Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2026
Classification of cortico-cortical evoked potential waveforms and their implications for brain anatomy.
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Mukae Nobutaka, Nakae Takuro, Kobayashi Katsuya, Togo Masaya, Usami Kiyohide, Shimotake Akihiro, Yamao Yukihiro, Kikuchi Takayuki, Matsuhashi Masao, Bonnetblanc François, Yoshimoto Koji, Iihara Koji, Kunieda Takeharu, Takahashi Ryosuke, Arakawa Yoshiki, Ikeda Akio, Matsumoto Riki
Аннотация
OBJECTIVE: Cortico-cortical evoked potential (CCEP) waveforms typically exhibit two negative peaks, an early peak (N1, 10-50 ms) and a late peak (N2, 100-500 ms). We aimed to classify CCEP waveform morphologies and examine their anatomical distributions.
METHODS: CCEP waveforms were classified as follows: Type I showed a typical N1 peak latency (10-50 ms), whereas Types II and III showed delayed N1 peaks (50-100 ms and > 100 ms, respectively). Type IV represented positive responses with inverted morphology, and Type V represented multimodal responses. A total of 7928 CCEP waveforms obtained from subdural grid recordings in ten patients with focal epilepsy were manually reviewed to assess anatomical distribution.
RESULTS: Type I accounted for 49.8% of responses and was distributed around the terminal regions of the superior longitudinal fasciculus. Types II and III accounted for 43.2% and were distributed around the interhemispheric cortical surface and dorsal parietal region. Type IV responses were observed in postero-inferior lateral and temporal basal areas.
CONCLUSIONS: Approximately half of CCEPs exhibited typical N1 (<50 ms) and N2 responses, while substantial morphological variants were also observed.
SIGNIFICANCE: This classification provides a neurophysiological framework for interpreting CCEP waveforms in relation to brain anatomy and connectivity. By linking waveform morphology to underlying white-matter pathways and terminal cortical properties, the framework offers a foundation for using CCEP features as candidate biomarkers in intraoperative language and functional network monitoring.
METHODS: CCEP waveforms were classified as follows: Type I showed a typical N1 peak latency (10-50 ms), whereas Types II and III showed delayed N1 peaks (50-100 ms and > 100 ms, respectively). Type IV represented positive responses with inverted morphology, and Type V represented multimodal responses. A total of 7928 CCEP waveforms obtained from subdural grid recordings in ten patients with focal epilepsy were manually reviewed to assess anatomical distribution.
RESULTS: Type I accounted for 49.8% of responses and was distributed around the terminal regions of the superior longitudinal fasciculus. Types II and III accounted for 43.2% and were distributed around the interhemispheric cortical surface and dorsal parietal region. Type IV responses were observed in postero-inferior lateral and temporal basal areas.
CONCLUSIONS: Approximately half of CCEPs exhibited typical N1 (<50 ms) and N2 responses, while substantial morphological variants were also observed.
SIGNIFICANCE: This classification provides a neurophysiological framework for interpreting CCEP waveforms in relation to brain anatomy and connectivity. By linking waveform morphology to underlying white-matter pathways and terminal cortical properties, the framework offers a foundation for using CCEP features as candidate biomarkers in intraoperative language and functional network monitoring.