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Hadzic A, Andersson S. Non-ictal, interictal and ictal déjà vu: a systematic review and meta-analysis. Front Neurol 2024; 15:1406889. [PMID: 38966090 PMCID: PMC11223632 DOI: 10.3389/fneur.2024.1406889] [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: 03/25/2024] [Accepted: 05/27/2024] [Indexed: 07/06/2024] Open
Abstract
Background Déjà vu, French for "already seen," is a phenomenon most people will experience at least once in their lifetime. Emerging evidence suggests that déjà vu occurs in healthy individuals (as "non-ictal déjà vu") and in epilepsy patients during seizures (as "ictal déjà vu") and between seizures (as "interictal déjà vu"). Although the ILAE has recognized déjà vu as a feature of epileptic seizures, it is notably absent from the ICD-11. A lack of evidence-based research may account for this omission. To our knowledge, this study represents the first systematic review and meta-analysis on déjà vu experiences. Through detailed examinations of non-ictal, interictal and ictal déjà vu, we seek to highlight possible clinical implications. Rethinking the status quo of ictal déjà vu could potentially lead to earlier interventions and improve outcomes for epilepsy patients. Methods This study was registered in PROSPERO (ID: CRD42023394239) on 5 February 2023. Systematic searches were conducted across four databases: EMBASE, MEDLINE, PsycINFO, and PubMed, from inception to 1 February 2023, limited to English language and human participants. Studies were included/excluded based on predefined criteria. Data was extracted according to the PICO framework and synthesized through a thematic approach. Meta-analyses were performed to estimate prevalence's of the phenomena. Study quality, heterogeneity, and publication bias were assessed. Results Database searching identified 1,677 records, of which 46 studies were included. Meta-analyses of prevalence showed that non-ictal déjà vu was experienced by 0.74 (95% CI [0.67, 0.79], p < 0.001) of healthy individuals, whereas interictal déjà vu was experienced by 0.62 (95% CI [0.48, 0.75], p = 0.099) and ictal déjà vu by 0.22 (95% CI [0.15, 0.32], p = 0.001) of epilepsy patients. Examinations of phenomenological (sex, age, frequency, duration, emotional valence, and dissociative symptoms) and neuroscientific (brain structures and functions) data revealed significant variations between non-ictal, interictal and ictal déjà vu on several domains. Conclusion This systematic review and meta-analysis do not support the notion that non-ictal, interictal and ictal déjà vu are homogenous experiences. Instead, it provides insight into ictal déjà vu as a symptom of epilepsy that should be considered included in future revisions of the ICD-11. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394239, CRD42023394239.
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Affiliation(s)
- Alena Hadzic
- Section for Clinical and Cognitive Neuroscience, Department of Psychology, University of Oslo, Oslo, Norway
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Stein Andersson
- Section for Clinical and Cognitive Neuroscience, Department of Psychology, University of Oslo, Oslo, Norway
- Psychosomatic Medicine and CL Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Aitken CBA, Jentzsch I, O'Connor AR. Towards a conflict account of déjà vu: The role of memory errors and memory expectation conflict in the experience of déjà vu. Neurosci Biobehav Rev 2023; 155:105467. [PMID: 37979736 DOI: 10.1016/j.neubiorev.2023.105467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Déjà vu can be defined as conflict between a subjective evaluation of familiarity and a concurrent evaluation of novelty. Accounts of the déjà vu experience have not explicitly referred to a "conflict account of déjà vu" despite the acceptance of conflict-based definitions of déjà vu and relatively recent neuroimaging work that has implicated brain areas associated with conflict as underpinning the experience. Conflict monitoring functioning follows a similar age-related trajectory to déjà vu with a peak in young adulthood and a subsequent age-related decline. In this narrative review of the literature to date, we consider how déjà vu is defined and how this has influenced the understanding of déjà vu. We also review how déjà vu can be understood within theories of recognition memory and cognitive control. Finally, we summarise the conflict account of déjà vu and propose that this account of the experience may provide a coherent explanation as to why déjà vu experiences tend to decrease with age in the non-clinical population.
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Affiliation(s)
- Courtney B A Aitken
- School of Psychology & Neuroscience, University of St Andrews, United Kingdom.
| | - Ines Jentzsch
- School of Psychology & Neuroscience, University of St Andrews, United Kingdom
| | - Akira R O'Connor
- School of Psychology & Neuroscience, University of St Andrews, United Kingdom
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Zatloukalova E, Mikl M, Shaw DJ, Marecek R, Sakalosova L, Kuratkova M, Mitterova K, Sklenarova B, Brazdil M. Insights into déjà vu: Associations between the frequency of experience and amplitudes of low-frequency oscillations in resting-state functional magnetic resonance imaging. Eur J Neurosci 2021; 55:426-437. [PMID: 34907615 DOI: 10.1111/ejn.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/31/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
The phenomenon of déjà vu (DV) has intrigued scientists for decades, yet its neurophysiological underpinnings remain elusive. Brain regions have been identified in which morphometry differs between healthy individuals according to the frequency of their DV experiences. This study built upon these findings by assessing if and how neural activity in these and other brain regions also differ with respect to DV experience. Resting-state fMRI was performed on 68 healthy volunteers, 44 of whom reported DV experiences (DV group) and 24 who did not (NDV group). Using multivariate analyses, we then assessed the (fractional) amplitude of low-frequency fluctuations (fALFF/ALFF), a metric that is believed to index brain tissue excitability, for five discrete frequency bands within sets of brain regions implicated in DV and those comprising the default mode network (DMN). Analyses revealed significantly lower values of fALFF/ALFF for specific frequency bands in the DV relative to the NDV group, particularly within mesiotemporal structures, bilateral putamina, right caudatum, bilateral superior frontal cortices, left lateral parietal cortex, dorsal and ventral medial prefrontal cortex, and the posterior cingulate cortex. The pattern of differences in fALFF/ALFF measures between the brains of individuals who have experienced DV and those who have not provides new neurophysiological insights into this phenomenon, including the potential role of the DMN. We suggest that the erroneous feeling of familiarity arises from a temporary disruption of cortico-subcortical circuitry together with the upregulation of cortical excitability.
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Affiliation(s)
- Eva Zatloukalova
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic
| | - Michal Mikl
- Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniel Joel Shaw
- Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Radek Marecek
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic.,Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Sakalosova
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic.,Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marie Kuratkova
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic.,Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Kristyna Mitterova
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic.,Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Sklenarova
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic
| | - Milan Brazdil
- Brno Epilepsy Center, 1st Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Full Member of the ERN EpiCARE, Brno, Czech Republic.,Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Nigro S, Cavalli SM, Cerasa A, Riccelli R, Fortunato F, Bianco MG, Martino I, Chiriaco C, Vaccaro MG, Quattrone A, Gambardella A, Labate A. Functional activity changes in memory and emotional systems of healthy subjects with déjà vu. Epilepsy Behav 2019; 97:8-14. [PMID: 31181431 DOI: 10.1016/j.yebeh.2019.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022]
Abstract
Déjà vu (DV) is a fascinating and mysterious human experience that has attracted interest from psychologists and neuroscientists for over a century. In recent years, several studies have been conducted to unravel the psychological and neurological correlates of this phenomenon. However, the neural mechanisms underlying the DV experience in benign manifestations are still poorly understood. Thirty-three healthy volunteers completed an extensive neuropsychiatric and neuropsychological battery including personality evaluation. The presence of DV was assessed with the Inventory for Deja vu Experiences Assessment. Participants underwent episodic memory learning test, and 2 days later during event-related functional magnetic resonance imaging (fMRI), they are asked to rate old and new pictures as a novel, moderately/very familiar, or recollected. We identified 18 subjects with DV (DV+) and 15 without DV (DV-) matched for demographical, neuropsychological, and personality characteristics. At a behavioral level, no significant difference was detected in the episodic memory tasks between DV+ and DV-. Functional magnetic resonance imaging analysis revealed that DV+, independently from task conditions, were characterized by increased activity of the bilateral insula coupled with reduced activation in the right parahippocampal, both hippocampi, superior/middle temporal gyri, thalami, caudate nuclei, and superior frontal gyri with respect to DV-. Our study demonstrates that individuals who experienced DV are not characterized by different performance underlying familiarity/recollection memory processes. However, fMRI results provide evidence that the physiological DV experience is associated with the employment of different neural responses of brain regions involved in memory and emotional processes.
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Affiliation(s)
- Salvatore Nigro
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Salvatore M Cavalli
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Antonio Cerasa
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Roberta Riccelli
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | | | - Iolanda Martino
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Carmelina Chiriaco
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Neuroscience Centre, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.
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Wells CE, O'Connor AR, Moulin CJA. Déjà vu experiences in anxiety. Memory 2018; 29:895-903. [PMID: 30384798 DOI: 10.1080/09658211.2018.1538418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Déjà vu occurs when a novel event is experienced with an erroneous sense of familiarity. Memory researchers theorise that this arises due to an error in the processes underlying the recognition memory system. Research has indicated that there may be a link between high levels of anxiety and increased frequency and intensity of déjà vu, however, there has been a comparatively little characterisation of déjà vu as experienced by individuals with clinical anxiety. We used an online questionnaire to collect data from individuals self-reporting a clinical diagnosis of anxiety, as well as from age-matched controls. The Anxiety Group reported a significantly higher frequency of déjà vu episodes over the previous month than controls. They also reported experiencing déjà vu more frequently and with higher intensity during periods of high anxiety. In addition, the Anxiety Group reported finding déjà vu episodes significantly more distressing than the Control Group. The findings indicate that there are differences in déjà vu experienced by people reporting high levels of anxiety compared to healthy controls without an anxiety diagnosis. We discuss structural and neural mechanisms thought to underpin déjà vu in relation to these results.
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Affiliation(s)
- Christine E Wells
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Akira R O'Connor
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
| | - Chris J A Moulin
- Laboratoire de Psychologie et Neurocognition, LPNC CNRS 5105, Université Grenoble Alpes, Grenoble, France
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Pešlová E, Mareček R, Shaw DJ, Kašpárek T, Pail M, Brázdil M. Hippocampal involvement in nonpathological déjà vu: Subfield vulnerability rather than temporal lobe epilepsy equivalent. Brain Behav 2018; 8:e00996. [PMID: 29873197 PMCID: PMC6043696 DOI: 10.1002/brb3.996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/15/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Morphological correlates of nonpathological déjà vu (DV) have been identified recently within the human brain. Significantly reduced gray matter volume (GMV) within a set of cortical and subcortical regions reported in subjects experiencing DV seems to mirror the distribution of GMV reduction in mesial temporal lobe epilepsy (MTLE) patients but vary in terms of the hippocampus. Another condition associated with hippocampal GMV reduction and DV alike disturbance in memory processing is schizophrenia (SCH). Here, we tested the hypothesis that hippocampal involvement in nonpathological DV resembles more closely the pattern of GMV decrease observed in MTLE compared with that occurring in SCH. METHODS Using automated segmentation of the MRI data we compared the medians of GMV within 12 specific hippocampal subfields in healthy individuals that do (DV+; N = 87) and do not report déjà vu experience (DV-; N = 26), and patients with MTLE (N = 47) and SCH (N = 29). By Pearson correlation, we then evaluated the similarity of MTLE and SCH groups to DV+ group with respect to spatial distribution of GMV deviation from DV- group. RESULTS Significant GMV decrease was found in MTLE group in most of the subfields. There were just trends in the hippocampal GMV decrease found in DV+ or SCH groups. Concerning the spatial distribution of GMV decrease, we revealed statistically significant correlation for the left hippocampus for SCH vs DV+. Otherwise there was no statistically significant correlation. CONCLUSIONS Our findings reveal structural features of hippocampal involvement in nonpathological DV, MTLE, and SCH. Despite our expectations, the pattern of GMV reduction in the DV+ relative to the DV- group does not resemble the pattern observed in MTLE any more than that observed in SCH. The highly similar patterns of the three clinical groups rather suggest an increased vulnerability of certain hippocampal subfields; namely, Cornu Ammonis (CA)4, CA3, dentate gyrus granular cell layer (GC-DG), hippocampal-amygdaloid transition area (HATA) and subiculum.
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Affiliation(s)
- Eva Pešlová
- Department of NeurologyBrno Epilepsy CenterSt. Anne’s University Hospital and Medical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Radek Mareček
- Department of NeurologyBrno Epilepsy CenterSt. Anne’s University Hospital and Medical Faculty of Masaryk UniversityBrnoCzech Republic
- Multi‐modal and Functional Neuroimaging Research GroupCEITEC ‐ Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Daniel J. Shaw
- Behavioral and Social Neuroscience Research GroupCEITEC ‐ Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Tomáš Kašpárek
- Behavioral and Social Neuroscience Research GroupCEITEC ‐ Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
- Department of PsychiatryFaculty Hospital Brno and Medical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Martin Pail
- Department of NeurologyBrno Epilepsy CenterSt. Anne’s University Hospital and Medical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Milan Brázdil
- Department of NeurologyBrno Epilepsy CenterSt. Anne’s University Hospital and Medical Faculty of Masaryk UniversityBrnoCzech Republic
- Behavioral and Social Neuroscience Research GroupCEITEC ‐ Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
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Qiu J, Xia Y, He L, Chen Q, Sang N, Liu W, Li H. Abnormal rsFC and GMV changes in parahippocampal and DLPFC for high Déjà vu experienced subjects. Biol Psychol 2018; 133:72-78. [PMID: 29426017 DOI: 10.1016/j.biopsycho.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/05/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
How déjà vu works has long been a mystery, partially because of its characteristics of unpredictable occurrences and quick disappearances, which make it difficult to be explored. Previous studies have described the anatomical structures underlying déjà vu in healthy subjects; however, the functional mechanism of déjà vu remains unclear. Therefore, this study investigated the brain structural and functional components underlying déjà vu by combining voxel-based morphometry analysis (VBM) with resting-state functional connectivity (rsFC). The VBM analysis revealed that the anterior parahippocampal gyrus (PHG) had significantly less grey matter volume (GMV) in high déjà vu group than low group, confirming previous studies. Further functional connectivity analysis revealed that the frequency of déjà vu experiences was negatively correlated with the strength of the rsFC between anterior dorsal lateral prefrontal cortex (DLPFC) and anterior PHG but positively correlated with the strength of the rsFC between posterior DLPFC and posterior PHG. Moreover, the frequency of déjà vu experiences was negatively correlated with the strength of the rsFC between the anterior and posterior regions of the PHG. These findings indicated that familiarity without recollection (PHG) and superior context monitoring (DLPFC) are critical for real-life déjà vu experiences.
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Affiliation(s)
- Jiang Qiu
- College of Education Science, ChengDu University, ChengDu, 610106, China; School of Psychology, Southwest University, Chongqing, 400715, China.
| | - Yunman Xia
- School of Psychology, Southwest University, Chongqing, 400715, China
| | - Li He
- School of Education, Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, 401331, China
| | - Qunlin Chen
- School of Psychology, Southwest University, Chongqing, 400715, China
| | - Na Sang
- School of Psychology, Southwest University, Chongqing, 400715, China
| | - Wei Liu
- Donders Institute for Brain, Cognition and Behavior Centre for Cognitive Neuroimaging (DCCN) Radboud University, Netherlands
| | - Hong Li
- College of Psychology and Sociology, Shenzhen University, Shenzhen, 518060, China.
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Perucca P, Crompton DE, Bellows ST, McIntosh AM, Kalincik T, Newton MR, Vajda FJE, Scheffer IE, Kwan P, O'Brien TJ, Tan KM, Berkovic SF. Familial mesial temporal lobe epilepsy and the borderland of déjà vu. Ann Neurol 2017; 82:166-176. [DOI: 10.1002/ana.24984] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/14/2017] [Accepted: 06/25/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Piero Perucca
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
| | - Douglas E. Crompton
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
- Neurology Department; Northern Health; Melbourne Victoria Australia
| | - Susannah T. Bellows
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
| | - Anne M. McIntosh
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
| | - Tomas Kalincik
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Mark R. Newton
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
| | - Frank J. E. Vajda
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Ingrid E. Scheffer
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
- Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Departments of Paediatrics and Neurology, Royal Children's Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Patrick Kwan
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Terence J. O'Brien
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - K. Meng Tan
- Departments of Medicine and Neurology, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Samuel F. Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health; University of Melbourne; Melbourne Victoria Australia
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