Percorrer por autor "Borges, Daniel Filipe"
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- Are wearable sleep-tracking devices reliable alternatives to Polysomnography? A Systematic Review and Meta-AnalysisPublication . Agostinho, Margarida; Borges, Maria; Pereira, Telmo; Borges, Daniel Filipe; Soares, Joana Isabel; Borges, Daniel FilipePolysomnography (PSG) is the reference method for characterizing sleep architecture, but it is resource-intensive and difficult to scale for large cohort assess ments. This has increased interest in wearable devices for naturalistic sleep monitoring. This systematic review and meta-analysis evaluated how wearable sleep-tracking devices compare with laboratory PSG in healthy adults across standard sleep metrics and sleep stage durations. PubMed, Scopus, Scielo, Web of Science, and the Cochrane Library were searched following PRISMA guidelines. Eligible studies included healthy adults under going simultaneous wearable and PSG recordings. Mean differences were synthesized for total sleep time, sleep latency, sleep efficiency, wake after sleep onset, and time spent in light (N1+N2), deep (N3), and REM sleep using fixed or random effects models based on heterogeneity, with significance set at p < .01. Risk of bias and applicability were assessed using QUADAS-2. Sixteen studies met the inclusion criteria, and ten contributed to the meta- analysis. Wearable devices overestimated total sleep time and sleep efficiency and underestimated wake after sleep onset, with substantial variability between devices. No device demonstrated consistently superior performance. In individual studies, the closest agreement with PSG was observed for the Oura Ring (third generation) for sleep latency and sleep efficiency, and for selected Fitbit models for deep and REM sleep. Wearable devices provide reasonable estimates of global sleep metrics and may complement PSG for population monitoring and longitudinal self-tracking. However, variable performance, methodological heterogeneity, and risk-of-bias consid erations currently limit their use as stand-alone diagnostic tools or for detailed sleep- stage characterization.
- Before the spike: Human oversight of artificial intelligence in EEG interpretation requires reasoning beyond recognitionPublication . Borges, Daniel Filipe; Leal, Alberto; Borges, Daniel FilipeArtificial intelligence (AI) is transforming EEGinterpretation faster than training is adapting to definewhat competent interpretation now requires. Errors arisebefore the first abnormal waveform appears, in whattrainees encounter, how they examine evidence, and howreadily a signal becomes a diagnostic label. That path isalready shortening: a deep neural network has achievedexpert- level detection of interictal epileptiform dischargesin selected settings.1 As automated recognition growsmore capable, human verification becomes more, notless, consequential. Protecting patients requires readers toreconstruct, defend, and revise the reasoning from signalto conclusion. What makes verification credible? Presenceis insufficient unless readers can explain why an output isplausible and recognize when it is not.
- Closing the temporal blind spot: Six additional electrodes increase patient-level EEG abnormality detection by ~12%Publication . Batista, Carla; Soares, Joana Isabel; Coelho, Paulo; Ferreira, Simão; Rosenzweig, Ivana; Borges, Daniel Filipe; Borges, Daniel Filipe; Ferreira, Simão; Soares, Joana I.To quantify the additional detection yield of the 25-channel electrodearray recommended by the International Federation of Clinical Neurophysiology(IFCN), which includes six inferior-temporal electrodes beyond the conventional 10–20 International System (IS) in identifying interictal epileptiform discharges(IEDs) and focal slow activity (SA). We analyzed 258 consecutive adult EEGs (routine or sleep-deprived; mean age, 57 ± 19 years; 55% female; 61% on anti-seizure medication). Indications were suspected epilepsy (33%) and seizure follow-up (28%). Two blinded neurophysiologists harmonized IED/SA terminology and applied the validated three-item subset of the IFCN's operational IED criteria. Each EEG was reviewed twice: first with the standard 19-electrode 10–20 system and, after a ≥ 4- week washout, with the 25-channel IFCN array. Reading lists were randomized between reviewers so that the sequence of cases differed, thereby reducing recallbias. Abnormalities were classified by type and lobe. Agreement was measured using Cohen's κ; yield gain was the detection-rate difference. Agreement ranged from substantial to almost perfect (κ = .65–.88;95% CI: .48–1.00), with disagreement rates of 1.2–7.8%. Temporal IEDs were detected more frequently with IFCN (72/71 patients) than with 10–20 (63 each), corresponding to gains of 12.5% and 11.3%, respectively. Temporal SA was also higher (98 vs. 86; +12.2% for both). Gains in extratemporal SA were smaller (10.7%and 9.5%) and differences in extratemporal IEDs were minimal (≤3.6%). Pooledacross all abnormalities, IFCN detected 183 and 182 patients versus 172 and 170with 10–20, respectively, an overall gain of 11.5%. The largest relative increase was seen in temporal IEDs, with an additional 11–12% of patients identified using the IFCN array compared with 10–20. The addition of six inferior-temporal electrodes increased the relative detection yield of EEG abnormalities by 11.5%, with the largest gains fortemporal IEDs, and required only minimal extra setup time. Although the true diagnostic accuracy of these additional detections can not be determined without an external gold standard, the findings support the routine use of the IFCN25-electrode array to address a major blind spot of the 10–20 system in adult EEGpractice.
- A custom-built single-channel in-ear electroencephalography sensor for sleep phase detection: an interdependent solution for at-home sleep studiesPublication . Borges, Daniel Filipe; Soares, Joana Isabel; Silva, Heloísa; Felgueiras, João; Batista, Carla; Ferreira, Simão; Rocha, Nuno; Leal, AlbertoSleep is vital for health. It has regenerative and protective functions. Its disruption reduces the quality of life and increases susceptibility to disease. During sleep, there is a cyclicity of distinct phases that are studied for clinical purposes using polysomnography (PSG), a costly and technically demanding method that compromises the quality of natural sleep. The search for simpler devices for recording biological signals at home addresses some of these issues. We have reworked a single-channel in-ear electroencephalography (EEG) sensor grounded to a commercially available memory foam earplug with conductive tape. A total of 14 healthy volunteers underwent a full night of simultaneous PSG, in-ear EEG and actigraphy recordings. We analysed the performance of the methods in terms of sleep metrics and staging. In another group of 14 patients evaluated for sleep-related pathologies, PSG and in-ear EEG were recorded simultaneously, the latter in two different configurations (with and without a contralateral reference on the scalp). In both groups, the in-ear EEG sensor showed a strong correlation, agreement and reliability with the ‘gold standard’ of PSG and thus supported accurate sleep classification, which is not feasible with actigraphy. Single-channel in-ear EEG offers compelling prospects for simplifying sleep parameterisation in both healthy individuals and clinical patients and paves the way for reliable assessments in a broader range of clinical situations, namely by integrating Level 3 polysomnography devices. In addition, addressing the recognised overestimation of the apnea-hypopnea index, due to the lack of an EEG signal, and the sparse information on sleep metrics could prove fundamental for optimised clinical decision making.
- EEG CLÍNICO: como descrever, interpretar e relatar em 10 passosPublication . Borges, Daniel Filipe
- Hippocampal volume loss in mesial temporal lobe epilepsy: Magnitude and laterality in a meta-analysis of MRI volumetry studiesPublication . Carvalho, Ruben Lopes; Borges, Daniel Filipe; Casalta-Lopes, João; Soares, Joana Isabel; Borges, Daniel FilipeHippocampal atrophy is a defining structural feature of mesial temporal lobe epilepsy (mTLE), yet the magnitude of volume loss and the extent of contralateral involvement vary across magnetic resonance imaging (MRI) studies, limiting quantitative interpretation in clinical practice. We conducted a systematic review and meta-analysis to quantify hippocampal volume reduction in adults with mTLE and assess the consistency of contralateral changes. Following PRISMA 2020 guidelines, we searched six bibliographic databases and different trial registries. Eligible studies included adults with unilateral mTLE who underwent pre-surgical structural MRI with quantitative hippocampal volumetry, as well as healthy controls. Two reviewers independently assessed risk of bias using ROBINS-E. Random-effects meta-analyses pooled mean differences in absolute hippocampal volume (mm ; controls minus patients) for hippocampi ipsilateral and contralateral to the seizure focus. Twenty-eight studies met the inclusion criteria; 23 contributed to the meta-analysis (803 patients, 613 controls). Ipsilateral hippocampal volume was significantly reduced (mean difference 985.2 mm 759.7–1210.7; p < 0.001; I 2 3 , 95% CI =98%). Contralateral volume was also reduced (22 studies; mean difference 198.8 mm 3 , 95% CI 124.4–273.3; p < 0.001; I 2 =85%). Funnel plot inspection and Egger testing showed no evidence of small-study effects. ROBINS-E indicated low to moderate risk of bias overall. Adult mTLE shows marked ipsilateral hippocampal atrophy with a smaller, consistent contralateral reduction, consistent with partial bilateral structural involvement. Pooled estimates provide clinically interpretable reference values for quantitative MRI in presurgical evaluation, though substantial heterogeneity warrants caution.
- Hippotherapy improves gross motor function in children with cerebral palsy: evidence from a systematic reviewPublication . Bernardino, Inês; Borges, Daniel Filipe; Casalta Lopes, João; Soares, Joana Isabel; Borges, Daniel Filipe"Hippotherapy uses horse movement to promote physical and psychosocial rehabilitation and may benefit children with cerebral palsy (CP). Standardised instruments such as the Activity Scale for Kids-Performance (ASK©), the Gross Motor Function Classification System (GMFCS) and the Gross Motor Function Measure (GMFM) are needed to quantify effects on motor function. To systematically review the effects of hippotherapy on gross motor skills in children with CP. Although autism spectrum disorder (ASD) was included in the search strategy, no eligible ASD studies were identified. Following PRISMA guidelines, six databases (PubMed, EMBASE, Web of Science, SCOPUS, Cochrane and SciELO) were searched for English, Portuguese or Spanish studies employing ASK©, GMFCS or GMFM. Two reviewers independently screened records, extracted data and assessed risk of bias. Twenty-five studies (602 participants, mean age 7.1 years, 3–14) met inclusion criteria; all involved CP, none ASD. Interventions lasted 8–24 weeks (1–3 sessions/week). Two ASK© studies showed significant motor gains (Hedges g=0.48–0.62). GMFM was used in 22 studies; 20 reported clinically relevant improvements, particularly in dimensions D (standing) and E (walking, running, jumping). The sole GMFCS study reported no change in classification. Methodological quality was moderate, limited by small samples and lack of blinding. Hippotherapy improves gross motor function in CP, best demonstrated with GMFM. Evidence for ASD is absent, highlighting a research gap. Broader application of ASK© and GMFCS is still needed to better define benefits across neurodevelopmental disorders."
- Ictal and interictal source connectivity during gelastic seizures in a focal cortical dysplasia of the cingulate gyrusPublication . Borges, Daniel Filipe; Dias, Daniela; Cordeiro, Helena; Leal, AlbertoGelastic seizures are rare manifestations of epilepsy often associated with hypothalamic hamartomas (HH). In the absence of HH, localization of the origin is more difficult and there are several less well-established possibilities. Non-invasive assessment is often complicated by the deep localization of the epileptogenic area and the complex dynamics of spike activity. Robust neurophysiologic methods and careful validation of intrinsically epileptogenic lesions detected by RM can improve the validity of scalp EEG analysis. To analyze the dynamics of epileptic activity in gelastic seizures associated with cortical dysplasia. A 26-year-old girl with daily refractory gelastic seizures since the age of 6 underwent a neurophysiological assessment with long-term EEG recordings (24h, 31 channels) and an MRI of the brain. She had previously been rejected in an epilepsy surgery program because no structural brain lesion had been found and the EEG information was not informative enough. A recent 3T MRI showed cortical dysplasia in the cingulate gyrus, which was highly suspicious as an epileptogenic focus. We analyzed the 31-channel EEG (ictal and interictal) using source and functional connectivity methods to obtain a solid computer model of the origin and dynamics of epileptic activity and correlate it with the anatomical information of the MRI. Source analysis of interictal activity revealed multiple sources that dominated at different time points, indicating considerable dynamics that prevented clear source identification. The ictal recordings demonstrated barely late rhythmic activity over the frontal areas, but no early focalization. Connectivity analysis, which revealed the flow of information between cortical sources, showed a consistent origin of epileptic activity in the vicinity of cortical dysplasia for both interictal and ictal activity. EEG connectivity analysis significantly improves the performance of non-invasive methods for determining intracranial dynamics of epileptic activity and correlation with structural lesions.
- Is a hypothalamic hamartoma always a suspect in gelastic seizures? A source functional connectivity studyPublication . Borges, Daniel Filipe; Leal, AlbertoGelastic seizures are rare manifestations of epilepsy that are often associated with hypothalamic hamartomas (HH). In the absence of HH, location of the origin is more difficult and there are several less well-established possibilities. Non-invasive assessment is often complicated by the deep localization of the epileptogenic area and the complex dynamics of spike activity. Robust neurophysiological methods and careful validation of intrinsically epileptogenic lesions detected by RM can improve the validity of scalp EEG analysis. This presentation will discuss a case report analysing the dynamics of epileptic activity in gelastic seizures associated with cortical dysplasia. The clinical case was a 26-year-old girl with daily refractory gelastic seizures since the age of 6 who underwent neurophysiological examination with long-term EEG recordings and MRI of the brain. She had previously been rejected in an epilepsy surgery programme because no structural brain lesion had been found and the EEG information was not conclusive enough. A recent 3T MRI showed cortical dysplasia in the cingulate gyrus, which was highly suspicious as an epileptogenic focus. We analysed the 31-channel EEG (ictal and interictal) using source and functional connectivity methods to obtain a solid computer model of the origin and dynamics of the epileptic activity and correlate it with the anatomical information of the MRI. Source analysis of the interictal activity revealed multiple sources that dominated at different time points, suggesting considerable dynamics that prevented clear identification of the source. The ictal recordings showed little late rhythmic activity over the frontal areas, but no early focalization. Connectivity analysis, which revealed the flow of information between cortical sources, showed a consistent origin of epileptic activity near the cortical dysplasia for both interictal and ictal activity. EEG connectivity analysis significantly improves the performance of non-invasive methods for determining the intracranial dynamics of epileptic activity and correlation with structural lesions.
- Neurophysiology in the WildPublication . Borges, Daniel Filipe; Leal, AlbertoIntroduction: The acquisition of bioelectrical signals from the nervous system is traditionally complex, prone to artifacts and technically demanding. Currently, there are signs that research in this field is saturated and confined to institutional walls due to the cost-effectiveness profile of the methods used. Therefore, the demand for portable technology has grown exponentially to significantly increase the amount of data collected. Therefore, epilepsy, specifically regarding long-term electroencephalography (EEG), and sleep medicine are two of the best examples of the clinical utility of wearables for real-world (Level IV) studies. Objective: Development of clinical and translational research based on the development, application and clinical validation of neurophysiological wearable technology to study neural networks in different clinical contexts. Methods: Using a tailor-made 2-channel EEG wearable device and a customized single-channel EEG sensor inserted into the external auditory canal, we conducted three clinical validation studies in patients' homes. We detected and sonified typical absence seizures in pediatric epilepsy patients, studied patients with clinically suspected temporal lobe epilepsy, and recorded and staged 30-second epochs from sleep studies of healthy and pathological subjects. Results: The wearable devices employed showed neurophysiological data with consistently strong positive correlations, consistent performance and high reliability compared to gold standard methods, as well as near perfect inter-observer agreement. Conclusions: Clinical neuroscientists require large amounts of data, so these developments, driven largely by the influx of gadgets in the consumer market, are enabling more do-it-yourself and quantified-self methods. These neurophysiological signals from wearables hold great promise for advancing neuroscience through real-world data.
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