My Editor’s Choice

Promoting Education and Attainment of the Highest Level of Knowledge and Understanding of Clinical Neurophysiology

The International Federation of Clinical Neurophysiology (IFCN) has member societies in 62 countries. The IFCN mission is to promote best practice in clinical neurophysiology through education and research throughout the world. And our vision is to improve healthcare worldwide by understanding the nervous system and optimizing the diagnosis and treatment of its disorders through clinical neurophysiology.

Professor Ulf Ziemann
Editor-in-Chief, Clinical Neurophysiology

The Editor’s Choice – Clinical Neurophysiology Volume 130, Issue 8

Lerner AJ, Wassermann EM, Tamir DI (2019) Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clin Neurophysiol 130:1409-1416.

Seizures are a possible risk of transcranial magnetic stimulation (TMS). However, no systematic data have been obtained since the first TMS safety conferences have taken place (Wassermann 1998, Electroencephalogr Clin Neurophysiol 108:1–16; Rossi et al. 2009, Clin Neurophysiol 120:2008–39). Lerner and colleagues conducted a survey in laboratories and clinics about seizures observed 2012-2016. Respondents (n = 174) reported an estimated 318,560 TMS sessions. 24 seizures were reported (.08/1000 sessions). TMS protocols within the published guidelines, including repetitive TMS (rTMS), applied to subjects without recognized risk factors caused 4 seizures (<.02/1000 sessions). Risk factors (e.g., brain lesions and epilepsy) increased seizure risk substantially (.33/1000 sessions). Seizures were most likely to occur within the first few exposures to TMS. Overall, these risks are very low, when put into context to other risks, e.g. the annual risk of developing epilepsy in the US population (approximately .47/1000). Although this study has several limitations, e.g., possible bias due to the small sample relative to the population and the underrepresentation of more recently developed rTMS protocols, such as theta-burst stimulation, the data are important, as they strongly support the notion that TMS and rTMS within the published safety guidelines are safe procedures in subjects without risk factors.

The Editor’s Choice – Clinical Neurophysiology Volume 130, Issue 9

Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, et al. (2019) Standards for quantification of EMG and neurography. Clin Neurophysiol 130:1688-1729.

The International Federation of Clinical Neurophysiology (IFCN) had published the book “Recommendations for the practice of clinical neurophysiology: guidelines of the IFCN” in 1999, i.e. 20 years ago. The chapter on “Standards for quantification of EMG and neurography” was already led by Prof. Erik Stålberg, but it was only 8 pages long at the time. The new document is a vastly extended consensus of globally distributed opinion leaders in this field. The document is now 42 pages long and covers conventional needle EMG, macro EMG, surface EMG, electrical impedance myography, motor and sensory neurography, F waves,  H-reflexes, short segment recordings, CMAP scan and motor unit number methods, repetitive nerve stimulation and pediatric electrodiagnostic testing. Methodologies, pitfalls, reference values, and clinical applications are described. The document may become the main reference text on how to do EMG and nerve conduction studies, the mainstay of classical clinical neurophysiology. To have such a reference text is more important than ever given the increasing complexity of some of these methods such as motor unit number estimation, new methods such as electrical impedance myography, and a growing number of complementary alternative methods such as muscle and nerve ultrasound. In summary: this consensus is a must read for anybody who does or plans to do EMG and neurography.

The paper is open access and can be downloaded by just one click from the following link: https://www.journals.elsevier.com/clinical-neurophysiology

Read editor’s choice collection of articles:

Standards for quantification of EMG and neurography
2019 September Vol. 130, Issue 9

Seizures from transcranial magnetic stimulation 2012–2016: Results of a survey of active laboratories and clinics
2019 August Vol. 130, Issue 8

Brain networks and their relevance for stroke rehabilitation
2019 July Vol. 130, Issue 7

Botulinum neurotoxin serotype D – A potential treatment alternative for BoNT/A and B non-responding patients
2019 June Vol. 130, Issue 6

Clinical utility and prospective of TMS-EEG
2019 May Vol. 130, Issue 5

Assessing blink reflex circuits by three different afferent routes in Parkinson’s disease
2019 April Vol. 130, Issue 4

Cortical networks are disturbed in people with cirrhosis even in the absence of neuropsychometric impairment
2019 March Vol. 130, Issue 3

Interictal spike connectivity in human epileptic neocortex
2019 February Vol. 130, Issue 2

Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials
2019 January Vol. 130, Issue 1

Indications for neuromuscular ultrasound: Expert opinion and review of the literature

2018 December Vol. 129, Issue 12

Decreasing subthalamic deep brain stimulation frequency reverses cognitive interference during gait initiation in Parkinson’s disease
2018 November Vol. 129, Issue 11

Fasciculation intensity and disease progression in amyotrophic lateral sclerosis
2018 October Vol. 129, Issue 10

Multi-component intrinsic brain activities as a safe alternative to cortical stimulation for sensori-motor mapping in neurosurgery
2018 September Vol. 129, Issue 9

Implementing Motor Unit Number Index (MUNIX) in a large clinical trial: Real world experience from 27 centres
2018 August Vol. 129, Issue 8

Decrease of motor cortex excitability following exposure to a 20 Hz magnetic field as generated by a rotating permanent magnet
2018 July Vol. 129, Issue 7

Phantom somatosensory evoked potentials following selective intraneural electrical stimulation in two amputees
2018 June Vol. 129, Issue 6

Clinical utility of EEG in diagnosing and monitoring epilepsy in adults
2018 May Vol. 129, Issue 5

Vestibulo-cochlear function in inflammatory neuropathies
2018 April Vol. 129, Issue 4

Sleep patterns associated with the severity of impairment in a large cohort of patients with chronic disorders of consciousness
2018 March Vol. 129, Issue 3

Somatosensory Evoked Potentials and Central Motor Conduction Times in children with dystonia and their correlation with outcomes from Deep Brain Stimulation of the Globus pallidus internus
2018 February Vol. 129, Issue 2

Abnormal functional connectivity of high-frequency rhythms in drug-naïve schizophrenia
2018 January Vol. 129, Issue 1

Ear-EEG detects ictal and interictal abnormalities in focal and generalized epilepsy – A comparison with scalp EEG monitoring
2017 December Vol. 128 Issue 12

Long term correlation of subthalamic beta band activity with motor impairment in patients with Parkinson’s disease
2017 November Vol. 128 Issue 11

The standardized EEG electrode array of the IFCN
2017 October Vol. 128 Issue 10

Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines
2017 September Vol. 128 Issue 9

Reduced electrode arrays for the automated detection of rhythmic and periodic patterns in the intensive care unit: Frequently tried, frequently failed?
2017 August Vol. 128 Issue 8

A novel methodology for assessing laryngeal and vagus nerve integrity in patients under general anesthesia
2017 July Vol. 128 Issue 7

The evolution of motor cortical dysfunction in amyotrophic lateral sclerosis
2017 June Vol. 128 Issue 6

Parietomotor connectivity in the contralesional hemisphere after stroke: A paired-pulse TMS study
2017 May Vol. 128 Issue 5

Early disturbances in multimodal evoked potentials as a prognostic factor for long-term disability in relapsing-remitting multiple sclerosis patients
2017 April Vol. 128 Issue 4

Pain perception in patients with chronic disorders of consciousness: What can limbic system tell us?
2017 March Vol. 128 Issue 3

TMS combined with EEG in genetic generalized epilepsy: A phase II diagnostic accuracy study
2017 February Vol. 128 Issue 2

Haemodialysis alters peripheral nerve morphology in end-stage kidney disease
2017 January Vol. 128 Issue 1

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome
2016 December Vol. 127 Issue 12

Motor cortical dysfunction develops in spinocerebellar ataxia type 3
2016 November Vol. 127 Issue 11

Intraoperative spinal cord monitoring using low intensity transcranial stimulation to remove post-activation depression of the H-reflex
2016 October Vol. 127 Issue 10

The relationship between seizures, interictal spikes and antiepileptic drugs
2016 September Vol. 127 Issue 9

Disease-specific sparing of the anterior semicircular canals in bilateral vestibulopathy
2016 August Vol. 127 Issue 8

Brain areas with epileptic high frequency oscillations are functionally isolated in MEG virtual electrode networks
2016 July Vol. 127 Issue 7

Cortical correlates of susceptibility to upper limb freezing in Parkinson’s disease
2016 June Vol. 127 Issue 6

Normal pressure hydrocephalus: Increase of utricular input in responders to spinal tap test
2016 May Vol. 127 Issue 5

Ascending vestibular drive is asymmetrically distributed to the inferior oblique motoneuron pools in a subset of hemispheric stroke survivors
2016 April Vol. 127 Issue 4

Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation
2016 March Vol. 127 Issue 3

Short pauses in thalamic deep brain stimulation promote tremor and neuronal bursting
2016 February Vol. 127 Issue 2

Yield of MRI, high-density electric source imaging (HD-ESI), SPECT and PET in epilepsy surgery candidates
2016 January Vol. 127 Issue 1

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