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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.
- Comparative evaluation of artificial intelligence chatbots in answering electroencephalography-related questionsPublication . Proença, Soraia; Soares, Joana Isabel; Parra, Joana; Maia, Gisela; Leite, Juliana; Beniczky, Sándor; Jesus-Ribeiro, Joana; Henrique Maia, Gisela MariaAs large language models (LLMs) become more accessible, they may be used to explain challenging EEG concepts to nonspecialists. This study aimed to compare the accuracy, completeness, and readability of EEG-related responses from three LLM-based chatbots and to assess inter-rateragreement. One hundred questions, covering 10 EEG categories, were entered into ChatGPT, Copilot, and Gemini. Six raters from the clinical neurophysiology field (two physicians, two teachers, and two technicians) evaluated the responses. Accuracy was rated on a 6-point scale, completeness on a 3-point scale, and readability was assessed using the Automated Readability Index (ARI). We used a repeated-measures ANOVA for group differences in accuracy and readability, the intraclass correlation coefficient (ICC) for inter-raterreliability, and a two way ANOVA, with chatbot and raters as factors, for completeness. Total accuracy was significantly higher for ChatGPT (mean ± SD 4.54 ± .05) compared with Copilot (mean ± SD 4.11 ± .08) and Gemini (mean ± SD 4.16 ± .13) (p < .001). ChatGPT's lowest performance was in normal variants and patterns of uncertain significance (mean ± SD 3.10 ± .14), while Copilot and Gemini performed lowest in ictal EEG patterns (mean ± SD 2.93 ± .11 and 3.37 ± .24, respectively). Although inter-rater agreement for accuracy was excellent among physicians (ICC = .969) and teachers (ICC = .926), it was poor for technicians in several EEG categories. ChatGPT achieved significantly higher completeness scores than Copilot (p < .001) and Gemini (p = .01). ChatGPT text (ARI − mean ± SD 17.41 ± 2.38) was less readable than Copilot (ARI −mean ± SD 11.14 ± 2.60) (p < .001) and Gemini (ARI − mean ± SD 14.16 ± 3.33). Chatbots achieved relatively high accuracy, but not without flaws, emphasizing that the information provided requires verification. ChatGPT outperformed the other chatbots in accuracy and completeness, though at the expense of readability. The lower inter-rater agreement among technicians may reflect a gap in standardized training or practical experience, potentially impacting the consistency of EEG-related content assessment.
- 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.
- Effects of caffeine on P300: A systematic review and meta-analysisPublication . Pinho, Beatriz B.; Mazer, Prune; Barroso, Beatriz; Pinto, Joana O.; Mazer, PruneCaffeine is a widely consumed psychoactive substance that stimulates the central nervous system, enhancing alertness and concentration. Its effects on brain activity can be examined using neurophysiological techniques such as event-related potentials, with emphasis on the P300 component. Caffeine appears to modulate P300 amplitude and latency, suggesting changes in processing speed and attention, although findings remain inconsistent. The objective of this work was to systematise the literature about the effects of caffeine on the amplitude and latency of the P300. A systematic review and meta-analysis of empirical studies measuring the effect of caffeine on P300 amplitude and latency was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses. Statistical analyses were performed using the meta-analysis package for R. Caffeine intake between 201 and 399 mg was associated with a significant increase in P300 amplitude across anterior, central, and posterior regions, whereas higher doses were associated with smaller effect sizes. No significant differences in P300 latency were observed between pre- and post-caffeine intake. Overall, our findings align with previous reviews showing that caffeine, as a stimulant, can modulate brain activity. The main limitation of this work is the high heterogeneity across studies. Future research directions are discussed.
- 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."
- Puzzling out presynaptic differentiationPublication . Pinto, Maria J.; Almeida, Ramiro D.Proper brain function in the nervous system relies on the accurate establishment of synaptic contacts during development. Countless synapses populate the adult brain in an orderly fashion. In each synapse, a presynaptic terminal loaded with neurotransmitters-containing synaptic vesicles is perfectly aligned to an array of receptors in the postsynaptic membrane. Presynaptic differentiation, which encompasses the events underlying assembly of new presynaptic units, has seen notable advances in recent years. It is now consensual that as a growing axon encounters the receptive dendrites of its partner, presynaptic assembly will be triggered and specified by multiple postsynaptically-derived factors including soluble molecules and cell adhesion complexes. Presynaptic material that reaches these distant sites by axonal transport in the form of pre-assembled packets will be retained and clustered, ultimately giving rise to a presynaptic bouton. This review focuses on the cellular and molecular aspects of presynaptic differentiation in the central nervous system, with a particular emphasis on the identity of the instructive factors and the intracellular processes used by neuronal cells to assemble functional presynaptic terminals. We provide a detailed description of the mechanisms leading to the formation of new presynaptic terminals. In brief, soma-derived packets of pre-assembled material are trafficked to distant axonal sites. Synaptogenic factors from dendritic or glial provenance activate downstream intra-axonal mediators to trigger clustering of passing material and their correct organization into a new presynaptic bouton. This article is part of a mini review series: "Synaptic Function and Dysfunction in Brain Diseases".
- Refining the link between psychopathy, antisocial behavior, and empathy: a meta-analytical approach across different conceptual frameworksPublication . Campos, Carlos; Pasion, Rita; Azeredo, Andreia; Eduarda, Ramião; Mazer, Prune; Machado, Inês; Barbosa, FernandoThe current meta-analysis included 431 records (N= 123,414) to comprehensively explore the complex interaction between psychopathy, antisocial behavior, and empathy. First, empathy domains (cognitive and affective) were used to provide critical insights for distinguishing antisocial behavior from psychopathy. Cognitive empathy was more impaired in antisocial groups (gcognitive= -.40; gaffective= -.11), while high psychopathy samples displayed larger deficits in affective empathy (gaffective= -.44; gcognitive= -.23), although this dissociation was not clear in correlational analyses. Secondly, the specific associations between empathy domains and psychopathy dimensions were evaluated. Psychopathy traits closely related to antisocial behavior were mildly associated with both empathy domains (r= -.07 to -.14). Callous-affective traits were largely associated with affective empathy (r= -.32 to -.35) and moderately correlated to cognitive empathy (r= -.26). Diverging results were found for the interpersonal dimension, as boldness-adaptive manifestations were unrelated to cognitive empathy (r= .05), while non-adaptive interpersonal traits were negatively associated with both empathy domains (rcognitive= -.14; raffective= -.25). Overall, these findings suggest that: (1) psychopathy and antisocial behavior display distinct empathic profiles; (2) psychopathy dimensions are differentially associated with cognitive and affective empathy; (3) the interaction between interpersonal traits and empathic processes is different across the conceptual models of psychopathy.
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