of scanning saccades when DBS was on and off.

Results

In the visual memory task, DBS increased the amplitude of saccades scanning simple but not complex drawings. In the visual search tasks, DBS showed no effect on saccade amplitude or frequency.

Conclusions

Saccades when viewing simple images were affected by DBS since they are internally guided saccades, for which the involvement of BG is large. In contrast, saccades when viewing complex images or during visual search, made with the help of visual cues in the images (externally guided saccades) and less dependent on BG, were resistant to the effect of DBS.

Significance

DBS affects saccades differentially depending on the task.  相似文献   

3.

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   

4.

Objective

To investigate the prevalence and the temporal structure of bilateral coherence in physiological (PT) and essential (ET) hand tremor.

Methods

Triaxial accelerometric recordings from both hands in 30 healthy subjects and 34 ET patients were analyzed using spectral coherence and wavelet coherence methods. In 12 additional healthy subjects, the relation between the hand tremor and the chest wall acceleration was evaluated using partial coherence analysis.

Results

The majority of both PT and ET subjects displayed significant bilateral coherence. While in PT, bilateral coherence was most frequently found in resting hand position (97% of subjects), in ET the prevalence was comparable for resting (54%) and postural (49%–57%) positions. In both PT and ET, epochs of strong coherence lasting several to a dozen seconds were separated by intervals of insignificant coherence. In PT, bilateral coherence at the main tremor frequency (8–12 Hz) was coupled with the ballistocardiac rhythm.

Conclusion

The oscillations of the two hands are intermittently synchronized in both PT and ET. We propose that in postural PT, bilateral coherence at the main tremor frequency arises from transient simultaneous entrainment of the left and right hand oscillations to ballistocardiac forcing.

Significance

Bilateral coherence of hand kinematics provides a sensitive measure of synchronizing influences on the left and right tremor oscillators.  相似文献   

5.

Objective

It has been reported that interictal epileptic discharges (IEDs) recorded in temporal regions on scalp EEG are unlikely to originate from mesial temporal structures. However, EEG-fMRI sometimes show mesial temporal activation. We hypothesized that BOLD activation in the temporal neocortex is weaker than in the mesial structures, reflecting the fact that propagated activity has less metabolic demand than the original discharge.

Methods

Twelve patients with epilepsy who have BOLD response in mesial temporal structures were selected from our EEG-fMRI database. We searched the temporal lobe ipsilateral to IEDs and checked whether there is positive BOLD response in the neocortex.

Results

All IED types showed a BOLD response in the temporal neocortex ipsilateral to the mesial temporal BOLD response. T-values were higher in mesial temporal structures than in neocortex in 13/16 cases.

Conclusions

Hemodynamic changes were observed in the mesial temporal lobe at the time of IEDs recorded from the temporal region on the scalp. The finding of smaller BOLD changes in the ipsilateral neocortex is in agreement with our hypothesis.

Significance

Our study indicates that scalp-recorded temporal lobe spikes are likely to result from mesial temporal spikes propagating neuronally to the neocortex.  相似文献   

6.

Objective

The somatosensory temporal discrimination threshold (STDT), defined as the shortest time interval required for two tactile stimuli to be perceived as separate, is longer in patients with Parkinson’s disease (PD). In this review, we discuss STDT findings in healthy subjects and in PD patients and the relationship between altered STDT and motor disturbances.

Methods

A search was conducted on PubMed for papers dealing with PD and temporal discrimination published from January 1990 to July 2017.

Results

Abnormal STDT in PD correlates with disease duration, disease severity and degree of nigrostriatal dopamine loss, and responds to dopaminergic medication. In PD, a prolonged STDT does not correlate, or only marginally correlates, with clinically assessed bradykinesia of finger tapping. By contrast, a prolonged STDT correlates with the variability in amplitude and speed of finger tapping as assessed by means of neurophysiological techniques and may contribute to impaired finger dexterity in PD.

Conclusions

We suggest that abnormal temporal processing of sensory information in PD generates incorrect signals for the execution and control of voluntary movements.

Significance

This review sheds light on unsolved questions regarding the relationship between STDT alterations and motor disturbances in PD and proposes directions for future research on this topic.  相似文献   

7.

Objective

In patients with Parkinson’s disease (PD), augmented visual feedback (VF) can improve functional motor performance. Conversely, they appear to rely more on visual information than healthy subjects, which is unfavorable when this information is unreliable. Cortical beta activity is thought to be associated with the need for motor adaptation. We here compared event-related EEG parameters during a whole-body postural weight-shifting task between congruent and incongruent feedback conditions.

Methods

Twenty-four patients with PD and fifteen healthy, age- and gender-matched controls performed rhythmic swaying movements. VF was presented in real-time (congruent), delayed (incongruent), or was entirely absent. We estimated source activity in four regions-of-interest and determined motor-related spectral power and power modulation in alpha and beta frequency bands.

Results

For congruent VF no significant differences in cortical activity between the two groups were present. For incongruent VF, the PD group showed significantly higher beta modulation in primary motor cortex, and higher alpha modulation in primary visual cortex.

Conclusions

Event-related beta modulation in the motor network and alpha modulation in visual areas discriminated between groups, suggesting altered visuomotor processing in PD patients.

Significance

This study finds evidence for increased modulation of alpha/beta activity during perceptual-motor tasks in PD, possibly indicating an unwarranted higher confidence in VF.  相似文献   

8.

Objective

The goal of this study was to determine the relative contributions of finger weakness and reduced finger individuation to reduced hand function after stroke, and their association with corticospinal tract (CST) injury.

Methods

We measured individuated and synergistic maximum voluntary contractions (MVCs) of the index and middle fingers, in both flexion and extension, of 26 individuals with a chronic stroke using a robotic exoskeleton. We quantified finger strength and individuation, and defined a novel metric that combines them – “multifinger capacity”. We used stepwise linear regression to identify which measure best predicted hand function (Box and Blocks Test, Nine Hole Peg Test) and arm impairment (the Upper Extremity Fugl-Meyer Test).

Results

Compared to metrics of strength or individuation, capacity survived the stepwise regression as the strongest predictor of hand function and arm impairment. Capacity was also most strongly related to presence or absence of lesion overlap with the CST.

Conclusions

Reduced strength and individuation combine to shrink the space of achievable finger torques, and it is the resulting size of this space – the multifinger capacity – that is of elevated importance for predicting loss of hand function.

Significance

Multi-finger capacity may be an important target for rehabilitative hand training.  相似文献   

9.

Objective

To determine whether a single dose of fluoxetine increases corticomotoneuronal excitability, motor performance and practice-dependent plasticity.

Methods

Twelve healthy adults completed this placebo-controlled, pseudo-randomized, double-blind crossover study. Transcranial magnetic stimulation (TMS) was used to assess corticomotoneuronal excitability, and two uni-axial accelerometers measured kinetics of fastest possible ballistic voluntary thumb movements and TMS-evoked thumb movements. Six hours after administration of either 20?mg of the serotonin reuptake inhibitor fluoxetine or placebo, participants practiced ballistic thumb movements in the direction opposite to the TMS-evoked thumb movements. The primary outcome of this study was the proportion of thumb movements that fell within the target-training zone (TTZ) during and for 30?min after the practice.

Results

All participants demonstrated practice-dependent plasticity evidenced by an increase of TMS-evoked thumb movements falling into the TTZ (P?=?0.045), with no difference between drugs. There was a significant increase in peak acceleration of the practiced voluntary thumb movements (P?=?0.002), but no DRUG by TIME interaction. Motor-evoked potential amplitudes were not changed by drug intake or practice.

Conclusions

A single dose of 20?mg of fluoxetine did not enhance corticomotoneuronal excitability, performance of a ballistic thumb movement task, or practice-dependent plasticity in healthy adults.

Significance

Longer administration fluoxetine may be necessary to enhance motor performance and plasticity.  相似文献   

10.

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   

11.

Objective

We propose an electrooculogram and submandibular montage that helps to discriminate eye/eyelid/tongue movements and to differentiate them from epileptiform activity or slowing on electroencephalography (EEG).

Methods

We analyzed different eye/eyelid and tongue movements in 6 and 4 patients, respectively. Six peri–orbitally and one submandibular electrodes were placed. We referred these electrodes to an indifferent reference (Cz/Pz) and we recorded eye/eyelid and tongue movements simultaneously with the 10–20 system EEG. Additionally, we analyzed 2 seizures with the electrooculogram montage.

Results

The electrooculogram deflections always showed an opposite phase direction when eye/eyelid movements occurred. Conversely, epileptiform activity produced deflections in the same phase direction in all electrooculogram electrodes. The electrooculogram montage was able to distinguish eye ictal semiology. Vertical tongue movements showed opposite phase deflections between the submandibular and the inferior ocular electrodes. Horizontal tongue movements revealed opposite phase reversal deflections between both inferior ocular electrodes.

Conclusions

The proposed montage accurately defines different eye/eyelid and tongue movements from brainwave activity. Additionally, it is useful to differentiate eye/eyelid movements from epileptiform activity and to characterize ictal ocular semiology, which can help localize or lateralize the epileptogenic zone.

Significance

We propose this new montage to provide added value to prolonged video-EEG studies.  相似文献   

12.

Objective

The relation between well-controlled auditory stimulation through cochlear implant (CI) and the body balance has been sparsely investigated. The purpose of this study was to evaluate the body balance function of CI patients with- and without-sound in anechoic sound-shielded room.

Methods

We recorded 8 experienced CI recipients and 8 young normal-hearing volunteers. All subjects were assessed using posturography under 4 conditions: (1) eyes open with-sound, (2) eyes closed with-sound, (3) eyes open without-sound, and (4) eyes closed without-sound.

Results

The total path length and the total area were significantly larger in the eyes closed condition than in the eyes open condition. In normal hearing subjects, the average displacement of center of pressure (COP) in the mediolateral direction under with-sound condition was not different from that under without-sound condition. In CI recipients, the COP significantly displaced to the CI side after the deprivation of visual cues in without-sound condition. This shift was eliminated in with-sound condition (significant interaction among sound condition, eye condition, and between-group factor).

Conclusion

In CI subjects, sound stimulation improves the abnormal displacement of COP in the mediolateral direction.

Significance

A posturographic study under an anechoic condition proved that sound stimulation improves body balance function in CI subjects.  相似文献   

13.

Objective

The present study evaluated ankle stiffness in adults with and without neurological disorders and investigated the accuracy and reproducibility of a clinically applicable method using a dynamometer.

Methods

Measurements were obtained from 8 healthy subjects (age 39.3), 9 subjects with spastic cerebral palsy (CP) (age 39.8) and 8 subjects with multiple sclerosis (MS) (age 49.9). Slow and fast dorsiflexion stretches of the ankle joint were performed to evaluate passive muscle-tendon-joint stiffness, reflex mediated stiffness and range of movement (ROM), respectively. Intra/inter-rater reliability for passive and reflex mediated ankle muscle stiffness was assessed for all groups.

Results

Subjects with CP and MS showed significantly larger values of passive stiffness in the triceps surae muscle tendon complex and smaller ROM compared to healthy individuals, while no significant difference in reflex mediated stiffness. Measurements of passive muscle-tendon-joint stiffness and reflex mediated stiffness showed good to excellent inter- and intra-rater reliability (ICC: 0.62–0.91) in all groups.

Conclusion

Increased stiffness was found in subjects with CP and MS with a clinically applicable method that provides valid and reproducible measurement of passive ankle muscle-tendon-joint stiffness and reflex mediated stiffness.

Significance

The present technique may provide important supplementary information for the clinician.  相似文献   

14.

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   

15.

Objective

The aim of the paper is to objectively demonstrate that amputees implanted with intraneural interfaces are truly able to feel a sensation in the phantom hand by recording “phantom” somatosensory evoked potentials from the corresponding brain areas.

Methods

We implanted four transverse intrafascicular multichannel electrodes, available with percutaneous connections to a multichannel electrical stimulator, in the median and ulnar nerves of two left trans-radial amputees. Two channels of the implants that were able to elicit sensations during intraneural nerve stimulation were chosen, in both patients, for recording somatosensory evoked potentials.

Results

We recorded reproducible evoked responses by stimulating the median and the ulnar nerves in both cases. Latencies were in accordance with the arrival of somatosensory information to the primary somatosensory cortex.

Conclusion

Our results provide evidence that sensations generated by intraneural stimulation are truly perceived by amputees and located in the phantom hand. Moreover, our results strongly suggest that sensations perceived in different parts of the phantom hand result in different evoked responses.

Significance

Somatosensory evoked potentials obtained by selective intraneural electrical stimulation in amputee patients are a useful tool to provide an objective demonstration of somatosensory feedback in new generation bidirectional prostheses.  相似文献   

16.

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   

17.

Objective

To study excitability of single motor units (MUs) using high-density surface-EMG.

Methods

Motor unit action potentials (MUAPs) were evoked by submaximal stimulation of the median nerve at the wrist and recorded with a 9?×?14 electrode grid on the skin overlying the thenar muscles. For excitability tests of single MUs, the most optimal specific single-channel surface-EMG signal was selected based on the spatiotemporal profile of single MUs.

Results

Axonal excitability measures were successfully obtained from 14 single MUs derived from ten healthy subjects. Selecting the optimal single-channel surface-EMG signals minimized interference from other single MUs and improved signal-to-noise ratio. The muscle fiber conduction velocity (MFCV) could also be derived from the unique spatiotemporal profile of single MUs.

Conclusion

High-density surface-EMG helps to isolate single MUAP responses, making it a suitable technique for assessing excitability in multiple single motor axons per nerve.

Significance

Our method enables the reliable study of ion-channel dysfunction in single motor axons of nerves without any requirement for specific conditions, such as prominent MU loss or enlarged MUAPs due to collateral sprouting.  相似文献   

18.

Objectives

We determined if eye movements evoked by Electrical Vestibular Stimulation (EVS) can be used to detect vestibular dysfunction in patients with unilateral vestibular schwannoma (VS).

Methods

Ocular torsion responses to monaural sinusoidal EVS currents (±2?mA, 2?Hz) were measured in 25 patients with tumours ranging in size from Koos grade 1–3. For comparative purposes we also measured postural sway response to EVS, and additionally assessed vestibular function with the lateral Head Impulse Test (HIT). Patient responses were compared to age-matched healthy control subjects.

Results

Patients exhibited smaller ocular responses to ipsilesional versus contralesional EVS, and showed a larger asymmetry ratio (AR) than control subjects (19.4 vs. 3.3%, p?<?0.05). EVS-evoked sway responses were also smaller in ipsilesional ear, but exhibited slightly more variability than the eye movement response, along with marginally lower discriminatory power (patients vs. controls: AR?=?16.6 vs 2.6%, p?<?0.05). The HIT test exhibited no significant difference between groups.

Conclusions

These results demonstrate significant deficits in the ocular torsion response to EVS in VS patients.

Significance

The fast, convenient and non-invasive nature of the test are well suited to clinical use.  相似文献   

19.

Objective

Mental rotation of body parts involves sequential cognitive processes, including visual processing, categorization and the mental rotation process itself. However, how these processes are affected by the amputation of a limb is still unclear.

Methods

Twenty-five right upper-limb amputees and the same number of matched healthy controls participated in a hand mental rotation task. Thirty-two-channel electroencephalography (EEG) was recorded and the event-related potentials (ERPs) were analyzed.

Results

In the early visual processing phase, amputees and controls showed a similar P100. During the categorization phase, the amputees exhibited a decreased N200 compared with controls, and the decline was positively correlated with the time since amputation. In the mental rotation phase, controls had a larger ERP for the right upright hand than for the left upright hand, while amputees had a larger ERP for the left (intact) upright hand than for the right (affected) upright hand.

Conclusions

Early visual processing was not affected by limb amputation. However, the perceptual salience of hand pictures decreased and the intact hand gained more significance in the amputees.

Significance

Event-related potentials had the capability of showing the differences in categorization and mental rotation phases between amputees and controls.  相似文献   

20.

Objective

Somatosensory evoked potentials have high prognostic value in neonatal intensive care, but their recording from infants is challenging. Here, we studied the possibility to elicit cortical responses in newborns by simple passive hand movements.

Methods

We examined 13 newborns (postnatal age 1–46 days) during clinically indicated 19-channel electroencephalography (EEG) recordings in the neonatal intensive care unit; EEG indications included birth asphyxia and suspected epileptic seizures. The experimenter moved the infant’s wrist or fingers at 1 or 2 Hz for 5–10 min, separately on both sides. We measured movement kinematics with an accelerometer attached to the infant’s hand and computed coherence between the EEG and acceleration signals (corticokinematic coherence, CKC).

Results

Statistically significant CKC (amplitude 0.020–0.511) with characteristic scalp topography was observed in all infants at twice the movement frequency. CKC was contralaterally dominant on the central scalp (median laterality index 0.48 for right-hand and ?0.63 for left-hand movements).

Conclusions

Passive movements elicit cortical responses that can be readily observed in clinical EEG recordings from newborns in the intensive-care environment.

Significance

CKC is a novel, noninvasive marker for the somatosensory system. Its robustness and practical ease make it attractive for bedside assessment of neurologically compromised newborns.  相似文献   

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