Schizophrenia (Sz) involves positive symptoms such as auditory hallucinations, paranoia, and delusions, and are commonly linked to deficits in cognitive control. These deficits appear in tasks like the A-X version of the continuous performance test (AX-CPT), which reflects reduced proactive control, and in diminished auditory steady-state responses (ASSR) during selective attention. Notably, in Sz, ASSR to sounds presented during diverted attention increases with hallucination severity. We report results from a single-blind randomized controlled trial evaluating Auditory Control Enhancement (ACE) therapy-the combination of transcranial direct current stimulation (tDCS) paired with Auditory Cognitive Control Training (ACCT)-to improve cognitive control in Sz. Ten individuals with Sz participated: six received active ACE and four received sham tDCS with ACCT. All experienced auditory hallucinations at least three days per week. ACCT consisted of three 45-min computerized sensory reaction-time sessions over three consecutive days. All procedures, including baseline and follow-up assessments, were performed over a two-week period. Electroencephalography (EEG) was collected before and after training while participants completed AX-CPT and ASSR tasks. ASSR blocks alternated between attending to auditory stimuli and ignoring them while watching a silent video. Auditory hallucinations were assessed using the PSYRATS at baseline and post-intervention. Procedures were well tolerated, and acceptability was high. Participants receiving ACE showed increased attention modulation (larger ASSR attend-ignore difference), greater beta desynchronization during proactive inhibition, and reductions in physical aspects of auditory hallucinations. In contrast, the sham group showed no changes in EEG measures or hallucination severity. These preliminary results suggest ACE may enhance cognitive control and reduce physical aspects of auditory hallucinations in Sz. ACE could represent a promising intervention for cognitive dysfunction.
ObjectiveTo investigate the neuroelectrophysiological characteristics of children with obstructive sleep apnea (OSA) accompanied by attention deficit hyperactivity disorder (ADHD)-like symptoms using attention network test (ANT) task-state electroencephalography analysis.MethodsAll participants completed the Attention Deficit Hyperactivity Disorder rating scale. Electroencephalography data were collected using 32 leads while the participants performed the ANT, followed by polysomnography.ResultsOf the 87 children, 21 were in the control group, 56 were in the OSA group, and 10 were in the OSA accompanied by ADHD-like symptoms group (OSA-co-ADHD). Each group had similar response time and accuracy for the different ANT conditions. At the O2 electrode, compared with the controls, the latency of the P1 component in the OSA group was shorter (P < 0.05). During the alerting network stage, in the PZ electrode, the beta band energy of the OSA-co-ADHD group was greater than that of the control group (Z -3.067, P = 0.006). During the executive control network stage, at the CZ electrode, the OSA-co-ADHD group exhibited higher alpha band energy than the OSA group (P < 0.05). During the alerting and orienting network phases, the connections of multiple brain regions changed (all P < 0.05), while the executive control network remained unchanged.ConclusionExcessive activation of the alerting network, reorganization of the orienting network in the brain, and compensation for inhibitory control during the process of the executive control network may be important characteristics of children with OSA accompanied by ADHD-like symptoms.
IntroductionAbsence seizures are characterized by the appearance of generalized spike-and-wave complexes (SWCs) on scalp electroencephalography (EEG), but the EEG-level physiological changes that precede the onset of SWCs remain poorly understood. Advances in scalp wide-band EEG have enabled the simultaneous visualization of ultraslow and high-frequency activity, providing an opportunity to examine early ictal dynamics in childhood absence epilepsy (CAE). Here, we report two cases of pediatric CAE in which scalp EEG captured ictal direct current (DC) shifts and ictal high-frequency oscillations (HFOs) within the same seizure epoch.Patients and MethodsWe report two pediatric patients with CAE who exhibited typical absence seizures during hyperventilation-provoked scalp EEG recordings. Across three seizures, the same wide-band EEG methodology enabled the evaluation of ictal DC shifts and HFOs.ResultsAcross three seizures, a reproducible temporal sequence was observed: a negative DC shift emerged several hundred milliseconds before the first SWC, followed by spike-locked HFOs shortly after ictal onset. The DC shift progressively deepened during this interval, whereas HFOs appeared as discrete, band-limited events with modest frequency evolution. Despite differences in seizure duration and clinical background, this pattern was consistent across seizures and between patients.DiscussionThese findings suggest that ictal DC shifts reflect slow network changes preceding thalamocortical hypersynchrony, whereas ictal HFOs index the fast dynamics involved in SWC generation. As both components can be detected noninvasively, scalp wide-band EEG may offer a foundation for developing early ictal biomarkers in CAE.
Clinical electroencephalography (EEG) remains a central diagnostic tool in psychiatry. As a non-invasive, widely available and cost-effective method with high temporal resolution, EEG contributes to the detection of epileptiform activity, exclusion of organic brain dysfunction, assessment of delirium and encephalopathies, differential diagnosis of dementias, and monitoring of psychopharmacological treatments. It provides functional information that complements structural imaging and serves as an indispensable auxiliary tool in the diagnostic work up.While EEG has not demonstrated sufficient specificity as a diagnostic marker for primary psychiatric disorders, there is growing evidence supporting the predictive use of quantitative EEG features, particularly in depression. Resting-state markers, including alpha peak frequency, vigilance regulation and frontal alpha asymmetry have shown small-to-moderate effect sizes in predicting differential treatment responses to antidepressants, brain stimulation techniques, ketamine and electroconvulsive therapy. These markers operate probabilistically, shifting response likelihoods rather than determining outcomes at the individual level. Even modest predictive effects can translate into meaningful population-level improvements by reducing ineffective treatment trials and accelerating remission.In summary, electroencephalography is a valuable tool in routine clinical practice that should be part of standard diagnostic procedures. Subject to large validation studies, quantitative EEG can provide predictive instruments in precision psychiatry, enhance treatment selection and thus improve outcomes by augmenting the clinical nature of psychiatric practice.
BackgroundStroke in the middle cerebral artery (MCA) often leads to persistent upper limb disability. While clinical scales such as the Fugl-Meyer Assessment for the Upper Extremity (FM-UE) track motor recovery, high-density EEG provides insight into cortical motor-activation patterns. Event-related desynchronization/synchronization (ERD/ERS) in mu and beta bands may offer insight into recovery mechanisms.Objectivea) To characterize changes in mu and beta oscillations following upper limb rehabilitation in chronic MCA stroke patients, and b) To identify ERD features most closely associated with residual motor function.MethodsTen chronic MCA stroke patients and seven healthy controls underwent EEG during motor-imagery and active-movement tasks. Stroke patients received 15 sessions of rehabilitation over 8 weeks. EEG data were processed using EEGLAB/MATLAB and analyzed with ERD/ERS metrics. Spearman correlations with FM-UE scores were calculated.ResultsChronic stroke patients showed pathological ERS in ipsilesional beta rhythms that shifted toward ERD after rehabilitation, paralleling significant motor recovery. Although correlations did not reach significance, alpha oscillations in the ipsilesional hemisphere most closely related to functional gains.ConclusionOur findings suggest that rehabilitation in chronic stroke patients induces real cortical changes reflected in EEG oscillatory dynamics. Although preliminary, ipsilesional alpha and beta changes may represent biomarkers of genuine recovery, distinguishing neuroplastic improvement from compensatory mechanisms and guiding future therapeutic strategies.
BackgroundChronic widespread pain (CWP), the hallmark of Fibromyalgia (FM), is poorly understood. Altered spectral power of cortical oscillations during rest have been identified in chronic pain, yet it is unknown whether people at high risk of future CWP show FM-like Electroencephalogram (EEG) features. This cross-sectional observational study is the first to examine spectral changes in individuals at high risk of CWP.MethodsDifferences in resting-state oscillatory power in FM (n = 19), At-Risk (AR; n = 21) and Healthy Control (HC; n = 17) groups were examined. Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep problems. Patients were not on centrally acting medication. EEG recordings were obtained in eyes-open and closed conditions (6 min of each) to assess alpha reactivity (eyes-closed minus eyes-open). Group differences in scalp-averaged spectral power were examined in several frequency bands, and topographic analysis was performed on alpha.ResultsAlpha reactivity was significantly lower in FM compared to AR and HC groups. Topographic analysis of alpha found that this interaction peaked in right-frontal electrodes, where there was a positive (uncorrected) correlation between alpha reactivity and morning salivary cortisol levels in AR individuals, not present in FM.ConclusionsAs expected, alpha reactivity differed between groups; however, contrary to our expectations, AR did not show FM-like resting alpha physiology, but were instead similar to HC. The (uncorrected) positive association of right-frontal alpha reactivity and cortisol hints at a pattern related to resilience to CWP in high-risk individuals, which larger, perhaps longitudinal studies may confirm.
Background Isolated paroxysmal eye deviation in children is often considered a benign nonepileptic phenomenon. When epileptic in origin, gaze deviation is usually accompanied by visual symptoms, autonomic features, impaired awareness, or additional motor manifestations. Case We report a 6-year-old boy with frequent daily episodes of brief right upward eye deviation without impaired awareness, visual symptoms, head version, or other ictal features. Neurological and ophthalmological examinations, routine laboratory investigations, and brain magnetic resonance imaging were unremarkable. Video-electroencephalography demonstrated repetitive spike-wave discharges over the left occipital region, supporting an epileptic origin. Results Carbamazepine treatment markedly reduced episode frequency, and the spells resolved completely after dose adjustment during follow-up. Next-generation sequencing analysis of calcium channelopathy-related genes revealed no pathogenic variants. Conclusions This case highlights that isolated paroxysmal right upward eye deviation, even in the absence of other ictal features, may represent a focal preserved consciousness seizure rather than a benign ocular phenomenon. Early electroencephalographic evaluation is essential in children with frequent or atypical paroxysmal eye movements to avoid misdiagnosis and delayed treatment.
IntroductionPosterior theta/alpha ratio (TAR) is among the best-validated qEEG biomarkers for dementia, yet remains largely unused in routine neurology practice - primarily because it is sensitive to the patient's arousal state, an uncontrolled variable in real-world clinical EEG. We evaluated whether aperiodic spectral correction can bridge this gap between research promise and clinical reality.MethodsRoutine EEGs from 73 participants (18 controls, 55 dementia patients) were analyzed across three arousal segments. Five correction strategies were evaluated for TAR, with the optimal method validated in an external dementia dataset (ds004504, n = 88) and a normative cohort (ds005385, n = 587, age 20-79).ResultsRaw TAR was diagnostically significant at Alert (AUC=0.772) and HVT (AUC=0.812) segments but failed in the Drowsy segment (AUC=0.631, p = 0.110) - the state most representative of uncontrolled clinical EEG. FOOOF-based aperiodic correction restored significance (AUC=0.701, p = 0.014), improved intraclass correlation to 0.945, and generalised to the external dataset (AUC=0.830). In the normative cohort, FOOOF-corrected TAR was completely age-independent (r = 0.000), supporting a universal threshold of ≥0.45 (specificity 92.3%).ConclusionsA single step of aperiodic correction transforms TAR from an arousal-sensitive research metric into a robust, age-independent clinical tool. Combined with cognitive assessment, FOOOF-corrected TAR offers practical, objective dementia screening within routine EEG practice.
ObjectiveThis study evaluated whether quantitative electroencephalography (QEEG) guided neurofeedback (NF) improves intellectual functioning and attention in children with mild to severe intellectual disability (ID).MethodsSixty-five children (38 males, 27 females; mean age ≈11 years) with DSM-5 diagnoses of mild-to-severe ID (IQ 28-68) and histories of unsuccessful standard treatments were enrolled. Baseline assessments included 19-channel QEEG referenced to FDA-approved Nx-Link™, BrainDx™, and NeuroGuide™ databases, Wechsler Intelligence Scale for Children (WISC-R or WISC-IV),and the Test of Variables of Attention (TOVA). Participants underwent 80-120 QEEG-guided NF sessions. Training protocols targeted deviant z-scores, with hypercoherence addressed prior to amplitude abnormalities. IQ and attention were reassessed 6-12 months post-treatment. Outcomes were analyzed using paired t-tests, correlation analyses, and generalized linear models.ResultsMean full-scale IQ increased by approximately 10 points (≈53 to ≈63; +18.6%, p < 0.001). Significant gains were observed in both WISC-IV (+≈11 points) and WISC-R (+≈10 points), with improvements across verbal, perceptual, working memory, processing speed, and performance domains (all p < 0.001). Two thirds of participants' IQ increased by ≥6 points. TOVA scores improved but were not correlated with IQ changes. QEEG analyses showed normalization of resting-state networks, including increased alpha power in default mode network hubs and reduced coherence and phase lag; reductions in slow-wave coherence predicted IQ improvement.ConclusionQEEG-guided NF was associated with clinically meaningful improvements in intellectual functioning and attention in children with ID, exceeding gains expected from environmental enrichment. Findings support NF as a promising nonpharmacologic intervention warranting randomized controlled trials.
Background Preschool children born preterm are at risk of developmental delay and cognitive deficits. However, the neurocognitive underpinnings of the cognitive deficits in preterm children remain unclear. Aims This study aimed to compare quantitative EEG (qEEG) profiles and cognitive function between preterm and full-term children aged 4 to 6 years. Method Children's cognitive ability was assessed using the Griffiths Development Scales-Chinese (GDS-C). Resting-state EEG was recorded, and spectrum analysis was conducted. In addition to conventional band power analysis, aperiodic components (exponent and offset) and center frequency of the dominant oscillatory peak were calculated by fitting oscillations and one-over-f (FOOOF). Results The study recruited 28 preterm-born children (15 girls, mean age = 62.14 months, SD = 7.31) and17 age-matched full-term children (7 girls, mean age = 59.8 months, SD = 8.49) Preterm children showed significantly elevated aperiodic offset and exponent. They also exhibited significantly slower center frequency of the dominant oscillatory peak and higher delta and theta band power compared to full-term children. Conclusion Preterm children demonstrated elevated aperiodic offset and exponent and slower center frequency of the dominant oscillatory peak compared to full-term children, at preschool age. These findings suggest that preschool children born preterm may exhibit less efficient functional neural connections and delayed brain maturation.
Brain activity can be assessed using electroencephalography (EEG) through measures such as power spectral density (PSD), functional connectivity, the brain symmetry index (BSI), and event-related brain responses. Transcranial direct current stimulation (tDCS) is an adjunctive intervention for post-stroke motor rehabilitation using different montages, including ipsilesional anodal, contralesional cathodal, and bilateral M1 stimulation. However, EEG-derived neurophysiological responses associated with motor recovery following tDCS have not been comprehensively reviewed. A PubMed search from 2000 to 2025 identified 12 studies investigating the effects of tDCS on oscillatory activity and 3 studies examining event-related brain responses. Five studies evaluated tDCS alone (without rehabilitation), whereas 10 investigated tDCS combined with rehabilitation. For tDCS alone, ipsilesional anodal stimulation (anode over the ipsilesional M1 and cathode over the contralateral supraorbital area) and bilateral M1 stimulation (anode over the ipsilesional M1 and cathode over the contralesional M1) showed similar trends toward enhancing high-frequency power and functional connectivity, whereas contralesional cathodal stimulation tended to reduce beta band connectivity. For tDCS combined with rehabilitation, PSD findings were inconsistent; however, BSI and event-related desynchronization (ERD) following ipsilesional anodal stimulation consistently showed increased high-frequency activity associated with motor improvement. ERD enhancements were also observed following bilateral M1 stimulation. Overall, heterogeneity in EEG analytical methods likely contributes to inconsistent findings. Nevertheless, current evidence suggests that ipsilesional anodal and bilateral M1 stimulation may upregulate high-frequency activity in individual with stroke. Future systematic studies integrating standardized EEG analyses with clinical outcomes across different tDCS montages are needed to establish EEG-based guidelines for post-stroke motor rehabilitation.
PurposeThis study aimed to systematically assess ictal scalp electroencephalography (EEG) evolution by examining both ictal onset characteristics and late significant patterns (LSPs) in adults with focal epilepsy. We aimed to investigate their individual and collective descriptive roles in seizure lateralization and localization, as well as their correlation with seizure semiology, interictal EEG findings, and structural magnetic resonance imaging (MRI) within a multimodal presurgical assessment framework.MethodsWe retrospectively analyzed 67 adults with drug-resistant focal epilepsy who underwent extended video-EEG monitoring, during which 242 seizures were documented. The ictal EEG findings were categorized based on the morphology of the onset and subsequent rhythmic patterns. The yields of lateralization and localization were evaluated independently for ictal onset patterns, LSPs, and combined ictal interpretations. Cohen's κ statistics were used to look at multimodal concordance between ictal EEG, seizure semiology, interictal EEG, and MRI findings.ResultsThe most common types of ictal onset were non-rhythmic or unclassifiable activity (29.3%) and low-voltage fast activity (28.5%). Late significant patterns were detected in 36.8% of seizures, predominantly manifesting as rhythmic theta-alpha activity, followed by repetitive spikes or sharp waves. The integration of LSPs resulted in enhanced lateralization and localization yields, in contrast to the analysis of onset patterns in isolation. At the individual patient level, combined ictal interpretation lateralized seizures in 68.6% of cases and localized seizure-onset regions in 70.1% of cases. There was a high degree of agreement between ictal and interictal EEG (κ = 0.775, strict right-left), a high degree of agreement between ictal EEG and MRI (κ = 0.710), and moderate-to-high agreement between ictal EEG and seizure semiology (κ = 0.647).ConclusionA systematic evaluation of ictal EEG evolution, including the identification of LSPs, provides additional descriptive data that augments conventional ictal-onset analysis in focal epilepsy. The integration of ictal evolution findings with semiology, interictal EEG, and MRI validates a multimodal interpretative framework for presurgical evaluation. These results highlight the possible clinical importance of incorporating seizure evolution analysis into conventional scalp EEG interpretation, although further validation with surgical outcome data is required.
Lithium carbonate is a first-line psychopharmacological agent for the treatment of mood disorders, demonstrating significant therapeutic and prophylactic efficacy in the management and prevention of relapses in bipolar affective disorders characterized by manic and depressive episodes. However, chronic lithium therapy or acute overdose can lead to toxicity, with symptoms predominantly observed in individuals with a psychiatric history. Clinical manifestations of lithium toxicity are primarily neurologic and gastrointestinal. This article presents the diagnosis and treatment of a case of lithium toxicity, incorporating an analysis of the literature on the characteristics of wakeful EEG before and after treatment in relation to serum lithium levels. It was found that EEG, as an adjunctive examination in lithium-induced encephalopathy, serves as a sensitive tool for assessing lithium-related neurotoxicity, facilitating the safe management of manic disorders and other psychiatric conditions treated with lithium carbonate.
BackgroundThere is a great need in distinguishing Dementia with Lewy Body (DLB) from Alzheimer's disease (AD) and elucidating its pathophysiology. Transcranial magnetic stimulation (TMS) evoked potentials (TEPs) offer a non-invasive measure of neurophysiological alterations associated with underlying disease pathology.MethodsA total of 39 participants were included: 12 DLB, 10 AD, and 17 age-matched healthy controls (HC). TEPs were measured in the dorsolateral prefrontal cortex (DLPFC), primary motor cortex (M1), and primary visual cortex (V1).ResultsGlobal mean field potential (GMFP) TEP (130-250 ms) showed a significant interaction of group and stimulation site (p = .0101, ηp2 = 0.175) with a significant group effect (p = .0071, ηp2 = 0.234), attributed to higher GMFP in DLB compared to AD and HC in response to V1 stimulation (p = .001, p = .001, respectively). TEP amplitude corresponding to P60 displayed a significant group*stimulation site interaction (p = .0037, ηp2 = 0.202) arising from differences in DLPFC stimulation, between DLB compared to AD (p = .0013) and HC (p = .0032). DLPFC N45 presented a significant stimulation site effect not associated to a specific group in addition to DLPFC N45 amplitude being correlated to the UPDRS-III score (r = 0.9, p = .0002). A relative higher left over right DLPFC P30 amplitude was correlated with poorer MoCA scores in AD (r = -0.84, p = .002), as indicated by others before.ConclusionsDLPFC may be a target for both diagnosis and assessment of severity of motor symptoms in DLB and cognitive impairment in AD. These results propose a promising method to non-invasively distinguish DLB from AD and monitor disease, based on DLPFC and V1 network characteristics.
Increasing evidence underscores the influence of social determinants and cultural factors on brain structure and function. Neurophysiological approaches offer unique advantages for assessing brain physiology and cognitive functioning, but challenges remain in building the capacity necessary to support the use of these resources in low- and middle-income countries (LMICs). The establishment of a first-of-its-kind neurophysiology lab in East Africa in January 2022, the Moi University Clinical and Cognitive Neuroscience Center (MU CCNC), promotes dedicated research infrastructure for patients within Moi Teaching and Referral Hospital (MTRH), the second-largest national referral hospital in Kenya, which serves about 24 million individuals. Built within the Academic Model Providing Access to Healthcare (AMPATH), a three-decade long collaboration between MTRH and a consortium of North American universities, the critical lessons learned while building this infrastructure in a low-resource setting included overcoming barriers to using and maintaining highly sensitive equipment in a setting with substantial environmental noise and electrical interference, ensuring secure and accurate data storage for complex files from precisely synchronized programs, and establishing standard operating procedures for laboratory continuity. Within the first two years of the establishment of the lab, capacity building has been prioritized, with a focus on extending neurophysiology training to research staff, students, and faculty throughout Kenya and developing research questions that can be addressed with lab methods and resources. By describing the process of developing a comprehensive human electrophysiology lab in a LMIC, we hope to streamline implementation for researchers to establish neurophysiology infrastructure in similar settings.
RationaleSubstance use disorders are associated with notable sleep disturbances. Electroencephalogram (EEG) alpha power occurs during wakeful rest, is associated with sleepiness, and indicates neural deactivation.ObjectivesThe goal of the current study was to assess the effects of abstinence on the relationship between alpha power and subjective sleep quality in participants with cocaine use disorder (CUD).MethodsParticipants with CUD (n = 32) who were recently or non-abstinent completed a resting-state EEG paradigm (90 s eyes open/closed). Absolute alpha power was calculated using the fast Fourier transform and by averaging within the power spectra of the alpha band (8-13 Hz). The participants rated their subjective sleep quality on a scale of 1-10 for the past 7 nights. Bayesian linear mixed models evaluated the unique and moderating effects of sleep quality, group (abstinent, non-abstinent), eye condition (open, closed), and electrode location on resting-state alpha power.ResultsResults indicated that subjective sleep quality did not differ between groups and that alpha power was decreased in the non-abstinent group. However, in the abstinent group only, better sleep quality was associated with decreased alpha power. There was no evidence of a relationship between sleep and alpha power in the non-abstinent group. This effect was similar across eye conditions, but was stronger at the right, posterior, and superior electrodes.ConclusionsThese results could indicate a return to homeostasis during early abstinence or that those currently using might not get as much benefit from sleep, highlighting resting-state alpha power as a potential target for addressing sleep-related issues.
IntroductionEEGLAB is a widely used software for analyzing electroencephalography (EEG) datasets, with over 20 years of global use. This bibliometric study investigates EEGLAB publications in the Asia-Pacific and Arabian regions, focusing on Scopus and Web of Science (WoS) indexed sources, to understand regional contributions and trends in EEG research across 80 countries and territories.MethodsBibliometric analysis was conducted using the Bibliometrix package in R, focusing on citations from WoS and Scopus indexed sources. The study covers data from the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) and West Asia (ESCWA), including 58 ESCAP countries and 22 ESCWA countries, with data collected until March 2024. Bibliometric indices such as Lotka's law, Bradford's law, co-citation networks, and in-depth historiography were analyzed to explore global and regional trends.ResultsEEGLAB's main article has received 22 298 citations on Google Scholar, with 14 958 (67.1%) citations in WoS and 15 827 (70.1%) in Scopus. The top ten WoS countries by citations are China, Australia, Japan, Republic of Korea, India, Iran, Russian Federation, Singapore, New Zealand, and Malaysia/Türkiye. Recent research themes include emotion recognition, driver distraction detection, deep learning, schizophrenia detection, and the cognitive impacts of COVID-19. China and the USA are the leading international collaborators.ConclusionsApproximately 35% of WoS documents and 41% of authors are from the ESCAP and ESCWA regions. The average citation per document in these regions is half of the global average. The study highlights EEGLAB's growing role in EEG research and collaborative trends.
BackgroundBrain-computer interface-driven functional electrical stimulation (BCI-FES) is a promising approach for post-stroke upper limb rehabilitation. However, considerable variability exists in stimulation parameters and task designs across studies, and evidence remains insufficient to support definitive protocol recommendations.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) up to September 2025. Eligible studies applied BCI-FES and reported the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Risk of bias was assessed with the PEDro scale, and evidence certainty graded with GRADE. Random-effects meta-analyses were performed.ResultsTwelve RCTs (n = 619) showed BCI-FES improved FMA-UE scores versus controls (MD = 5.82, 95% CI 3.04-8.59, p < 0.00001; I2 = 39%), with larger benefits in subacute stroke (MD = 8.45). Dynamic-threshold paradigms and motor imagery were associated with higher effect sizes. Higher stimulation frequency (>50 Hz), narrow-pulse width (150 µs) more frequent sessions (≥5/week), shorter session duration (≤30 min), greater total sessions (>20), and longer intervention (>4 weeks) tended to be associated with larger effect sizes, though evidence is limited and based on few studies. Secondary outcomes (ARAT, WMFT, MBI) improved, and no serious adverse events were reported. Evidence certainty was moderate.ConclusionBCI-FES was associated with improvements in upper limb motor recovery after stroke, especially in subacute patients. Some stimulation and training features may relate to greater effects, but current evidence remains insufficient for definitive clinical guidance. Larger multicenter RCTs are needed to clarify dose-response relationships and support biomarker-guided, personalized interventions.
Background Interictal epileptiform discharges (IED) frequency is the most commonly studied interictal measure of ASM efficacy in patients with epilepsy, and IED suppression in a repeat pediatric EEG is usually interpreted as a reduced tendency towards seizures.Objective To assess whether the amplitude and morphology of IED can serve as surrogate measures of levetiracetam (LEV) efficacy in children with drug-resistant epilepsy.Methods Patients with refractory epilepsy, who were treated with oral LEV during a 5-year period, and who had at least 24 h long-term video-EEG recording (LTVEEG) before LEV was initiated and after attaining maximal dosage, were retrospectively selected from the database of the pediatric epilepsy clinic and LTVEEG monitoring unit. IED kurtosis (degree of peakedness), skewness (degree of asymmetry), and below-curve-area (area of the IED) were estimated by a signal processing analysis program.Results IED analysis in 20 patients aged 3.6 months to 15 years at maximal LEV dosage revealed increased kurtosis, increased skewness positivity and decreased below-curve-area compared to pre-treatment values. Visual analysis revealed a mean IED amplitude decrease in 30% of the patients, mainly in patients with generalized seizures. Neither the changes in IED measures nor the decrease of the visually determined IED amplitude correlated with decreased seizure frequency.Conclusions IED amplitude, kurtosis, skewness and below-curve-area were not correlated with seizure outcome after LEV initiation. Further studies with larger samples and additional seizure outcome measures are warranted.
Early clinical response to electroconvulsive therapy (ECT) varies substantially across patients. The physiological expression of ECT-induced seizures, captured by routinely recorded EEG seizure duration and suppression indices together with autonomic responses, reflects interactions among cortical excitability, inhibitory processes, and peripheral activation. In younger patients, these systems may operate within a distinct physiological range, making early-session responses a particularly informative window for examining how seizure dynamics and cortical suppression relate to antidepressant effects, yet the clinical relevance of coordinated early physiological patterns remains unclear. We studied 28 young patients with major depressive disorder receiving ECT. Five routinely recorded physiological measures-stimulus dose, EEG seizure duration, EEG suppression index, systolic blood pressure change, and pulse rate change-were averaged across the first three ECT sessions and standardized. Unsupervised k-means clustering characterized early physiological response patterns, and exploratory logistic regression examined associations with early clinical improvement, defined as a ≥ 5-point reduction in HAMD-17 score by the third session. Two early physiological patterns were identified. A pattern characterized by longer seizure duration and lower EEG suppression was associated with greater early symptom improvement, despite heterogeneous autonomic responses. In regression analyses, seizure duration was positively associated with improvement, whereas EEG suppression index showed a strong negative association. Collectively, early physiological features showed clear within-sample separation between patients with and without early improvement (apparent AUC = 0.86). These findings suggest that early ECT physiology in young patients reflects coordinated response states rather than isolated markers, highlighting the potential value of multivariate interpretation of routine EEG-derived indices.
