Schedule

Intraoperative and ICU monitoring During cardiac and major vascular surgery, maintaining adequate cerebral and spinal cord perfusion is paramount because short-lived hypoperfusion can translate into irreversible neural injury. From a neurophysiological perspective, “critical blood flow” refers to the lowest regional perfusion that still sustains neuronal function and permits reversible changes in intraoperative neurophysiological monitoring (IONM) signals.When mean arterial pressure (MAP) or regional flow drops below this threshold, somatosensory-evoked potentials (SSEPs) typically show progressive latency prolongation and amplitude loss; motor-evoked potentials (MEPs) are even more flow-sensitive and may disappear abruptly. Experimental data suggest cortical SSEPs begin to decline when cerebral blood flow falls below ~20 mL/100 g/min, whereas complete SSEP loss and metabolic failure occur near 10 mL/100 g/min. Factors that narrow the safety margin include hypothermia, hemodilution, and volatile anesthetic use, each lowering the critical flow threshold or masking early warning changes. Conversely, total intravenous anesthesia and mild hypercapnia can increase neural tolerance by augmenting collateral perfusion.Clinically, continuous IONM allows real-time titration of perfusion targets. A reproducible 50 % SSEP or EEG amplitude drop—if promptly reversed by raising MAP, adjusting bypass flows, or reimplanting critical intercostal arteries—correlates with favorable neurological outcomes. Persistent losses predict postoperative stroke or paraparesis.Therefore, understanding critical blood-flow thresholds and their neurophysiological surrogates enables anesthesiologists and surgeons to intervene before ischemia becomes irreversible, bridging physiology with operative practice and improving neural protection during complex cardiac and vascular procedures. Decoding neurophysiologic patterns in perioperative cerebro-vascular injury Mirela Simon Acute Neurocognitive Disorders Following Cardiac and Vascular Procedures Parthasarathy Thirumala Autoregulation, cerebral blood flow management and neuroprotective strategies during cardiovascular surgery Daniel Santos MD

EMG & NCS This symposium will focus on in vivo techniques that test the excitability of upper and lower motor neurons to probe mechanisms of disease, assist with diagnosis, and monitor disease progression. These methods are easy to perform for a clinical neurophysiologist, and in the research clinic can provide additional insight into the disease process.The first talk will discuss three aspects of cortical excitability measurement: a new method for simultaneously assessing short interval cortical inhibition (SICI) and facilitation (SICF); the neuroplastic reserve in ALS using non-invasive brain stimulation and the application of TMS-EEG to explore motor and extra-motor cortical dysfunction in ALS.Clearly, there is a need for reliable and repeatable motor unit number estimation methods, particularly in MND diseases such as ALS. The CMAP scan has emerged as an easy to perform method for acquiring data for MUNE analysis. The second talk will discuss the utility of four promising methods based on the CMAP scan.The third talk will focus on the use of nerve excitability techniques in ALS and mimic disorders. The abnormal excitability of ALS axons is characteristic of the disease, and axonal excitability studies are well suited to monitor disease progression and target engagement in lower motor neurons. Probing Upper Motor Neuron changes in ALS José Manuel Matamala Reliability and Repeatability of 4 CMAP-Scan MUNE methods: MScanFit, STEPIX, StairFit and CDIX Kelvin E. Jones Axons are not just cables! Insights into LMN dysfunction from the axon James (Tim) Howells, PhD

EEG & MEG Pharmacological efficacy is mainly depended from the patient's report. This may not be the most reliable source of information, as the placebo effect explains already 30% of improvement. In this symposium, we will give updates on the latest discoveries of neurophysiological correlates of drug effects. The audience will learn when and which tool is the most reliable tool to verify that the new drug - for central or peripheral diseases - is indeed working. Pharmacological efficacy as measured by non-invasive brain stimulation Ulf Ziemann Pharmacological efficacy as measured by ENMG Hatice Tankisi Pharmacological efficacy as measured by EEG Margitta Seeck

Brainstem neurophysiology Swallowing is a complex sensorimotor function that we perform many times daily. However, due to its complexity, various types of dysfunction may occur in various disorders. Dysphagia is a real life-threatening situation. In this symposium, the three speakers will deal with the physiology underlying this important function and remark on its disorders. They will cover from the sensory inputs generated in vagal, trigeminal and glosopharyngeal nerves, the voluntary control of deglutition up to the oro-pharyngeal phase, and the reflexes leading to pass the food into the esophagus avoiding aspiration. As it happens with many complex human sensorimotor functions, there are many disciplines joining efforts in the study of swallowing. However, neurophysiology is a tool to be commonly used in all these disciplines. The learning objectives of this symposium are to revise all aspects of swallowing with special remark to the neurophysiological studies that contribute to the understanding of this complex phenomenon and its disorders. Swallowing and its disorders Antonio Schindler Protection of aerial pathways: Laryngeal reflexes Maria J Téllez Dysphagia in stroke and therapeutic approaches Ayodele Sasegbon

Brain stimulation & neuromodulation TMS-EEG is the combination of transcranial magnetic stimulation (TMS) to perturb the brain and electroencephalography (EEG) to record the TMS-evoked brain response. TMS-EEG allows inferences on causal input-output relation, therefore going critically beyond pure recording techniques to study brain dynamics, such as resting-state EEG or functional MRI. The physiological mechanisms of a variety of TMS-EEG metrics are becoming increasingly better understood. This justifies their investigation in clinical studies. This symposium will provide an overview on TMS-EEG responses (Ulf Ziemann) to provide the audience with an introduction into the technology, physiology, metrics and pitfalls of TMS-EEG recordings. The other two talks will then provide insights into clinical applications of TMS-EEG. One talk (Caroline Tscherpel) will show in detail the value of TMS-EEG responses for long-term outcome prediction of acute stroke patients. The other talk (Annerose Mengel) will provide recent information on the value of TMS-EEG responses in the prediction of post-stroke delirium, a frequent complication in acute stroke patients. Both topics are of great medical importance given the high incidence of stroke. In addition they showcase the high relevance of advanced clinical neurophysiology in precise outcome prediction that is unparalleled by any other approach. Introduction to TMS-EEG: technology, physiology, metrics and pitfalls Ulf Ziemann TMS-EEG: long-term functional outcome prediction in acute stroke Caroline Tscherpel TMS-EEG: prediction of post-stroke delirium in acute stroke Annerose Mengel

EEG & MEG This symposium will offer a comprehensive platform to showcase cutting-edge methodological advances and experimental findings on disrupted neurophysiological communication between the brain and bodily dynamics. We will examine the mechanisms driving these communication breakdowns and their broad implications for health. Participants will gain a deeper understanding of how disturbances in brain-heart and brain-body interactions inform the onset, progression, and severity of mental health conditions, neurodegenerative diseases, and severe brain injuries. Ultimately, this symposium will foster discussion on the clinical applications of brain-body research, paving the way for innovative approaches to diagnosis, treatment, and prognosis across a wide spectrum of disorders. Learning Objectives:- Identify interoceptive and neurophysiological markers of brain-body communication.- Understand the consequences of disrupted brain-body interactions in mental health and their therapeutic potential.- Gain insights into the role of brain-body communication in the progression of neurodegenerative disorders.- Explore the diagnostic value of brain-body interaction markers in severe brain injury, including predictions of severity, consciousness, and survival.- Acquire knowledge of disease-specific brain-body dynamics and their potential clinical utility. Cortical and spinal markers of brain-body alterations in psychosis: evidence from self-generated sensations Paula C. Salamone Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia Jessica L. Hazelton The diagnostic and prognostic potential of brain-heart interplay markers following severe brain damage Diego Candia-Rivera

Motor control & movement disorders neurophysiology Parkinson’s disease (PD) is traditionally framed as a disorder of the basal ganglia, yet converging evidence indicates that its motor symptoms emerge from the dysfunctional interplay among multiple nodes of the motor network, including the cortex and cerebellum. This symposium takes a deliberately provocative perspective, highlighting the “division of labor” between the basal ganglia, cortex, and cerebellum in shaping aberrant motor output. The first talk (Litvak, "The Pillars: Basal Ganglia") will focus on basal ganglia physiology, predominantly from invasive local field potential recordings in patients DBS. Beyond characterizing oscillatory signatures of motor symptoms, this work delineates the connectivity profiles between the basal ganglia and cortex that shape clinical response to DBS—providing the physiological substrate and a transition to cortical mechanisms. The second talk (Belvisi: "The Deliverer: Cortical Output") shifts the focus to the cortex, conceptualized as the final station that delivers the abnormal motor command. Using non-invasive methods such as TMS, EEG, EMG, and kinematic analysis, this presentation will demonstrate how cortical excitability, inhibition, and sensorimotor integration abnormalities drive clinical symptoms and interact with basal ganglia inputs. Finally, the third talk (Popa: "The Conductor: Cerebellar Contribution to Parkinson’s Disease") examines the cerebellum—the “outsider” of the PD motor network. Combining TMS, neurophysiology, and imaging, it will explore cerebellar contributions to abnormal plasticity, compensation, and dyskinesias, as well as emerging evidence linking cerebellar dysfunction to clinical heterogeneity in PD. Together, these talks offer an integrated, network-based view of PD motor pathophysiology, and open new avenues for targeted interventions across distributed motor circuits The Pillars: Basal Ganglia Vladimir Litvak The Deliverer: Cortical Output Daniele Belvisi The Conductor: Cerebellar Contribution to Parkinson’s Disease Traian Popa

Intraoperative and ICU monitoring Motor evoked potentials (MEPs) are a cornerstone of intraoperative neurophysiological monitoring, yet their variability and interpretation continue to pose challenges. This session offers a continuum of evidence and perspectives that deepen our understanding and refine clinical practice.The first presentation addresses the fundamental question of MEP variability by comparing motor responses with H-reflexes in pediatric scoliosis patients. The findings suggest that fluctuations in lower motor neuron excitability contribute less than previously assumed, and that the efficacy of corticospinal volleys is the critical determinant of reproducibility.Building on this physiological insight, the second talk turns to D-waves, a powerful and stable marker of corticospinal integrity in spinal cord tumor surgery. While highly valuable, their limitations—such as lack of lateralization, occasional absence, and variability across patient groups—will be critically discussed, offering a nuanced framework for interpretation.Finally, the third presentation introduces an optimized MEP protocol designed to enhance stability, predictive accuracy, and intraoperative prognostic value. This practical innovation demonstrates how refined techniques can directly translate into improved surgical outcomes. Together, these three talks create an attractive session that integrates basic mechanisms, clinical application, and forward-looking innovation in motor pathway monitoring. New Insights into the Underlying Mechanisms of Intraoperative MEP Variability Martín J. Segura D-waves in Intraoperative Neurophysiology of the Spinal Cord: Mastering Interpretation, Addressing Limitations, and Unlocking New Applications Francisco Soto Optimizing Transcranial Motor Evoked Potential (tcMEP) Protocols to Increase the Positive Rate of Preoperative Findings and Ensure Response Stability for Intraoperative Prognostic Assessment Ricardo J. Ferreira

Brain stimulation & neuromodulation The mechanism of action of the TUS remains to be clarified and no standard stimulation protocol has been settled. Several mechanisms may contribute to TUS effects, but the main one seems related to calcium influx into neurons. It must be mediated by electrophysiological events similarly to rTMS or by direct mechanoreceptor activation with ultrasound energy. The first speaker will summarize possible mechanisms underlying TUS and present the dependency of TUS effects on the stimulation parameters including the effects on vasoconstriction. The second speaker will present a newly developed TUS procedure inducing both LTP and LTD consistently, deca-pulse stimulation (DPS). He will show its effects on the huma primary motor cortex by DPS using MEP modulation. The third speaker will present EEG entropy changes induced by DPS, which suggest a physiological mechanism of DPS and support the bidirectionality of DPS. Optimized TUS parameters based on animal experiments Keith Murphy Deca-pulse stimulation (DPS): Newly developed TUS protocol Yasuo Terao EEG entropy changes induced by Deca-pulse TUS Francesco Fisicaro

EMG & NCS This session provides a comprehensive overview of the recent knowledge about pathophysiology of peripheral nerve injuries, emphasizing neuropathological changes during the stages of denervation and reinnervation. It highlights the Electrodiagnostic correlation of these injuries, demonstrating how findings from techniques such as NCVs and EMG are instrumental in assessing lesion severity and predicting recovery outcomes. Non-surgical management strategies are discussed, including pain management and rehabilitation approaches designed to optimize functional recovery and patient comfort. The session also covers surgical interventions for peripheral nerve trauma, with particular attention to the pivotal role of intraoperative neurophysiological monitoring (IONM) in guiding surgical decision-making and improving patient outcomes. Recent knowledge about pathophysiology of peripheral nerve injury: Sequence of events and its Electrodiagnostic correlation Larry Robinson Rehabilitation and pain management of peripheral nerve injuries Carlos Eduardo Rangel Surgical strategy and role of IONM in the treatment of peripheral nerve trauma Jorge Eduardo Gutierrez

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Motor control & movement disorders neurophysiology Focal dystonia is increasingly understood as a distributed network disorder in which basal ganglia, cerebellum, and sensorimotor cortex interact abnormally, leading to impaired sensorimotor integration, loss of inhibition, and maladaptive plasticity, which ultimately results in involuntary muscle spasms. This session bridges an arc from understanding the underlying pathophysiology, identifying suitable biomarkers of the disease to developing appropriate therapies. We first set the pathophysiological framework: converging neurophysiological evidence (altered tactile/proprioceptive processing, surround inhibition deficits, somatosensory dedifferentiation, maladaptive plasticity) that supports a network model to explain the core clinical features of dystonia. We then review current evidence on non-invasive EEG/EMG and kinematics, highlighting oscillatory signatures (theta-centric), cortico-muscular/inter-muscular coherence, and task-evoked measures of sensorimotor integration/inhibitory control, and identify the most promising biomarkers for clinical translation. We focus on clinical interpretability, reliability, minimal detectable change, and responsiveness, aiming at composite indices suitable for clinical trial research and longitudinal monitoring. Finally, we translate mechanisms and markers into network-informed, non-invasive therapies, highlighting vibro-tactile stimulation (VTS) as a sensory-guided neuromodulation approach that can rapidly relieve symptoms and is linked to normalization of aberrant low-frequency sensorimotor synchrony, providing objective on-target readouts and a pathway to patient stratification. Dystonia as a Disorder of Distributed Network Physiology: Converging on Sensorimotor Integration Laura Avanzino Non-invasive EEG/EMG Signatures in Dystonia: Toward Clinically Actionable Biomarkers Giorgio Leodori From biomarker to target: network-informed non-invasive neuromodulation in dystonia Jürgen Konczak

Brain stimulation & neuromodulation Multiple Sclerosis (MS) is increasingly framed as an inflammatory synaptopathy that perturbs large-scale networks and drives symptoms and progression before overt structural damage. This symposium links inflammatory synaptopathy in MS to non-invasive EEG/TMS-EEG biomarkers that quantify network dysfunction and to clinically actionable pathways for early progression prediction and symptom-focused interventions. First, we synthesize preclinical evidence showing how immune signaling (infiltrating T cells, microglia/astrocytes) disrupts excitation-inhibition balance, enhances glutamatergic drive, down-regulates GABAergic inhibition, and exhausts plasticity reserves—processes that seed network dysfunction and help explain symptoms as well as subsequent disability accrual. Second, we provide a concise introduction to TMS-EEG, explaining the physiological basis of its responses—what TMS-evoked potentials (TEPs), induced oscillations, and propagation/effective-connectivity indices actually reflect—and how these metrics can be used to quantify the synaptopathy-related alterations outlined in Talk 1 (excitatory-inhibitory imbalance, impaired inhibition, and dysregulated network communication). Third, we synthesize empirical TMS-EEG and EEG microstate findings in MS patients, linking altered cortical excitability/connectivity and large-scale dynamics to MS-specific symptoms and early progression signals. We conclude with prospects for implementing non-invasive neurophysiology—using composite, clinically interpretable indices—to support earlier detection of network dysfunction, forecast disease progression, and inform treatment decisions and monitoring in MS. The overarching arc—synaptopathy → biomarkers → clinical action—is designed for clinical neurophysiologists and neurologists aiming to operationalize non-invasive neurophysiology in MS care and research. Inflammatory Synaptopathy in Multiple Sclerosis: Evidence from Basic Science and Preclinical Models Diego Centonze TMS-EEG Measures of Cortical Excitability and Connectivity: A Conceptual Introduction and Possibilities for Probing Synaptopathy in Multiple Sclerosis Ulf Ziemann TMS-EEG Biomarkers of Network Dysfunction in MS: Evidence and Routes to Clinical Implementation Giorgio Leodori

EEG & MEG Pharmacological efficacy is mainly depended from the patient's report. This may not be the most reliable source of information, as the placebo effect explains already 30% of improvement. In this symposium, we will give updates on the latest discoveries of neurophysiological correlates of drug effects. The audience will learn when and which tool is the most reliable tool to verify that the new drug - for central or peripheral diseases - is indeed working. Pharmacological efficacy as measured by non-invasive brain stimulation Ulf Ziemann Pharmacological efficacy as measured by ENMG Hatice Tankisi Pharmacological efficacy as measured by EEG Margitta Seeck

EMG & NCS This session will address recent progress in diagnosing and understanding neuromuscular transmission disorders, combining state-of-the-art clinical practice with novel research approaches. The first presentation will focus on electrodiagnostic (EDX) techniques in myasthenia gravis, including the particular challenges of seronegative subtypes, highlighting advances, recommendations, and practical pitfalls. (Speaker: Professor Pushpa Narayanaswami, Harvard Medical School, Boston, internationally recognized expert in neuromuscular disorders and leader of clinical and guideline initiatives in myasthenia gravis.)The second talk will explore the long-term neuromuscular side effects of botulinum toxin injections used in both cosmetic and therapeutic settings. New data on chronic changes in facial muscles, particularly in chronic migraine, will be presented, along with guidance on differentiating toxin-related effects from neuromuscular transmission disorders such as myasthenia gravis. (Speaker: Professor Anna Rostedt Punga, Uppsala University, Sweden; professor and consultant physician of clinical neurophysiology, leading translational research on myasthenia gravis and botulinum toxin effects.)The third presentation will highlight novel non-invasive diagnostic methods, including advanced imaging, electrophysiological innovations, and AI-driven approaches, with the potential to improve early and precise detection of neuromuscular transmission disorders. (Speaker: Dr. Martijn Tannemaat, Leiden University Medical Center, the Netherlands, neurologist and clinical neurophysiologist, focusing on neuromuscular diseases and development of innovative diagnostic tools.)Learning objectives:Update knowledge on electrodiagnostic strategies for myasthenia gravis, including seronegative cases.Recognize and differentiate long-term botulinum toxin side effects from primary neuromuscular transmission disorders.Explore emerging non-invasive and AI-based diagnostic tools to enhance clinical precision and patient safety. State-of-the-Art EDX Diagnostics in Myasthenia Gravis, including Seronegative Subtypes Pushpa Narayaswami Long-term Neuromuscular Side Effects of Botulinum Toxin Injections - Mimicking Myasthenia Gravis and Beyond Anna Rostedt Punga Novel Non-invasive Methods for Diagnosing Neuromuscular Transmission Disorders Martijn Tannemaat

Monitoreo en deformdades espinales Ricardo Ferrerira Instrumentacion pedicular Ricardo Ferrerira Monitoreo en Cirugia de cara y cuello Armando Tello Modelo multimodal de MNIO en diversas patologias Francisco Soto Q/A ALL

AI in Neurophysiology Artificial intelligence is rapidly transforming the practice of medicine, and clinical neurophysiology is no exception. While AI innovations hold great promise for improving patient care, they also raise important concerns that must be addressed thoughtfully. In 2024, the International Federation of Clinical Neurophysiology (IFCN) established a taskforce to evaluate the current landscape of AI in clinical neurophysiology and to develop guidance for its responsible integration into practice.This symposium will present a summary of the IFCN position statement on the use of AI in clinical neurophysiology. The statement outlines best practices for the training, validation, and implementation of AI models, while also addressing potential risks, safety concerns, and practical challenges. The session will be led by members of the IFCN taskforce and will provide attendees with a comprehensive overview of the recommendations and their implications for clinical practice. Overview Aatif Husain Building Trustworthy AI: Best Practices for Training, Testing, and Validation in CNP Benjamin Brinkman Navigating the Risks: Safety, Ethics, and Implementation Challenges of AI in CNP Martijn Tannemaat

Autonomic nervous system neurophysiology The autonomic nervous system (ANS), traditionally recognized for its role in regulating involuntary physiological processes such as heart rate, digestion, and respiration, has increasingly been acknowledged for its influence on cognitive function. Recent research suggests that autonomic responses significantly affect higher-order brain functions, including attention, memory, decision-making, and emotional regulation. The interaction between autonomic activity and cognition is bidirectional; not only does cognitive stress alter autonomic outputs, but autonomic states also shape cognitive performance. For instance, heightened sympathetic arousal, often associated with stress or anxiety, can impair working memory and attentional control, whereas parasympathetic dominance—reflected in high vagal tone—is linked to improved executive function and emotional regulation. Neural circuits connecting the prefrontal cortex, amygdala, and brainstem nuclei facilitate this cross-talk, illustrating the close integration of autonomic and cognitive systems. Understanding this relationship has important implications for both mental and physical health, shedding light on how chronic stress and dysregulation of the ANS may contribute to cognitive decline. As such, the study of ANS influence on cognition represents a critical intersection of neuroscience, psychology, and physiology.This focused workshop explores the role of the autonomic nervous system (ANS) in cognitive processes, with a particular focus on its dysfunction in neurological disorders. Through a structured approach, participants will gain foundational knowledge, examine its implications in movement disorders, and delve into its relevance in multiple sclerosis (MS). The workshop is designed for clinicians, neuroscientists, and allied health professionals interested in neurophysiology, neuropsychology, and rehabilitation. General Introduction to ANS and Cognition Anita Kamondi ANS and Cognitive Function in alpha-synucleinopathies Alessandra Fanciulli ANS and Cognitive Function in Multiple Sclerosis Mario Habek

Brainstem neurophysiology This Symposium is submitted as part of the functions of the Brainstem Special Interest Group, under the umbrella of the IFCN.This session will cover new developments with regards to VEMPs. This will include new case examples that have not been emphasized before, new methodologies that include differnent recording protocols (for example from the Massetter muscle), and new developments with regards to recording signals directly from the Cerebellum. Cervical and Ocular VEMPs Eleftherios Papathanasiou Alternative VEMP Methodologies Franca Deriu Cerebellar Evoked Potentials James Colebatch

Sleep and disorders of consciousness This session will provide an up-to-date overview on how sleep can provide a window into brain health. The first speaker, Ambra Stefani, will discuss changes in sleep macro- and microarchitecture presenting a relationship with brain health. In particular, current knowledge on how reduction in deep-sleep and REM-sleep, sleep duration but also circadian changes can affect brain health. The debated but increasingly recognized role of the glymphatic system will also be addressed, focusing on neurophysiological aspects of sleep related to its function. Building up on the previous talk, the second speaker (Erik StLouis) will focus on the relationship between sleep and neurodegeneration. Besides addressing how specific changes in sleep and circadian rhythms can affect the risk of neurodegeneration, or contribute to its development, this talk will underline the relationship between specific sleep disorders and neurodegenerative diseases (e.g. obstructive sleep apnea/Alzheimer's disease, or REM sleep behavior disorder/synucleinopathies). A special focus will be kept on neurophysiological aspects of sleep in relation to neurodegeneration. The third speaker, Ki-Young Jung, will present the current landscape of AI applications for sleep tracking devices, in particular focusing on those allowing home-based monitoring. He will discuss how these instruments could be integrated in the early detection of neurodegeneration and for promoting brain health, with a focus on future directions. Sleep and brain health Ambra Stefani Sleep disorders and neurodegeneration Erik StLoius AI and sleep tracking: monitoring, & screening and modulation Ki-Young Jung

Neuromuscular imaging This symposium will address the use of ultrasound as an adjunct in the diagnosis of motor neuron diseases. Considering the impact of this diagnosis on therapeutic planning and patient prognosis, the addition of a tool with high sensitivity for the detection of fasciculations and the ability to identify peripheral nerve enlargement can assist in defining a diagnosis as well as in excluding differential diagnoses. Entrapment neuropathies in upper limbs Monika Krzesniak-Swinarska Entrapment neuropathies in lower limbs Eman Tawfik Guidelines for Best Practices with Ultrasound Nicolas Cavalcante