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Wang J, Sugiyama A, Yokota H, Hirano S, Yamamoto T, Yamanaka Y, Araki N, Ito S, Paul F, Kuwabara S. Differentiation between Parkinson's Disease and the Parkinsonian Subtype of Multiple System Atrophy Using the Magnetic Resonance T1w/T2w Ratio in the Middle Cerebellar Peduncle. Diagnostics (Basel) 2024; 14:201. [PMID: 38248077 PMCID: PMC10814850 DOI: 10.3390/diagnostics14020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Multiple system atrophy with predominant parkinsonism (MSA-P) can hardly be distinguished from Parkinson's disease (PD) clinically in the early stages. This study investigated whether a standardized T1-weighted/T2-weighted ratio (sT1w/T2w ratio) can effectively detect degenerative changes in the middle cerebellar peduncle (MCP) associated with MSA-P and PD and evaluated its potential to distinguish between these two diseases. We included 35 patients with MSA-P, 32 patients with PD, and 17 controls. T1w and T2w scans were acquired using a 1.5-T MR system. The MCP sT1w/T2w ratio was analyzed via SPM12 using a region-of-interest approach in a normalized space. The diagnostic performance of the MCP sT1w/T2w ratio was compared between the MSA-P, PD, and controls. Patients with MSA-P had significantly lower MCP sT1w/T2w ratios than patients with PD and controls. Furthermore, MCP sT1w/T2w ratios were lower in patients with PD than in the controls. The MCP sT1w/T2w ratio showed excellent or good accuracy for differentiating MSA-P or PD from the control (area under the curve (AUC) = 0.919 and 0.814, respectively) and substantial power for differentiating MSA-P from PD (AUC = 0.724). Therefore, the MCP sT1w/T2w ratio is sensitive in detecting degenerative changes in the MCP associated with MSA-P and PD and is useful in distinguishing MSA-P from PD.
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Affiliation(s)
- Jiaqi Wang
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
| | - Tatsuya Yamamoto
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
- Department of Rehabilitation, Division of Occupational Therapy, Chiba Prefectural University of Health Sciences, Chiba 261-0014, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
- Urayasu Rehabilitation Education Center, Chiba University Hospital, Urayasu 279-0023, Japan
| | - Nobuyuki Araki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Einstein Center for Neurosciences, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (J.W.); (T.Y.); (S.I.); (S.K.)
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Purrer V, Pohl E, Lueckel JM, Borger V, Sauer M, Radbruch A, Wüllner U, Schmeel FC. Artificial-intelligence-based MRI brain volumetry in patients with essential tremor and tremor-dominant Parkinson's disease. Brain Commun 2023; 5:fcad271. [PMID: 37946794 PMCID: PMC10631860 DOI: 10.1093/braincomms/fcad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023] Open
Abstract
Essential tremor and Parkinson's disease patients may present with various tremor types. Overlapping tremor features can be challenging to diagnosis and misdiagnosis is common. Although underlying neurodegenerative mechanisms are suggested, neuroimaging studies arrived at controversial results and often the different tremor types were not considered. We investigated whether different tremor types displayed distinct structural brain features. Structural MRI of 61 patients with essential tremor and 29 with tremor-dominant Parkinson's disease was analysed using a fully automated artificial-intelligence-based brain volumetry to compare volumes of several cortical and subcortical regions. Furthermore, essential tremor subgroups with and without rest tremor or more pronounced postural and kinetic tremor were investigated. Deviations from an internal reference collective of age- and sex-adjusted healthy controls and volumetric differences between groups were examined; regression analysis was used to determine the contribution of disease-related factors on volumetric measurements. Compared with healthy controls, essential tremor and tremor-dominant Parkinson's disease patients displayed deviations in the occipital lobes, hippocampus, putamen, pallidum and mesencephalon while essential tremor patients exhibited decreased volumes within the nucleus caudatus and thalamus. Analysis of covariance revealed similar volumetric patterns in both diseases. Essential tremor patients without rest tremor showed a significant atrophy within the thalamus compared to tremor-dominant Parkinson's disease and atrophy of the mesencephalon and putamen were found in both subgroups compared to essential tremor with rest tremor. Disease-related factors contribute to volumes of occipital lobes in both diseases and to volumes of temporal lobes in essential tremor and the putamen in Parkinson's disease. Fully automated artificial-intelligence-based volumetry provides a fast and rater-independent method to investigate brain volumes in different neurological disorders and allows comparisons with an internal reference collective. Our results indicate that essential tremor and tremor-dominant Parkinson's disease share structural changes, indicative of neurodegenerative mechanisms, particularly of the basal-ganglia-thalamocortical circuitry. A discriminating, possibly disease-specific involvement of the thalamus was found in essential tremor patients without rest tremor and the mesencephalon and putamen in tremor-dominant Parkinson's disease and essential tremor without rest tremor.
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Affiliation(s)
- Veronika Purrer
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Emily Pohl
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Julia M Lueckel
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Malte Sauer
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Alexander Radbruch
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Frederic Carsten Schmeel
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
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6
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Younger E, Ellis EG, Parsons N, Pantano P, Tommasin S, Caeyenberghs K, Benito-León J, Romero JP, Joutsa J, Corp DT. Mapping Essential Tremor to a Common Brain Network Using Functional Connectivity Analysis. Neurology 2023; 101:e1483-e1494. [PMID: 37596042 PMCID: PMC10585696 DOI: 10.1212/wnl.0000000000207701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The cerebello-thalamo-cortical circuit plays a critical role in essential tremor (ET). However, abnormalities have been reported in multiple brain regions outside this circuit, leading to inconsistent characterization of ET pathophysiology. Here, we test whether these mixed findings in ET localize to a common functional network and whether this network has therapeutic relevance. METHODS We conducted a systematic literature search to identify studies reporting structural or metabolic brain abnormalities in ET. We then used 'coordinate network mapping,' which leverages a normative connectome (n = 1,000) of resting-state fMRI data to identify regions commonly connected to findings across all studies. To assess whether these regions may be relevant for the treatment of ET, we compared our network with a therapeutic network derived from lesions that relieved ET. Finally, we investigated whether the functional connectivity of this ET symptom network is abnormal in an independent cohort of patients with ET as compared with healthy controls. RESULTS Structural and metabolic brain abnormalities in ET were located in heterogeneous regions throughout the brain. However, these coordinates were connected to a common functional brain network, including the cerebellum, thalamus, motor cortex, precuneus, inferior parietal lobe, and insula. The cerebellum was identified as the hub of this network because it was the only brain region that was both functionally connected to the findings of over 90% of studies and significantly different in connectivity compared with a control data set of other movement disorders. This network was strikingly similar to the therapeutic network derived from lesions improving ET, with key regions aligning in the thalamus and cerebellum. Furthermore, positive functional connectivity between the cerebellar network hub and the sensorimotor cortices was significantly reduced in patients with ET compared with healthy controls, and connectivity within this network was correlated with tremor severity and cognitive functioning. DISCUSSION These findings suggest that the cerebellum is the central hub of a network commonly connected to structural and metabolic abnormalities in ET. This network may have therapeutic utility in refining and informing new targets for neuromodulation of ET.
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Affiliation(s)
- Ellen Younger
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Elizabeth G Ellis
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nicholas Parsons
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrizia Pantano
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Silvia Tommasin
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karen Caeyenberghs
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julián Benito-León
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Juan Pablo Romero
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Juho Joutsa
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Daniel T Corp
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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7
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Kane JM, McDonnell JL, Neimat JS, Hedera P, van den Wildenberg WPM, Phibbs FT, Bradley EB, Wylie SA, van Wouwe NC. Essential tremor impairs the ability to suppress involuntary action impulses. Exp Brain Res 2022; 240:1957-1966. [PMID: 35562536 PMCID: PMC11150918 DOI: 10.1007/s00221-022-06373-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/13/2022] [Indexed: 11/04/2022]
Abstract
Essential tremor (ET) is a movement disorder characterized primarily by action tremor which affects the regulation of movements. Disruptions in cerebello-thalamocortical networks could interfere with cognitive control over actions in ET, for example, the ability to suppress a strong automatic impulse over a more appropriate action (conflict control). The current study investigated whether ET impacts conflict control proficiency. Forty-one ET patients and 29 age-matched healthy controls (HCs) performed a conflict control task (Simon task). Participants were instructed to give a left or right response to a spatially lateralized arrow (direction of the arrow). When the action signaled by the spatial location and direction of the arrow were non-corresponding (induced conflict), the inappropriate action impulse required suppression. Overall, ET patients responded slower and less accurately compared to HCs. ET patients were especially less accurate on non-corresponding conflict (Nc) versus corresponding (Cs) trials. A focused analysis on fast impulsive response rates (based on the accuracy rate at the fastest reaction times on Nc trials) showed that ET patients made more fast errors compared to HCs. Results suggest impaired conflict control in ET compared to HCs. The increased impulsive errors seen in the ET population may be a symptom of deficiencies in the cerebello-thalamocortical networks, or, be caused by indirect effects on the cortico-striatal pathways. Future studies into the functional networks impacted by ET (cortico-striatal and cerebello-thalamocortical pathways) could advance our understanding of inhibitory control in general and the cognitive deficits in ET.
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Affiliation(s)
- Jessi M Kane
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Department of Psychology, University of Louisville, Louisville, KY, USA
| | | | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Peter Hedera
- Department of Neurology, University of Louisville, Louisville, KY, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wery P M van den Wildenberg
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elise B Bradley
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott A Wylie
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Nelleke C van Wouwe
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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